Comparison of Maternal and Neonatal Outcomes among COVID-Positive Pregnant Women Affected in Second and Third Waves in a Dedicated COVID Hospital in Amritsar

Abstract

ABSTRACT Background: With the emergence of new mutated variants of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), we have witnessed three waves of coronavirus disease (COVID) with varying severity, complication, and outcome in Punjab. The physiological changes of pregnancy make mother more vulnerable for severe infection. Current study is aimed at comparison of maternal and neonatal outcomes of COVID-positive pregnant women in second and third waves. Materials and Methods: This was a retrospective observational single-center study conducted at a dedicated COVID hospital in Punjab, India. Records of all COVID-positive pregnant women admitted from January to June 2021 and from January to February 2022 were reviewed. The demographic details, severity of symptoms, maternal and fetal complications, outcomes, and mortality were noted. Results: There were 220 COVID-positive pregnant patients in the second wave and 65 in third wave. The majority of patients belonged to the age group of 20–34 years (57.73% in the second wave and 70.77% in the third wave). Maternal deaths and severity of disease increased with increasing age of the mother, that is, 6.7% in <35 years and 13.95% in >35 years age group (RR = 2.058, P value = 0.1248). Also, the maternal deaths increased with increasing parity (RR = 2.00, P value = 0.2380). The majority of the study subjects were in the third trimester, with 77.73% in the second wave and 90.77% in the third wave. The majority of the patients in both the waves were asymptomatic or had mild symptoms. In the COVID second wave, 10.91% pregnant patients had moderate COVID symptoms and 8.18% had severe COVID symptoms, whereas none presented with moderate or severe symptoms in the third wave. Eighteen maternal deaths (8.18%) were seen during the COVID second wave, whereas no maternal death occurred in the third COVID wave. 100% of these deaths were because of COVID. Need of oxygen supplementation and intensive care unit admission had statistically significant association with maternal mortality. Conclusion: In the third COVID wave, the morbidity and mortality were significantly reduced. This could be a result of wide-spread vaccination, new strain of COVID, or both. In spite of this, the pregnancy complications such as pre-term birth, IUGR, and IUD were significant. Hence, pregnancies complicated by COVID should be considered as a high risk and closely monitored.