New Delhi: Covid-19 may infect a high proportion of pregnant women, and when symptomatic, a large proportion of them can develop moderate to severe disease, said a new study published in the Indian Journal of Medical Research Thursday.
Pregnant and postpartum women younger than 30 face twice as severe disease as compared to women above 30, the study said, recommending immediate medical attention towards Covid-positive pregnant women.
The study was conducted under PregCovid registry, an ongoing prospective cohort study of 4,203 Covid-positive pregnant and postpartum women in Maharashtra. Around 40 per cent of these women were recruited from the Mumbai metropolitan region.
According to the study, 3,441 of the women (82 per cent) were between 18-30 years.
Of the total, 534 women (13 per cent) were symptomatic of Covid, of which 382 (72 per cent) had mild, 112 (21 per cent) had moderate, and 40 (7 per cent) had severe disease.
A total of 158 (3.8 per cent) pregnant and postpartum women required intensive care, of which 96 per cent cases were due to Covid-related complications.
There were 16.3 per cent preterm births in the study cohort. However, the study did not conclude that preterm births could be blamed on Covid.
Six per cent pregnancy losses (childbirth, miscarriage and ectopic pregnancy) were reported in the cohort, which is significantly higher than the average pregnancy losses reported from Maharashtra (1 per cent).
Of the 40 severe Covid cases found in the group, 28 turned out to be women who had anemia, while one had diabetes and five had tuberculosis as comorbidities. Anaemia was discovered in 50 per cent of women who had tested positive for the virus.
The case fatality ratio of pregnant and postpartum women was found to be at 0.8 per cent — 34 out of 4,203 women under observation died during their pregnancy or the postpartum period.
Comorbidities like anaemia, tuberculosis and diabetes mellitus were associated with maternal deaths.
The study saw 3,213 live births, 77 miscarriages and 834 undelivered pregnancies. The proportion of pregnancy loss including stillbirths was six per cent.
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What the study calls for
The study recommended case-controlled studies to establish the relationship between pregnancy losses and Covid. It also called for increased focus on integrated tuberculosis and Covid treatment for pregnant women in India.
“The finding of tuberculosis as a risk factor is important as India has one of the highest burden of tuberculosis in the general population as well as in pregnant women. As suggested previously, this study further reiterates that the healthcare services for the treatment of tuberculosis and COVID-19 must be integrated, and pregnant women with respiratory symptoms should be tested for both Covid-19 and tuberculosis,” it said.
The study further advocated for vaccinating pregnant women. “With the availability of the vaccine, pregnant women may be counselled for vaccination to reduce the adverse impact of Covid-19 on maternal health,” it said.
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