Increased rate of miscarriage during second wave of <scp>COVID</scp>‐19 pandemic in India

Gajbhiye, Rahul; Tilve, Arundhati; Kesarwani, Shweta; Srivastava, S.; Kore, Shailesh; Patil, Kanchan; Mahale, Smita D.; Mahajan, Niraj N.

doi:10.1002/uog.24784

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…Among them, semen as a source of viral transmission was not documented (6). The correlation between SARS-CoV-2 infection, stillbirths, and miscarriages is still debated, as some authors have not found an increase in miscarriages among COVID-19 pregnant women (7-9), while others have found an increased incidence (10). Further, which is reassuring, anti-COVID19 vaccination is also safe and strongly advocated before and after conception.…”

Section: Timeline and Consequences Of Maternal Exposure To Sars-cov-2mentioning

confidence: 99%

SARS-CoV-2 vertical transmission supports innate fetal protection: A narrative review

Barnea¹,

Simone²,

Hayrabedyan³

et al. 2022

Front. Virol.

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Prenatal infections that have been exhaustively studied help frame the current Severe Acute Respiratory Syndrome related coronavirus-2 (SARS-CoV-2) pandemic, with the caveat that asymptomatic SARS-CoV-2 infected patients are not tested, while those symptomatic are delivered and/or treated with drug(s) available on-site. Thus, management and therapy are still heterogeneous. SARS-CoV-2 induced respiratory infection remains mostly local, unless severe, which lessens transplacental vertical transmission (VT). Vaccination prior to or during pregnancy significantly changes the prognosis for both the mother and newborn. The virus spread to the fetus can be binding to ACE2 and TMPRSS2 protein receptors. A recent study demonstrated ACE2 and TMPRSS2 fetal expression in the intestine from the second trimester. Most placental infections are subclinical unless severe villitis and apoptosis are observed. The placenta is rarely tested, and it is highly probable that most are positive for the virus, requiring sophisticated diagnostics to document. Other VT modalities, such as vaginal, rectal or through amniotic fluid contamination, are very rare. Therefore, vaginal delivery is preferable when clinically feasible. It has not yet been determined whether the placenta is a shield or if it transmits infection, while, on the other hand, recent data support fetal resilience, which is plausible due to the major difference between the placental and fetal rates of infection: only 3%–5% of documentable VT compared with up to 100% expected placental exposure to viremia. Newborn Polymerase Chain Reaction (PCR) from nasal swab is more practical as an option for VT diagnosis compared to ocular or anal swab, with low yield. The maternal infection leads to antiviral IgG production of 100% in severe cases, which is transferred to the fetus and breast milk. Postpartum-documenting VT is difficult since horizontal viral transmission may be common and minimized by mother/staff/family-preventive measures. Breastfeeding is safe and encouraged because, beyond nutrition, it promotes protective antibody transfer and maternal bonding. Lessons learned from other Betacorona viruses (SARS-CoV and Middle East Respiratory Syndrome related coronavirus [MERS-CoV]) virulence are relevant since mutations can increase or decrease vulnerability. Overall, data support fetal/newborn resilience against SARS-CoV-2 VT. However, viremia monitoring by sensitive tests and assessment for delayed sequelae shown in adults is necessary.

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Section: Timeline and Consequences Of Maternal Exposure To Sars-cov-2mentioning

confidence: 99%

SARS-CoV-2 vertical transmission supports innate fetal protection: A narrative review

Barnea¹,

Simone²,

Hayrabedyan³

et al. 2022

Front. Virol.

View full text Add to dashboard Cite

show abstract

“…In Italy, Zelini’s data suggested that SARS-CoV-2 infection does not appear to cause first-trimester miscarriage, and asymptomatic or mildly symptomatic infections even have a more limited effect [ 11 ]. While in India, an increased rate of miscarriage was observed during second wave of COVID-19 pandemic [ 12 ]. Furthermore, a retrospective study conducted in Turkey and a prospective cohort study in the USA both revealed an increased miscarriage rate [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 is not a causal risk for miscarriage: evidence from a Mendelian randomization study

