Most pregnant women who had Covid asymptomatic, at least 16% had pre-term delivery: study

Considering the emerging threat of Covid-19 and the need for data on the health effects of SARS-CoV-2 infection in pregnant women in India, PregCovid registry was jointly set up by the Municipal Corporation of Greater Mumbai (MCGM), Medical Education and Drugs Department (MEDD), Maharashtra, and Indian Council of Medical Research (ICMR)-National Institute for Research in Reproductive Health (NIRRH).

The PregCovid registry collects information in near-real time on pregnant and post-partum women, with a laboratory-confirmed diagnosis of SARS-CoV-2, from 19 medical colleges across Maharashtra.

While 4,276 pregnant and post-partum women with Covid-19 were registered during the first wave at the government medical colleges of the state Medical Education and Drugs Department, and BYL Nair Hospital, Mumbai, data of 4,203 women was analysed and published in IJMR.

A total of 158 (3.8%) pregnant and post-partum women required intensive care, of which 152 (96%) were due to Covid-19, according to the analysis..
Of the 4,203 pregnant women with Covid-19, a total of 15 women had ectopic pregnancies and 27 underwent medical termination of pregnancy (MTP). There were 77 miscarriages and 834 women had ongoing pregnancy. The proportion of pregnancy/foetal loss including stillbirths was six per cent, the study said.

The majority of women (3,441) were in the age group of 18-30 and 92 per cent of the women were in the third trimester of pregnancy. Women with comorbidities of anaemia, tuberculosis and diabetes mellitus had a higher risk of death. The overall case fatality rate (CFR) in pregnant and post-partum women with Covid-19 was 0.8 per cent. Out of 34 maternal deaths, 10 women died during the postpartum period. At least 528 had a pre-term delivery, which was the most common complication, while 328 had hypertensive disorders in pregnancy.

The study has demonstrated the adverse outcomes — including severe Covid-19 disease, pregnancy loss and maternal death — in women with Covid-19 in Maharashtra, says lead author and principal investigator of PregCovid registry, Dr Rahul Gajbhiye.

Dr Niraj Mahajan at BYL Nair Hospital, Mumbai, is the joint first author in this study as well as the principal investigator at BYL Nair Hospital, Mumbai.

According to the study findings, vaginal delivery occurred in 1,719 (53%) of women and 1,531 (47%) were delivered by caesarean section. Live birth occurred in 3213 women with 3189 singletons, 60 twins and one set of triplets, resulting in a total of 3312 neonates born to mothers with COVID-19.
The twinning rate in the Covid-positive mothers was 18.4 per 1000 births.

“We found that a majority (3,669, 87.3%) of the pregnant and post-partum women with Covid-19 were asymptomatic and only 534 (12.7%) women were symptomatic,” adds co-author Dr Rakesh Waghmare, associate professor from J J Hospital.

As many as 534 women (13%) were symptomatic, of which 382 (72%) had mild, 112 (21%) had moderate, and 40 (7.5%) had severe form of the disease. The study noted a higher case fatality rate 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.

This is the first large-scale report of systematically collected, multi-centre data on clinical presentation, pregnancy outcomes and maternal deaths among women with Covid-19 in Maharashtra, said Dr Smita Mahale, former director of ICMR-NIRRH.

“The proportion of symptomatic Covid-19 women in our study was 12.7 per cent… nearly 30 percent of the symptomatic cases had moderate to a severe disease requiring ICU/HDU admission. What could contribute to such high regional differences in ICU/HDU admissions need to be determined,” said Dr Deepak Modi, co-author of the study.