The Impact of COVID-19 Pandemic Waves on Maternal Health and Infant Outcomes—A Retrospective Cohort Study
by
, and
Gail Ohaegbulam
1, 
Kedra Wallace
1,2,3
,
Wondwosen K. Yimer
4,
Ahmed S. Z. Moustafa
1 and
Rachael Morris
1,* 1
Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA
2
Department of Pharmacology & Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA
3
Myrlie Evers-Williams Institute for the Elimination of Health Disparities, University of Mississippi Medical Center, Jackson, MS 39216, USA
4
Department of Data Science, University of Mississippi Medical Center, Jackson, MS 39216, USA
*
Author to whom correspondence should be addressed.
Women 2024, 4(4), 469-479; https://doi.org/10.3390/women4040035
Submission received: 10 September 2024
/
Revised: 6 November 2024
/
Accepted: 15 November 2024
/
Published: 21 November 2024
Abstract
The initial presentation of COVID-19 to the world left many in the medical community perplexed about its true nature and potential impact on individuals. Many investigations into the pathology of the virus resulted from this; however, studies were limited in the obstetric community, especially in high-risk communities. Each pandemic wave (Alpha, Delta, Omicron) had different transmission rates and inflicted different COVID-19 severity levels among those infected. This study aimed to determine if the effects of COVID-19 on maternal and infant outcomes varied by pandemic waves. This is an observational cohort study utilizing women enrolled in a COVID-19 pregnancy study. A review of 374 electronic medical records of women who received care at the University of Mississippi Medical Center after testing positive for SARS-CoV2 was conducted. During the Alpha pandemic wave, women contracted COVID-19 significantly earlier in pregnancy; however, higher rates of COVID-19 infection occurred during the Omicron pandemic wave. During the Delta pandemic wave, more women were morbidly obese and were likely to deliver significantly earlier, and, when compared to infants born during the Omicron pandemic wave, the infants born during the Delta wave weighed significantly less. The effects of COVID-19 on high-risk pregnant patients may deviate from previous reports, indicating a need for further investigation of the biological and social factors that may lead to these differences. Studies into the effects of COVID-19 in pregnancy remain limited and this study provides valuable insight into how varying COVID-19 strains affected a high-risk obstetric community.
1. Introduction
The impact of COVID-19 (Coronavirus 2019) was experienced globally, and no demographic was unaffected, with those already affected by disparities being significantly impacted. Increased severity and mortality rates were seen in persons of color, individuals of lower socioeconomic status, and those of uninsured status [1,2]. Several studies have shown a reduced risk of hospitalizations and outcomes when the Delta and Omicron variants are compared [3,4]. However, the Delta variant after the Alpha variant demonstrated greater adverse outcomes. Individuals with pre-existing comorbidities such as non-white race, hypertension, diabetes, advanced maternal age, and increased body mass index (BMI) were more likely to suffer severe COVID-19 infections [5]. Studies conducted in Hong Kong and Saudia Arabia evaluating pregnant women indicate that pregnant women may be severely affected by respiratory illness associated with coronavirus infection, reporting 40–57% of cases having maternal morbidity and 28–40% maternal mortality [6,7,8]. Studies conducted on patients infected during the Alpha pandemic wave reported that pregnancies affected by COVID-19 infections were associated with higher rates of preterm birth, preeclampsia (PreE), admission to the intensive care unit (ICU), cesarean section, and maternal and perinatal death [9,10]. Reports have varied on whether there are links between pre-existing comorbidities and pregnancy-related COVID-19 morbidities. For instance, studies conducted in Uganda found no significant associations between the maternal outcomes following COVID-19 infection and pre-existing comorbidities that have been associated with COVID-19 infection [11], whereas a recent report from Brazil along with data from our own group has reported direct associations between the two [12,13]. It is imperative to evaluate the impact of COVID-19 on pregnancies to understand its contribution to complications in pregnancies so that future research may assess ways to mitigate this. In the current study, our objective was to investigate whether there are variations in the negative maternal and infant outcomes linked with COVID-19 infection and whether these variations were influenced by different pandemic waves.