Shi

Zhao

Zhang

et al. 2022

J Assist Reprod Genet

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Objective Coronavirus disease 2019 (COVID-19) has caused a global pandemic in the last three years. The lack of reliable evidence on the risk of miscarriage due to COVID-19 has become a concern for patients and obstetricians. We sought to identify rigorous evidence using two-sample Mendelian randomization (MR) analysis. Methods Seven single-nucleotide polymorphisms (SNPs) associated with COVID-19 were used as instrumental variables to explore causality by two-sample MR. The summary data of genetic variants were obtained from the Genome Wide Association Study (GWAS) among European populations in the UK Biobank and EBI database. Inverse variance weighting (IVW) method was taken as the gold standard for MR results, and other methods were taken as auxiliary. We also performed sensitivity analysis to evaluate the robustness of MR. Results The MR analysis showed there was no clear causal association between COVID-19 and miscarriage in the genetic prediction [OR 0.9981 (95% CI, 0.9872–1.0091), p = 0.7336]. Sensitivity analysis suggested that the MR results were robust [horizontal pleiotropy (MR-Egger, intercept = 0.0001592; se = 0.0023; p = 0.9480)]. Conclusions The evidence from MR does not support COVID-19 as a causal risk factor for miscarriage in European populations. The small probability of direct placental infection, as well as the inability to stratify the data may explain the results of MR. These findings can be informative for obstetricians when managing women in labor. Supplementary Information The online version contains supplementary material available at 10.1007/s10815-022-02675-x.

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Impact of COVID-19 pandemic on maternal and neonatal outcomes: A narrative review and evidence from the PregCovid registry

Zala

Munshi

Mahajan

et al. 2023

JRHM

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More than 533 million Coronavirus Disease 2019 (COVID-19) cases and associated 6 million fatalities were reported globally whereas 43 million cases and 0.5 million deaths in India were reported till June 2022. Maharashtra state alone reported about one-third of the total cases of COVID-19 in India in the early period of COVID-19 pandemic. The lack of epidemiological, demographic, and impact data of COVID-19 on pregnant women and newborns, advocated the need for recording and documenting population specific data for clinical management and policy decisions in India. The PregCovid registry was launched in April 2020 by the Indian Council of Medical Research-National Institute for Research in Reproductive and Child Health, Mumbai, in collaboration with the Medical Education and Drugs Department, Government of Maharashtra, and Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital to gain insights into clinical and socio-epidemiological characteristics of pregnant women with lab confirmed COVID-19 and assess its impact on maternal and neonatal outcomes. The registry has collected data of 8428 pregnant and postpartum women with COVID-19 from 19 participating centers across Maharashtra in a near real-time manner. The registry first reported that the delta variant (B.1.617.2) dominant second wave was more lethal (case fatality rate 5.7%) to pregnant and postpartum women than the alpha (0.7%) dominant wave of COVID-19 in India. There was also a higher incidence of moderate to severe cases, intensive care admissions and maternal complications including pre-eclampsia, low birth weight and preterm deliveries during the delta wave. The omicron dominant third wave of the COVID-19 pandemic exhibited a higher transmission rate compared to the previous two waves, causing a surge in cases but minimally impacting adverse outcomes. The registry further analyzed and reported the impact of COVID-19 on pregnant and postpartum women with comorbidities, coinfections, twin pregnancies, and neonatal outcomes, while providing crucial policy inputs to improve maternal and newborn health during the pandemic. The registry model can be replicated at tertiary care hospitals across India to understand various maternal-neonatal outcomes. The evidence generated from PregCovid registry was useful for improved clinical management and also contributed to a policy decision on COVID-19 vaccination in pregnant women in India. The registry envisions a collaboration with similar regional, national and international registries to form an international consortium for data sharing and reporting to promote global policy level interventions and advocates a sustainable and collective response to improve the COVID-19 global vaccination coverage.

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Increased rate of miscarriage during second wave of COVID‐19 pandemic in India

Cited by 3 publications

References 6 publications

SARS-CoV-2 vertical transmission supports innate fetal protection: A narrative review

SARS-CoV-2 vertical transmission supports innate fetal protection: A narrative review

COVID-19 is not a causal risk for miscarriage: evidence from a Mendelian randomization study

Impact of COVID-19 pandemic on maternal and neonatal outcomes: A narrative review and evidence from the PregCovid registry

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