Women’s COVID-19 outcomes worse during pandemic’s second wave in India

Women with COVID-19 during the pandemic’s second wave in India had higher rates of severe disease, admissions to the ICU or high dependency unit and maternal deaths compared with the first wave, findings show.

Researchers reported these results from a retrospective observational cohort study in a research letter published in Obstetrics & Gynecology.

“Understanding the impact of COVID-19 on pregnant women from different ethnic/racial backgrounds is important to know the disparities in disease presentation and plan global policies to reduce the adverse effects of COVID-19 on pregnant women,” Rahul Gajbhiye, MBBS, PhD, head of the Clinical Research Lab & Andrology Clinic at ICMR-National Institute for Research in Reproductive Health in India, told Healio. “Information on the impact of the second wave of the COVID-19 pandemic on pregnant women was lacking. Also, comparative data on clinical presentations, co-morbidities, pregnancy complications and maternal outcomes in women with COVID-19 during the first and second waves of the COVID-19 pandemic was not available.”

Gajbhiye and colleagues included pregnant and postpartum women with COVID-19 diagnosed according to national testing guidelines who were admitted at a single COVID-19 tertiary care hospital. After screening at a special screening outpatient department, the hospital admitted pregnant women with confirmed COVID-19 who were near-term and those requiring obstetric interventions, those with high-risk pregnancies, pregnant women and women postpartum up to 6 weeks with moderate or severe disease. The researchers compared pregnancy outcomes and COVID-19 severity between women admitted during the pandemic’s first (n = 1,143) and second waves (n = 387) in India. They categorized COVID-19 severity according to the Clinical Management Protocol for COVID-19 (in Adults).

Results showed higher rates of severe COVID-19 and admissions to the ICU or high dependency unit, as well as higher case fatality rates and maternal mortality rates during the second wave. The researchers reported no statistically significant difference in the preterm birth rate and stillbirth rate. COVID-19 pneumonia and respiratory failure were linked to most (93%) maternal deaths.

Gajbhiye and colleagues observed no statistical differences in baseline characteristics or clinical presentation between deaths in the two waves, possibly because of the low sample size.

Rahul Gajbhiye

“The cause of death in the majority of women was COVID-19 pneumonia and respiratory failure,” Gajbhiye said. “The highly virulent variant of concern B.1.617 is likely to be responsible for the adverse impact during the second wave; however, we do not have genome sequencing data, so the direct association cannot be established. The findings of our study suggest the importance of offering vaccination to pregnant and lactating women during the ongoing COVID- 19 pandemic.”