Citation Information :
Goyal M, Mascarenhas D, Shah J, Nanavati R, Mayadeo N. Perinatal COVID-19 Infection and Outcomes: A Retrospective Observational Study from a Low–Middle Income Setting. J South Asian Feder Obs Gynae 2022; 14 (4):374-380.
Aim: Coronavirus disease 2019 (COVID-19) pandemic is an ongoing emergency with limited data on perinatal outcomes. The aim of the study was to describe key maternal, perinatal, and neonatal outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from low–middle income settings. Materials and methods: We conducted a retrospective observational study in a tertiary level public hospital in India. All pregnant women admitted from May 2020 to July 2020 were included in the study. Maternal demography, medical and obstetric complications, clinical characteristics, and investigations were described. Symptomatic infected women were compared with the asymptomatic group for important outcomes. Key perinatal outcomes such as early pregnancy losses, fetal distress, stillbirths, and placental changes were evaluated. Neonatal characteristics of SARS-CoV-2 positive and negative pregnancies were described and compared. Results: Among the 702 pregnant women enrolled, the incidence of SARS-CoV-2 infection was 16.2%, with the majority being asymptomatic. Infected women had an increased mortality, while symptomatic women had a significant risk of stillbirth. Mean placental weight of infected women was significantly higher. Neonatal infection rate was 9.1%, with 50% manifesting mild respiratory symptoms without any mortality. Conclusion: This study provides a comprehensive description of important antenatal, intrapartum and neonatal complications and outcomes in a low–middle income setting characterized by high disease burden and an overwhelmed health care system. Clinical significance: Incidence of SARS-CoV-2 infection in pregnancy was 16.2%. The symptomatic infected women had increased stillbirth and mortality. Neonatal transmission was seen in 9.1% with good survival.
World Health Organization. Listings of WHO's response to COVID-19. https://www.who.int/news/item/29-06-2020-covidtimeline Accessed: 28 July 2021.
Worldmeter. COVID-19 coronavirus pandemic. https://www.worldometers.info/coronavirus/ Accessed: 6 January 2022.
Allotey J, Stallings E, Bonet M, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. Brit Med J 2020:370m3320. DOI:10.1136/bmj.m3320.
Wei SQ, Bilodeau–Bertrand M, Liu S, et al. The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis. Can Med Assoc J 2021;193(16):E540–E548. DOI:10.1503/cmaj.202604.
Yan J, Guo J, Fan C, et al. Coronavirus disease 2019 in pregnant women: a report based on 116 cases. Am J Obstet Gynecol 2020;223(1):111.e1–111.e14. DOI:10.1016/j.ajog.2020.04.014.
Di Mascio D, Khalil A, Saccone G, et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2020;2(2):100107. DOI:10.1016/j.ajogmf.2020.100107.
Smith V, Seo D, Warty R, et al. Maternal and neonatal outcomes associated with COVID-19 infection: A systematic review. PLoS One 2020;15(6):e0234187. DOI:10.1371/journal.pone.0234187.
Nanavati R, Mascarenhas D, Goyal M, et al. A single-center observational study on clinical features and outcomes of 21 SARS-CoV-2-infected neonates from India. Eur J Pediatr 2021;180(6):1895–1906. DOI:10.1007/s00431-021-03967-7.
Zeng L, Xia S, Yuan W, et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr 2020;174(7):722–725. DOI:10.1001/jamapediatrics.2020.0878.
Anand P, Yadav A, Debata P, et al. Clinical profile, viral load, management and outcome of neonates born to COVID 19 positive mothers: a tertiary care centre experience from India. Eur J Pediatr 2021;180(2):547–559. DOI:10.1007/s00431-020-03800-7.
Villar J, Ariff S, Gunier RB, et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection. JAMA Pediatr 2021;175(8):817–826. DOI:10.1001/jamapediatrics.2021.1050.
World Health Organization. COVID-19 Clinical management: living guidance. https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-1 Accessed: 28 July 2021.
Huntley BJF, Mulder IA, Di Mascio D, et al. Adverse pregnancy outcomes among individuals with and without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): a systematic review and meta-analysis. Obstet Gynecol 2021;137(4):585–596. DOI:10.1097/AOG.0000000000004320.
Agarwal N, Garg R, Singh S, et al. Coronavirus disease 2019 in pregnancy: maternal and perinatal outcome. J Educ Health Promot 2021;10(1): 194. DOI: 10.4103/jehp.jehp_954_20.
Mirbeyk M, Saghazadeh A, Rezaei N. A systematic review of pregnant women with COVID-19 and their neonates. Arch Gynecol Obstet 2021;304(1):5–38. DOI:10.1007/s00404-021-06049-z.
