Impact of COVID-19 pandemic on maternal and neonatal outcomes: A narrative review and evidence from the PregCovid registry

Abstract

More than 533 million Coronavirus Disease 2019 (COVID-19) cases and associated 6 million fatalities were reported globally whereas 43 million cases and 0.5 million deaths in India were reported till June 2022. Maharashtra state alone reported about one-third of the total cases of COVID-19 in India in the early period of COVID-19 pandemic. The lack of epidemiological, demographic, and impact data of COVID-19 on pregnant women and newborns, advocated the need for recording and documenting population specific data for clinical management and policy decisions in India. The PregCovid registry was launched in April 2020 by the Indian Council of Medical Research-National Institute for Research in Reproductive and Child Health, Mumbai, in collaboration with the Medical Education and Drugs Department, Government of Maharashtra, and Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital to gain insights into clinical and socio-epidemiological characteristics of pregnant women with lab confirmed COVID-19 and assess its impact on maternal and neonatal outcomes. The registry has collected data of 8428 pregnant and postpartum women with COVID-19 from 19 participating centers across Maharashtra in a near real-time manner. The registry first reported that the delta variant (B.1.617.2) dominant second wave was more lethal (case fatality rate 5.7%) to pregnant and postpartum women than the alpha (0.7%) dominant wave of COVID-19 in India. There was also a higher incidence of moderate to severe cases, intensive care admissions and maternal complications including pre-eclampsia, low birth weight and preterm deliveries during the delta wave. The omicron dominant third wave of the COVID-19 pandemic exhibited a higher transmission rate compared to the previous two waves, causing a surge in cases but minimally impacting adverse outcomes. The registry further analyzed and reported the impact of COVID-19 on pregnant and postpartum women with comorbidities, coinfections, twin pregnancies, and neonatal outcomes, while providing crucial policy inputs to improve maternal and newborn health during the pandemic. The registry model can be replicated at tertiary care hospitals across India to understand various maternal-neonatal outcomes. The evidence generated from PregCovid registry was useful for improved clinical management and also contributed to a policy decision on COVID-19 vaccination in pregnant women in India. The registry envisions a collaboration with similar regional, national and international registries to form an international consortium for data sharing and reporting to promote global policy level interventions and advocates a sustainable and collective response to improve the COVID-19 global vaccination coverage.