Secondary Analysis of Maternal Characteristics and Pregnancy Outcomes of COVID-19 Positive Pregnant Women in Sri Lanka using National COVID-19 Positive Pregnant Women Surveillance

Abstract

Aims: Limited knowledge exists on pregnancy outcome among COVID-19 positive pregnant women despite relatively better understanding on disease severity in pregnancy. Objective of this assessment is to describe the maternal characteristics and factors associated with disease severity and pregnancy outcome of COVID-19 positive pregnant women in Sri Lanka.
 Study Design: Secondary descriptive analysis was conducted using data reported in the National COVID-19 positive pregnant women surveillance, Sri Lanka.
 Place and Duration of Study: All pregnant women who were tested positive either by RT-PCR or by Rapid Antigen Test for SARS CoV-2 virus and their pregnancy and neonatal outcomes reported from 1st March 2020 to 31st October 2021 in the National surveillance in Sri Lanka, were included in the study.
 Methodology: Sri Lankan country-level pregnant women characteristics were compared with COVID-19 positive pregnant women using Z test. Associated factors for disease severity and pregnancy outcome was calculated using univariate and multivariate Odds ratios.
 Results: Details of pregnancy and neonatal outcomes were reported for 2493 COVID-19 positive pregnant women. Less cases of severe COVID-19 infection were observed among pregnant women with no co-morbidities compared with women having at least single co-morbidity (AOR=0.508, CI=0.293-0.879, P=0.04). Pregnant women with mild to moderate infection reported better pregnancy outcome compared to women with severe infection (AOR=7.376, CI=3.557-15.292, P<0.001).  In contrast, COVID-19 diagnosis in 1st and 2nd trimesters significantly reduced the good pregnancy outcome compared to pregnant women with diagnosis of COVID-19 in 3rd trimester of the pregnancy (AOR=0.009, CI=0.005-0.015, P<0.001 and AOR=0.113, CI=0.072-0.179, P<0.001 respectively).
 Conclusion: Our study showed poor pregnancy outcome among severe vs mild to moderate infection and diagnosis in 1st and 2nd trimesters vs 3rd trimester among COVID-19 positive women. Further, increased severity of COVID-19 infection among pregnant women with co-morbidities vs no comorbidities.