Comparing Infection Profiles of Expectant Mothers with COVID-19 and Impacts on Maternal and Perinatal Outcomes between the First Two Waves of the Pandemic

Abstract

During 2020, Coronavirus Disease-19 (COVID-19) incidence fluctuated in two clear waves across the spring and autumn periods. This study was designed to compare the maternal and perinatal clinical outcomes in obstetrics patients with COVID-19 between the two waves of infection in Spain. We conducted an observational, analytical, ambispective cohort study with longitudinal follow-up of mothers with confirmed SARV-CoV-2 infection from different hospitals in our country between March–November 2020. We recruited 1295 pregnant women with SARS-CoV2 infection from 78 hospitals, 846 (65.3%) of whom were diagnosed during the first wave and 449 (34.7%) during the second wave. Our results show that patients developing COVID-19 during the first wave had more symptoms at triage, early in pregnancy with greater rates of COVID-19-related maternal morbidity; caesarean section and preterm birth in the first wave. We register two cases of maternal mortality and only during the first wave. Maternal morbidity events showed a strong link to perinatal mortality events in the first wave compared to the second wave, in which maternal morbidity was more associated with pneumonia. Likewise, maternal morbidity showed a strong correlation with perinatal morbidity events in both waves. We describe the differences between the patients’ profiles and management between the two waves and related to maternal and perinatal outcomes. Differences were also observed in the management of pregnant women with COVID-19. Thus, there were fewer caesarean sections, and maternal and perinatal morbidity events were reduced in the second wave, while the impacts of respiratory symptoms and their severity, including a greater need for maternal treatment, were greater in this last period. Identifying the impact that changes in the profile as well as in the treatment have on maternal–perinatal morbidity and mortality will help improve the well-being of our patients and their newborns.

Comparison between the demographic shift clinical severity and outcome of the first two waves of COVID‐19 in pregnancy in a tertiary hospital in India

“…During this period, vaccination had not been approved for pregnant women 9 . Our findings are consistent with other studies, 10 in which more women presented in advanced pregnancy causing more maternal morbidity and mortality.…”

A temporal study of Brazilian pregnant and postpartum women vulnerability for COVID-19: Characteristics, risk factors and outcomes

“… 9 A study performed with Spanish obstetric COVID-19 patients showed worsening respiratory symptoms during the second wave. 19 A major data analysis carried out in the UK covering the waves March 2020-November 2020 and December 2020-February 2021 showed that among hospitalized COVID-19 pregnant women aged 20-39 years, 10% received critical care, 1% died, and 18% had a preterm birth. In addition, since the B.1.1.7 variant became predominant (second wave), the number of pregnant women with COVID-19 admitted to the hospital were more than twice higher and more likely to require respiratory support, and obesity was significantly associated with adverse outcome.…”

Impact of Severity of Maternal COVID-19 Infection on Perinatal Outcome and Vertical Transmission Risk: An Ambispective Study From North India

“…An observational analytical study on 1295 COVID-19 infected pregnant women, comparing two waves in Spain reported a strong correlation of maternal morbidity with perinatal morbidity similar to our study. On univariate analysis mechanical ventilation and maternal ICU admission showed a positive association with perinatal morbidity (10-fold and fivefold increased risk respectively); while lymphocytopenia was associated with maternal morbidity [ 23 ]. A study from India also attributed the increased perinatal mortality directly to increased severity of maternal infection, and indirectly to increased obstetrical complications due to disrupted maternal services [ 7 ].…”