Di Toro F, Gjoka M, Di Lorenzo G, et al. Impact of COVID-19 on maternal and neonatal outcomes: a systematic review and meta-analysis. Clin Microbiol Infect 2021;27(1):36–46. DOI:10.1016/j.cmi.2020.10.007.
Nayak AH, Kapote DS, Fonseca M, et al. Impact of the coronavirus infection in pregnancy: a preliminary study of 141 patients. J Obstet Gynecol India. 2020;70(4):256–261. DOI:10.1007/s13224-020-01335-3.
Goel H, Gupta I, Mourya M, et al. A systematic review of clinical and laboratory parameters of 3,000 COVID-19 cases. Obstet Gynecol Sci 2021;64(2):174–189. DOI:10.5468/ogs.20174.
Yee J, Kim W, Han JM, et al. Clinical manifestations and perinatal outcomes of pregnant women with COVID-19: a systematic review and meta-analysis. Sci Rep 2020;10(1):18126. DOI:10.1038/s41598-020-75096-4.
Chi J, Gong W, Gao Q. Clinical characteristics and outcomes of pregnant women with COVID-19 and the risk of vertical transmission: a systematic review. Arch Gynecol Obstet 2021;303(2):337–345. DOI:10.1007/s00404-020-05889-5.
Dang D, Wang L, Zhang C, et al. Potential effects of SARS-CoV -2 infection during pregnancy on fetuses and newborns are worthy of attention. J Obstet Gynaecol Res 2020;46(10):1951–1957. DOI:10.1111/jog.14406.
Khalil A, Von Dadelszen P, Draycott T, et al. Change in the incidence of stillbirth and preterm delivery during the COVID-19 pandemic. JAMA 2020;324(7):705–706. DOI:10.1001/jama.2020.12746.
Bunnell ME, Koenigs KJ, Roberts DJ, et al. Third trimester stillbirth during the first wave of the SARS-CoV-2 pandemic: similar rates with increase in placental vasculopathic pathology. Placenta 2021;109:72–74. DOI:10.1016/j.placenta.2021.04.003.
Bisht R, Kandalgaonkar VP, Shinde KK. Cesarean section rate among COVID-19 mothers and its classification through robson's criteria. JSAFOG 2021:13(5):342–346. DOI: 10.5005/jp-journals-10006-1921.
Schoenmakers S, Snijder P, Verdijk RM, et al. Severe acute respiratory syndrome coronavirus 2 placental infection and inflammation leading to fetal distress and neonatal multi-organ failure in an asymptomatic woman. J Pediatric Infect Dis Soc 2021;10(5):556–561. DOI:10.1093/jpids/piaa153.
Tasca C, Rossi RS, Corti S, et al. Placental pathology in COVID-19 affected pregnant women: a prospective case–control study. Placenta 2021;110:9–15. DOI:10.1016/j.placenta.2021.04.002.
Nambiar S, Ajith S, Reshmi V. Assessing disease outcome in COVID-19 pregnancies in a tertiary referral center in south India: a single-center retrospective cohort study. JSAFOG 2020:335–339. DOI: 10.5005/jp-journals-10006-1822.
Chaudhary D, Chauhan M, Gupta D, et al. A comparative review of maternal and neonatal outcome among pregnant women with COVID-19 in first and second wave in a tertiary care centre of South Rajasthan. Int J Reprod Contracept Obstet Gynecol 2021;10(12):4471–4478. DOI: 10.18203/2320-1770.ijrcog20214644.
Mahajan NN, Pophalkar M, Patil S, et al. Pregnancy outcomes and maternal complications during the second wave of coronavirus disease 2019 (COVID-19) in India. Obstet Gynecol 2021;138(4):660–662. DOI: 10.1097/AOG.0000000000004529.
Singh V, Choudhary A, Datta MR, et al. Maternal and neonatal outcome of pregnant women with SARS-CoV-2 infection during the first and second wave of COVID-19 in a tertiary care institute in Eastern India. Cureus 2022;14(2) e22360. DOI: 10.7759/cureus.22360.
Kadiwar S, Smith JJ, Ledot S, et al. Were pregnant women more affected by COVID-19 in the second wave of the pandemic? Lancet 2021;397(10284):1539–1540.
Malhotra J, Agrawal P, Garg R, et al. Corona virus disease (COVID-19) and pregnancy: what obstetrician should know. J South Asian Feder Obst Gynae 2019;11(6):337–339. DOI: 10.5005/jp-journals-10006-1744.
Malhotra N, Garg R, Singh S, et al. Pregnancy management in coronavirus disease: challenges in developing countries. J Reprod Healthc Med 2021;2:18. DOI: 10.25259/JRHM_58_2020.
Malhotra N, Malhotra N, Garg R. COVID and women's health in India. J Indian Med Assoc 2022;120(3):48–52.