Clinical presentation, pregnancy complications and maternal outcomes of SARS-CoV-2 infection in pregnant women during the third wave of COVID-19 in Mumbai, India
Authors: Mahajan Niraj , Kesarwani Shweta , Salunke Chetna , Kumbhar Padmaja , Yenkure Piyusha , Shaikh Juvairiya , Shikhare Shrutika , Mahale Smita , Sachdeva Geetanjali , Gajbhiye Rahul 
Published: January 2022

Abstract
Importance: Following the outbreak of SARS-CoV-2 infection, it is unclear whether there is any difference in clinical presentation, disease severity, pregnancy complications, and maternal outcomes in pregnant and postpartum women during the third wave of COVID-19 as compared to the earlier two waves of COVID-19. Objective: To assess the clinical presentation, disease severity, pregnancy complications, and maternal outcomes in women affected with COVID-19 during the third wave in India and compare these parameters with the first wave and second wave of COVID-19.Design: Retrospective observational cohort study Setting: Tertiary care, dedicated COVID-19 hospital catering to Mumbai Metropolitan Region, India Participants: A total of 2,028 pregnant and postpartum women were admitted during three-wave periods: first wave - 1st April 2020 to 31st January 2021, second wave - 1st February 2021 to 10th December 2021; and third wave - 18th December 2021 to 19th January 2022. Exposures: SARS-CoV-2 infection in pregnant and post-partum women confirmed by laboratory confirmation of COVID-19 Main Outcomes and Measures: The primary outcome measures were disease severity, pregnancy complications, and maternal mortality during the third wave compared to the first and second waves of COVID-19. Results: A total of 2028 pregnant and postpartum women with COVID-19 diagnosis were enrolled during the first, second, and third waves of COVID-19. The hospitalization rate of pregnant and post-partum women with COVID-19 during the first four weeks of the third wave was higher than the earlier two waves as 288 women got admitted within 33 days. The number of SARS-CoV-2 infected pregnant and post-partum women with symptoms of COVID-19 were five times higher during the third wave as compared to the first wave (OR=5.1, 95% CI, 3.8-6.7, p<.001). On the contrary, there was a significantly lower proportion of pregnant and postpartum women with moderate to severe COVID-19 during the third wave (0.3%, 1/288) as compared to those during the first wave (2.4%, 27/1143, p<.001) and second wave (14.4%, 86/597) [p<.001]. The ICU/HDU admissions during the third wave were significantly lower (2.4%,7/288) than those during the second wave (14.7%,88/597) [OR =0.1, 95% CI, 0.1-0.3, p<.001] but similar to the first wave (2.4%,27/1143). No maternal deaths were reported during the third wave till 19th January 2022. Eclampsia was observed four times higher during the third wave as compared to the second wave (OR=4.1, 95 % CI, 0.8-22.6, p =.19) and first wave (OR=4.4, 95% CI, 0.9-12.7, p=.15). Conclusions and Relevance: Decreased severity of COVID-19 and reduced maternal mortality and morbidity were reported in the third wave as compared to the first wave and second wave of COVID-19 in the Mumbai Metropolitan Region, India.Trial Registration: The study is registered with the Clinical Trial Registry of India (Registration no: CTRI/2020/05/025423).