A new study by Indian Council of Medical Research (ICMR) suggests that SARS-CoV-2 may infect a higher proportion of pregnant women, and when symptomatic, a large proportion can develop moderate-to-severe disease.
The experts have recommended that pregnant women may be counselled for vaccination to reduce the adverse impact of Covid-19 on maternal health.
In their first large-scale study report of systematically collected, multicentre data on the clinical presentation, pregnancy outcomes and maternal deaths amongst women with Covid-19 in Maharashtra, the experts observed that nearly 30% of the symptomatic cases had moderate to a severe disease requiring ICU/HDU admission.
“Almost 96% of the ICU/HDU admissions were due to Covid-19 and only 4% were due to non-Covid-19 causes. Thus, our analysis suggests that SARS-CoV-2 may infect a higher proportion of pregnant women,” said the study.
It said that pregnant women with Covid-19 need “immediate medical attention” from the healthcare system in India.
It also said that co-infections could be a greater threat to pregnant women with Covid-19 in the Indian context.
The experts analysed data of 4,203 women with Covid-19 for the study. The majority of pregnant and post-partum women in Maharashtra with Covid-19 were recruited from the Mumbai metropolitan region (1684, 40%) followed by Vidarbha (1155, 27.5%), Pune (853, 20.3%), Marathwada (351, 8.4%) and Khandesh region (160, 3.8%).
The experts analysed the majority of women (3441, 82%) aged 18-30 years, with 92% being in the third trimester and the median gestational age was 38 weeks.
Out of 4,203 women, 3,865 were registered during their ongoing pregnancy and 338 were enrolled during the post-partum period.
According to the study, majority (3669, 87.3%) of the pregnant and post-partum women with Covid-19 were asymptomatic and only 534 (12.7%) were symptomatic.
The study found that pregnant and post-partum women above 30 years of age had “two times higher severity” of Covid-19 disease as compared to women aged less than 30 years of age.
“The study demonstrates the adverse outcomes, including severe Covid-19 disease, pregnancy loss and maternal death in women with Covid-19 in Maharashtra,” it said.
The study revealed that there were 3,213 live births, 77 miscarriages and 834 undelivered pregnancies. The proportion of pregnancy/foetal loss including stillbirths was 6%. Five hundred and thirty-four women (13%) were symptomatic, of which 382 (72%) had mild, 112 (21%) had moderate, and 40 (7.5%) had severe disease.
The most common complication was preterm delivery (528, 16.3%) and hypertensive disorders in pregnancy (328, 10.1%). A total of 158 (3.8%) pregnant and post-partum women required intensive care, of which 152 (96%) were due to Covid-19 related complications.
According to the experts, higher case fatality rate (CFR) was observed in Pune (9/853, 1.1%) and 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. Comorbidities of anaemia, tuberculosis and diabetes mellitus were associated with maternal deaths.
Among severe Covid-19 cases, the most common presenting symptoms were shortness of breath (34, 85%), dry cough (23, 57.5%) and fever (22, 55%).