Higher complications among newborns of Covid-infected mothers during Delta wave: Study

Mumbai: The incidence of preterm births, low birth weight, admissions to Neonatal Intensive Care Unit (NICU), and other adverse outcomes in newborns of mothers infected with Sars-Cov-2 virus that causes Covid-19 were higher during the Delta variant-driven second wave, according to a new multi-institutional study published in the European Journal of Paediatrics on Saturday. Previous studies have also shown that compared to the pandemic’s first wave, the second wave was more harmful to pregnant women with neonates at risk of developing complications.

The 18-member study, conducted using data from PregCovid -- a registry aimed to study pregnant and post-partum women with Sars-CoV-2 infection -- was led by the Parel-based ICMR-National Institute for Research in Reproductive and Child Health (NIRRCH).

The study found that significantly higher neonatal complications were reported in Mumbai Metropolitan Region. The analysis also found that birth asphyxia (the failure to initiate and sustain breathing at birth), preterm births and neonatal resuscitation (number of newborns who required intervention to establish breathing and circulation) at birth were significantly higher in the second wave than during the first wave in India.

Researchers said their findings on the effect of the specific variant on newborns of Covid -infected mothers suggest the need for continuous surveillance and counselling of pregnant women for Covid-19 vaccination to avoid detrimental outcomes in neonates, as well as the need to devise evidence-based approaches for managing these neonates.

A study from Italy had earlier reported that 15% newborns of mothers infected with Covid that were followed up for seven months showed retinal abnormalities, researchers have also suggested that these children should be followed up for years to understand the long-term impact of the Sars-CoV-2 infection.

For the study, researchers analysed 2,524 neonates born to Covid-positive mothers during the first wave (1,782) and second wave (742) of the pandemic at five study sites of the PregCovid registry in Maharashtra. PregCovid is a registry started by ICMR-NIRRCH in collaboration with Maharashtra Education and Drug Department and the Brihanmumbai Municipal Corporation (BMC).

Results showed that preterm birth was higher in the second wave – 111 of 742 neonates (15%) – than in the first wave – 139 of 1782 neonates (7.8%). Even the number of newborns requiring admission to the Neonatal Intensive Care Unit (NICU) was significantly higher at 19% (141/742) in the second wave as compared to 264 of 1782 (or 14.8%) in the first wave.

During the second wave, birth asphyxia and prematurity were 3.8 and 2.1-fold higher, respectively. Cases of neonatal resuscitation were higher in the second wave at 3.4% (25 of 742) as compared to 1.8% (32 of 1782) in the first wave. However, the prevalence of Covid in neonates showed almost no difference between the two waves (4.2% as against 4.6%). The proportion of newborns who died within the first 28 days of life – neonatal deaths – was also similar during the two Covid waves (2.3% as against 2.1%).

“The findings suggest that SARS-CoV-2 infection at late gestational is an important factor in influencing negative clinical outcomes in the offspring as reported earlier…Higher incidence of complications in the neonatal period and intensive care including resuscitation at birth could have been attributed to increased severe Covid-19 disease in mothers during the second wave of the pandemic,” stated the study.

“The severity in clinical profile in neonates may be attributed to the highly virulent strain B.1.617.2 (Delta) variant reported during the second wave of the pandemic in India. The findings emphasize the need to devise evidence-based management strategies for neonates born to SARS-CoV-2 infected mothers,” said Dr Rahul Gajbhiye, principal investigator, PregCovid registry. “The study importantly highlights the crucial need for COVID-19 vaccination of pregnant women to avoid detrimental outcomes in neonates,”

During the first wave (January–June 2020), B.1 lineages were the default strain across India, while from May/June 2021, the Delta variant B.1.617.2 was the dominant lineage during the second-wave period.

“The differences in the clinical presentations and neonatal complications observed in our study cohort could be due to the diffusion of different viral strains in circulation during the first and second waves of Covid-19 in Maharashtra, India,” the study states.

While the study has not undertaken genotyping of the virus in infected mothers to draw an association between complications in newborns with the highly virulent Delta variant, researchers said differential observations could be attributed to differences in the Sars-CoV-2 strains, differences in access to health care facilities and reporting of pregnant women during the first and second wave, and change in population dynamics during the lockdown during both waves. More number of Covid infected mothers going to private hospitals rather than government hospitals could also be another reason for the difference in numbers in the two waves.

“One of the limitation of the study was inability of long term follow-up. However, it is important to note that impact of COVID-19 in pregnancy may go beyond the early neonatal outcomes as reported by some cohort studies in Italy and USA including increased risk for neurodevelopmental disorders among these neonates. Hence there is need of regular follow up of such neonates to understand the long term impact,” said Dr Suchitra Surve, co-principal investigator.

ABOUT THE STUDY

The first wave of Covid-19 is between April 1, 2020, and January 31, 2021; and the second wave was between February 1 and July 15, 2021.

PregCovid comprises data from 18 government medical colleges across rural and urban Maharashtra and the civic-run BYL Nair Hospital, Mumbai Central.

In the present study, the analysis was based on five sites in Maharashtra – BYL Nair Charitable Hospital, Mumbai Central, Government Medical College, Nagpur, Indira Gandhi Government Medical College, Nagpur, Vaishampayan Memorial Government Medical College, Solapur, Government Medical College, Aurangabad.