2. Results
2.1. General Demographics and Patient Characteristics
A total of 374 women met the inclusion criteria, which included 11 maternal deaths. Overall, general patient characteristics for all women included in this study can be found in Table S1. Women were 27.66 ± 5.95 years of age, multiparous, and obese (average population, body mass index, BMI 34.87 ± 10.07 kg/m2) at the time of COVID-19 diagnosis. In total, 17% and 13% of women had a pre-existing hypertension diagnosis of chronic hypertension or diabetes, respectively, 64% of women identified as black, and 67.7% of women qualified for Medicaid insurance. Delivery records were obtained for 298 (79.7%) women in this study, and maternal and fetal outcomes were extracted. Table S2 compares sociodemographic and clinical characteristic data from women with delivery records vs. those without delivery records. There was a significant association between the gestational age at COVID-19 diagnosis and the gestational age at delivery (p < 0.001; Table S1), with 51.33% of women delivering < ten days after their COVID-19 diagnosis.
2.2. COVID-19 Pandemic Waves and Maternal Outcomes
Women were subdivided into cohorts based on when they tested positive for COVID-19 (Table 1). Most women contracted COVID-19 during the Omicron pandemic wave. However, women in the Alpha pandemic wave were significantly earlier in their pregnancy (27.44 ± 9.59 wks) at the time of COVID-19 infection vs. women in the Omicron pandemic wave (30.03 ± 9.56 wks; p = 0.04). There was a significant difference in the distribution of BMI between the pandemic waves (p = 0.04), whereas the most obese women were seen during the Delta pandemic wave, with 28.42% of the women contracting COVID-19 during that time period having a BMI of at least 40 kg/m2. Even though black women made up the majority of our population, most black women contracted COVID-19 during Omicron (70.68%). In contrast, the majority of white (25%) and Hispanic women (14.71%) contracted COVID-19 during the Alpha pandemic wave.
The rates of chronic hypertension among women remained consistent (p = 0.91) between pandemic waves: 18.25% (Alpha), 15.96% (Delta), and 17.29% (Omicron). With each pandemic wave, the number of women with a hypertensive disorder of pregnancy (clinical diagnosis of gestational hypertension, PreE, chronic hypertension, superimposed PreE) also remained consistent, ranging from 24.79 to 25.23% among the population. The rates of PreE increased after the Alpha pandemic wave; however, there was no increased risk of developing PreE in the Delta pandemic wave, 1.32, aOR (95%CI 0.54–3.25), or the Omicron pandemic wave, 1.56, aOR (95%CI 0.71–3.43), relative to the Alpha pandemic wave. Overall, approximately 49 (16.4%; n = 298 delivery records) women were diagnosed with PreE and neither maternal age at delivery (p = 0.34) nor maternal race (p = 0.76) increased the odds of developing PreE; however, maternal BMI at the time of COVID-19 diagnosis significantly increased the odds of developing PreE, 1.08, aOR (95%CI 1.05–1.12).
A total of 31.21% of women experienced a preterm birth, with women delivering during Omicron being the least affected by preterm birth. Women infected with COVID-19 during the Delta pandemic wave delivered significantly earlier (35.62 ± 4.3 wks) than those infected during the Omicron pandemic wave (37.28 ± 2.69 wks; p = 0.006). As indicated in Table 2, most of the women (72.2–78.2% of the population) in the study had no maternal complications. However, women infected during the Alpha pandemic wave had the highest incidence of complications, with postpartum hemorrhage being the single most recorded complication. Other commonly occurring complications included shoulder dystocia, breech delivery, and oligohydramnios.
We examined the length of time between COVID-19 diagnosis and the end of pregnancy relative to the wave of diagnosis and did not find a statistical difference (p = 0.14; Figure 1A). Throughout the study, 6.4% (n = 24/374) of women were admitted to the ICU for COVID-19 treatment. Most ICU admissions occurred during the Alpha (n = 11, 45.8%) and Delta (n = 12, 50%) pandemic waves, with only one (4.2%) admission during the Omicron pandemic wave.
For comparison purposes, COVID-19 severity classifications were grouped into asymptomatic/mild vs. moderate vs. severe/critical, as women with these symptoms were generally subjected to the same form of clinical treatment. We found that with each new COVID-19 pandemic wave, the severity of symptoms among patients would decrease until most women presented as asymptomatic or with mild symptoms (p < 0.001, Figure 1B). There was a large group of women who did not have any maternal complications; however, among the 73 women who did experience maternal complications, most of the women (83.8%) were asymptomatic or had mild symptoms. There was no association between COVID-19 severity and maternal race (p = 0.17). COVID-19 severity impacted the incidence of PreE (p = 0.004). Compared to asymptomatic/mild women, women with moderate symptoms of COVID-19 had significantly increased odds of developing PreE, 4.1 aOR (95%CI 1.18–14.26). The opposite was found in women with critical/severe symptoms of COVID-19, who had significantly decreased odds of developing PreE, 0.17 aOR (95%CI 0.02–1.48), compared to asymptomatic/mild women.
