# Comparative Study of Pregnancy Outcomes in Women With COVID-19 Disease During the Three Waves of the Pandemic in Eastern India

## TL;DR

This study compares pregnancy outcomes in women with COVID-19 across three pandemic waves in eastern India, finding higher severity and complications during the second and third waves.

## Contribution

The study provides a comparative analysis of maternal and fetal outcomes during three distinct waves of the pandemic in a specific geographic region.

## Key findings

- The second wave had the highest number of moderate and severe cases and higher cesarean section rates.
- The third wave had the highest percentage of stillbirths compared to the first and second waves.
- Preterm delivery rates remained high across all three waves.

## Abstract

Introduction

Healthcare systems around the world were disrupted by the COVID-19 pandemic. Multiple waves were experienced by most countries, and clinical symptoms and severity varied between these waves. A COVID-19 infection in pregnant women may result in complications for both the mother and the fetus and thus pose an additional challenge for clinicians. The study of the different presentations, complications, and pregnancy outcomes during the three waves is important to study the effect of the disease on pregnant women.

Objective

This study aimed to analyze and compare the clinical presentations, comorbid conditions, complications, and pregnancy outcomes in women with SARS-CoV-2 infection during the three waves of the pandemic.

Methodology

The present study is a comparative study undertaken at Tata Main Hospital, a referral hospital in Jamshedpur in eastern India. The study period was from May 2020 to February 2022 and was divided according to the three waves of the pandemic. The duration of the first wave was between 1st May 2020 and 28th February 2021; the second wave was between 1st March 2021 and 31st October 2021; and the third wave was between 1st November 2021 and 28th February 2022. A total of 306 pregnant women tested positive for COVID-19 disease during the study period. A retrospective collection of data was done, and clinical findings, laboratory results, comorbid conditions, and outcomes were compared across the three waves.

Results

During the first wave of the pandemic, 139 COVID-19-positive pregnant women were admitted to our hospital. During the second wave, 110 admitted pregnant women tested positive for SARS-CoV-2 infection, and during the third wave, 57 pregnant women tested positive for SARS-CoV-2 infection. Asymptomatic or mild disease was the most commonly seen presentation during all the waves, but a significantly higher number of moderate and severe cases were seen during the second wave. The second wave also witnessed a higher rate of cesarean sections when compared to the other two waves. The preterm delivery rate was 27.8%, 24.7%, and 25% during the first, second, and third waves of the pandemic, respectively. The third wave of the pandemic had the highest percentage of stillbirths, which was significantly higher than both the first and second waves. The COVID-19 test was positive in four babies during the study period.

Conclusion

The severity of COVID-19 disease varied among the three waves, and the second wave recorded the maximum number of moderate and severe cases. Maternal mortality was also significantly higher during the second wave. The rate of preterm deliveries was high during all the waves, and the incidence of stillbirths was highest during the third wave.