ABSTRACT
Importance: Following the outbreak of SARS-CoV-2 infection, it is unclear whether there is any difference in clinical presentation, disease severity, pregnancy complications, and maternal outcomes in pregnant and postpartum women during the third wave of COVID-19 as compared to the earlier two waves of COVID-19. Objective: To assess the clinical presentation, disease severity, pregnancy complications, and maternal outcomes in women affected with COVID-19 during the third wave in India and compare these parameters with the first wave and second wave of COVID-19. Design: Retrospective observational cohort study Setting: Tertiary care, dedicated COVID-19 hospital catering to Mumbai Metropolitan Region, India Participants: A total of 2,028 pregnant and postpartum women were admitted during three-wave periods: first wave - 1 st April 2020 to 31 st January 2021, second wave - 1 st February 2021 to 10 th December 2021; and third wave - 18 th December 2021 to 19 th January 2022. Exposures: SARS-CoV-2 infection in pregnant and post-partum women confirmed by laboratory confirmation of COVID-19 Main Outcomes and Measures: The primary outcome measures were disease severity, pregnancy complications, and maternal mortality during the third wave compared to the first and second waves of COVID-19. Results: : A total of 2028 pregnant and postpartum women with COVID-19 diagnosis were enrolled during the first, second, and third waves of COVID-19. The hospitalization rate of pregnant and post-partum women with COVID-19 during the first four weeks of the third wave was higher than the earlier two waves as 288 women got admitted within 33 days. The number of SARS-CoV-2 infected pregnant and post-partum women with symptoms of COVID-19 were five times higher during the third wave as compared to the first wave (OR=5.1, 95% CI, 3.8-6.7, pConclusions: and Relevance: Decreased severity of COVID-19 and reduced maternal mortality and morbidity were reported in the third wave as compared to the first wave and second wave of COVID-19 in the Mumbai Metropolitan Region, India. Trial Registration: The study is registered with the Clinical Trial Registry of India (Registration no: CTRI/2020/05/025423).