Of the eleven maternal deaths, five (45.5%) occurred during the Alpha pandemic wave and the remaining six (54.5%) during the Delta pandemic wave, with no deaths occurring during the Omicron wave. Table 3 provides details on the 11 women who died during the course of the study. Among the women who died, all women but one during the Alpha pandemic wave delivered viable infants. Women in the Delta pandemic wave were significantly older (p = 0.02), delivered significantly earlier (p = 0.009), and gave birth to babies that weighed significantly less (p = 0.0005) when compared to women who died during the Alpha pandemic wave. As expected, most women had severe to critical symptoms of COVID-19 but did not necessarily have a pre-existing case of diabetes or chronic hypertension; however, they were more than likely morbidly obese. There were no significant differences among maternal race, COVID-19 severity, or gestational age at diagnosis between the groups, and only one patient had received a COVID-19 vaccination.
There were eight infant deaths and four cases of intrauterine fetal demise (IUFD) or spontaneous abortion in this study, with zero reports of infant COVID-19 transmission. One case of spontaneous abortion was a result of a vehicular accident and was not believed to be related to the positive COVID-19 status of the mother. Six infants died during the Alpha pandemic wave and two during the Delta pandemic wave, with no deaths occurring during the Omicron pandemic wave. There was more maternal racial diversity during the Alpha pandemic wave vs. the Delta pandemic wave where both infants were born to black mothers. Infants who died during the Alpha pandemic wave were born to mothers who were diagnosed with COVID-19 in the second trimester of pregnancy vs. those in the Delta pandemic wave who were diagnosed in the third trimester; this is despite both sets of infants being born in the third trimester. Three of the mothers of these infants received at least one COVID-19 vaccination prior to infant death.
2.3. Infant Outcomes
There was a significant association between birthweight and gestational age at delivery, with infants weighing, on average, 186.4 g more each week of birth (p < 0.001). Female infants weighed statistically less at birth relative to male infants (p = 0.008; Table S1). Infants with IUGR (intrauterine growth restriction) weighed significantly less at birth than infants without IUGR (2239.46 ± 822.7 g vs. 3018.95 ± 652.6 g, p < 0.001).
The severity of maternal COVID-19 infection was not found to impact birthweight (p > 0.05). Regarding NICU (neonatal ICU) admission, there was no association between the trimester women diagnosed with COVID-19 and whether or not infants were admitted to the NICU (p > 0.99; Table S1). Infants admitted to the NICU weighed significantly less compared to those not admitted to the NICU (2427.09 ± 945 g vs. 3023.99 ± 628.11 g, p < 0.001); however, when this was controlled by gestational age at delivery, this association was no longer significant (p = 0.08).
When evaluating the impact of the COVID-19 pandemic wave on birth outcomes, the Delta pandemic wave appeared to have the most negative impact on birthweight (Table 1). When compared directly to infants born during the Omicron pandemic wave, those born during the Delta pandemic wave weighed significantly less (p = 0.02; Table 1). The COVID-19 pandemic wave of maternal diagnosis was not associated with an increased risk of IUGR (p = 0.95) or NICU admission (p = 0.16). However, there was a significant difference in birthweights (p = 0.05) among infants admitted to the NICU, with those born during Delta (2095.31 ± 1104.21 g) weighing less compared to those born during Alpha (2307.58 ± 908.67 g) and Omicron (27,630.93 ± 806.95 g).
