Maternal mortality from COVID-positive pregnancy

Maternal mortality from COVID-positive pregnancy | Image Credit: © Paolese - © Paolese - stock.adobe.com.

COVID-19 infection may be associated with maternal mortality during pregnancy but is not significantly associated with infant morbidity and mortality, according to a recent study published in Cureus.

Pregnancy risks were at their most severe during the COVID-19 pandemic. Beforehand, pregnancy had been considered an immunocompromised state, but it is now considered a state of immune modulation.

Wave 2 of the pandemic, from March 2021 to August 2021, saw an increase in adverse outcomes compared to wave 1, from January 2020 to January 2021. To examine the maternal and neonatal effects of COVID-19 during pregnancy in the first and second waves of COVID-19, investigators conducted a prospective, longitudinal, observational study.

Participants included COVID-positive antenatal and postnatal women admitted to the Department of Obstetrics and Gynecology and the Neonatology Unit of the Pediatrics Department at Guru Gobind Singh Medical College and Hospital, Faridkot from January 2020 to August 2021.

Inclusion criteria included being hospitalized with a positive COVID-19 antenatal case, a post-partum case referred because of COVID-19-positive status, and a neonate of a COVID-positive mother. Patients with only suspected COVID-19 infection without laboratory confirmation were excluded from the analysis. 

Enrollment occurred immediately following confirmation of COVID-19 in a patient. Maternal information collected included demographic data, disease history during the antenatal period, time of disease onset, clinical symptoms, associated comorbidities, signs of sepsis, and mode of delivery.

Neonatal appearance, pulse, grimace, activity, and respiration scores were recorded, along with data on obstetric complications, intrauterine fetal death not associated with obstetric cause, and neonatal complications.

Following Indian Council of Medical Research guidelines, pregnant women in containment zones or hotspot districts were tested even if asymptomatic, and patient management occurred in separate COVID-19 wards under physician and obstetrician care. Nasal swabs were sent 24 hours after birth in infants with a COVID-positive mother.

Of the 3421 obstetric admissions and 2132 deliveries recorded during both waves, there were 123 COVID-positive admissions and 85 COVID-positive deliveries during wave 1, compared to 101 admissions and 73 deliveries during wave 2. This was an incidence of COVID infection in pregnancy of 6.54.

Most patients were aged 21 to 30 years, though patients were on averaged aged younger during wave 2 than wave 1. Multigravida women were seen more often than primigravida women in both waves. Women were 29- to 36-weeks’ gestation in 66% of cases in wave 1 and 46% in wave 2.

Obstetrical comorbidities were the main comorbidities observed in both groups, at 46% in wave 1 and 78% in wave 2. Common obstetric comorbidities included anemia at 16% and pregnancy-induced hypertension at 19%, both during wave 2. Medical illnesses were almost twice as common for women in wave 2. 

During wave 1, patients were often asymptomatic or had mild symptoms. However, patients during wave 2 were often symptomatic, with 38% presenting with symptoms. There were also more cases of altered biological data in wave 2, with 11% of cases showing altered D-dimers, 14% altered prothrombin time, and 17% altered platelet count.

Moderate to severe COVID-19 infection was seen in 52% of cases during wave 2, which were managed in a high dependency unit or intensive care unit (ICU). Twenty-one ICU admission were recorded, 90% of which required ventilatory support, 76% inotropic support, and 71% anti-coagulation.

During wave 2, 20 ICU mortalities were recorded in the study population, while only 1 was recorded during wave 1. Early treatment was sought by only 44% of patients in wave 2, compared to 82% in wave 1. Admissions after a 7-day interval were seen in 57% of cases in wave 2.

COVID-19 infection was seen in 1 neonate in wave 1 and 4 neonates in wave 2. This indicateda low risk of infant morbidity and mortality in cases of COVID-19 infection during pregnancy, but a notable risk of maternal mortality was found, with worse outcomes seen during wave 2.

Reference

Tapasvi I, Sethi A, Tapasvi C, Grover S, Rajora P. To compare the maternal and fetal outcomes of COVID-19-affected expectant mothers during the first and second COVID-19 waves: data from a tertiary care referral hospital in Punjab. Cureus. 2023;15(3):e36319. doi:10.7759/cureus.36319