Novel coronavirus may infect a higher proportion of pregnant women: ICMR study

The novel coronavirus may infect a higher proportion of pregnant women and they can develop moderate-to-severe diseases, an ICMR study has said, underlining the need for them to seek immediate medical attention.

According to the study published in the Indian Journal of Medical Research, the most common complication were a pre-term delivery and hypertensive disorders in pregnancy.

Comorbidities such as anaemia, tuberculosis and diabetes mellitus were associated with an increased risk of maternal death in pregnant and post-partum women with COVID-19, the study said.

It analysed clinical characteristics and pregnancy outcomes of women with COVID-19 enrolled during the first wave of the pandemic in Maharashtra.

The analysis was based on the data from the PregCovid registry, a study of pregnant women and women in post-partum period with confirmed diagnosis of COVID-19.

The PregCovid registry collected information on near-real time basis on pregnant and post-partum women with a laboratory-confirmed coronavirus infection from 19 medical colleges across Maharashtra.

The data of 4,203 pregnant women collected during the first wave (March 2020-January 2021) was analysed.

"There were 3213 live births, 77 miscarriages and 834 undelivered pregnancies. The proportion of pregnancy/foetal loss including stillbirths was six per cent. Five hundred and thirty-four women (13%) were symptomatic, of which 382 (72%) had mild, 112 (21%) had moderate, and 40 (7.5 %) had severe disease. “The most common complication was preterm delivery (528, 16.3%) and hypertensive disorders in pregnancy (328, 10.1%). A total of 158 (3.8%) pregnant and post-partum women required intensive care, of which 152 (96%) were due to COVID-19 related complications," the findings of the study stated.

The overall case fatality rate (CFR) in was 0.8 per cent. Higher CFR was observed in Pune (9/853, 1.1%), Marathwada (4/351, 1.1%) regions as compared to Vidarbha (9/1155, 0.8%), Mumbai Metropolitan (11/1684, 0.7%), and Khandesh (1/160, 0.6%) regions.

"Thus, our analysis suggests that SARS-CoV-2 may infect a higher proportion of pregnant women, and when symptomatic, a large proportion can develop moderate-to-severe diseases. Therefore, pregnant women with COVID-19 need immediate medical attention from the healthcare system in India,”" said the study.

The finding of tuberculosis as a risk factor is important as India has one of the highest burden of TB in the general population as well as in pregnant women, the study stated. It suggested the healthcare services for the treatment of tuberculosis and COVID-19 must be integrated and pregnant women with respiratory symptoms tested for both.

There were a total of 34 deaths reported among pregnant and post-partum women with COVID-19, the study said, adding out of 34 maternal deaths, 10 women died during the post-partum period.

Twenty-five women (73%) were 30 or below, while the others were in the age range of 30-45 years.

This is the first large-scale report of systematically collected, multicentre data on the clinical presentation, pregnancy outcomes and maternal deaths amongst women with COVID-19 in Maharashtra, the study said.

"The pre-term birth in the present study group (16.3 per cent) is comparable to those reported by other countries. However, in the absence of detailed data of pre-term birth from pregnant women without COVID-19, it is difficult to comment if COVID-19 is a risk factor for pre-term birth," the study stated.

Pregnancy loss is a major health concern for obstetricians and whether COVID-19 is a contributing risk factor is an important aspect to be considered, it said.