3. Discussion
When we evaluated maternal and fetal outcomes, we found that subsequent COVID-19 pandemic waves resulted in less severe maternal and fetal outcomes, except maternal deaths. This was accompanied by more women presenting with less severe or critical COVID-19 severity with each subsequent wave. The likelihood of delivering earlier increased in women infected during the Delta pandemic wave, which was accompanied by having a baby born with a lower birthweight. Women infected during this pandemic wave were also more likely to have a higher BMI than those infected during the Alpha or Omicron pandemic waves. There have been reports of individuals infected during the Delta pandemic wave presenting with more severe COVID-19 symptoms [14,15]; however, that was not the case in our study. COVID-19 symptomology decreased with each pandemic wave. We found that throughout the three pandemic waves, Alpha, Delta, and Omicron, the number of patients with asymptomatic or mild symptoms increased while the number of patients with severe or critical illness decreased, with the Omicron wave having the majority of those infected with COVID-19 who have asymptomatic disease. A mouse model was used to compare the different variants, SARS-CoV-2 wild type, Alpha, Beta, Delta, and Omicron, and showed that with each emerging variant, Omicron had the mildest pathogenicity and lowest mortality rates, which was attributed to an impaired replication ability in the respiratory tract [16]. It is also important to note that although it was considered by most sources to be the mildest [17], the Omicron variant had one of the highest transmissible rates. Similar results from clinical studies conducted both within and outside of the United States have reported that adverse maternal and infant outcomes are decreased in the Omicron pandemic wave compared to the Alpha and Delta pandemic waves [18,19,20]. The findings in our study supported the conclusion that pregnant women infected during the Omicron wave had the least pregnancy complications. Whether this was due to an increase in herd immunity or the increased availability and acceptance of vaccines for COVID warrants additional investigation.
Many reports on pregnant women infected with COVID-19 showed that there was an increased risk of developing PreE. A recent meta-analysis of 28 observational studies, which totaled almost 80,000 pregnant women, found that there were significantly increased odds of creating not only PreE without severe features but PreE with severe features, eclampsia, and Hemolysis, Elevated Liver Enzyme, and Low Platelet syndrome [21]. This was significant in those with symptomatic and asymptomatic COVID-19 states; however, the odds increased in those with symptomatic COVID-19 [21]. A retrospective study of 14 maternity hospitals in the United Kingdom also examined the effect of COVID-19 on PreE and found a dose–response relationship between the severity of the infection and subsequent risk of developing PreE, and those with severe COVID-19 had a 5-fold greater risk of PreE [22]. However, when we examined the association between PreE or hypertensive disorders of pregnancy and the severity of COVID-19 infection, there was no association seen. What is important to note is the high rate of PreE in our population, 12.4% at its lowest during the Alpha pandemic wave vs. 8.1% in other studies [23]. We have previously published a COVID-19 case–control study reporting a PreE rate of 26% in our non-COVID pregnant population [12], suggesting that in rural and underserved areas, there is an increase in hypertensive disorders of pregnancy outside of COVID-19 infection. It was also reported that emergency department visits for PreE-related symptoms increased with each COVID-19 pandemic wave [24], which could reflect an increased incidence of PreE or decreased access to clinics [25].
The majority of women contracted COVID during their third trimester, regardless of the pandemic wave. However, among the women who died, their average age at COVID-19 diagnosis was within the second trimester. Our findings are in contrast to what has been reported by others who found higher maternal morbidity and mortality when COVID-19 was contracted in the third trimester of pregnancy [26,27]. By the Omicron pandemic wave, 32.2% of women were vaccinated; however, whether the vaccination occurred before or after COVID-19 infection and/or pregnancy was not determined. As the majority of women in this study had a COVID-19 vaccination status that was not available (not applicable group), or the vaccination status was not stated in the medical record (unknown group), the impact of vaccination on maternal and fetal outcomes was not evaluated. Qin et al. conducted a retrospective cohort analysis of over one million vaccinated and unvaccinated pregnant women and reported that vaccination decreases the severity of COVID-19 among this population relative to unvaccinated pregnant women [28]. The steady increase in vaccination rates or natural and herd immunity could also contribute to the improvement in maternal and fetal outcomes during Omicron. This information may have provided more context to some of the observed findings.
The findings of the current study were subject to a few limitations. First, in this study, we were unable to have laboratory-confirmed results of the COVID-19 variants for which individuals tested positive. As a result, individuals may have been miscategorized for the primary pandemic wave at their time of diagnosis, as determined by the Mississippi State Department of Health. Second, we attempted to account for the vaccination status of individuals. However, it was inconsistent as we could only record what was in the electronic medical record. Our study suffered from a limited population size, which can make it difficult to detect a significant difference and can lead to inherent biases within the data. Finally, as we are the only level three hospital located in a rural state, most women were transferred or referred to our facility for COVID-19 care during pregnancy and delivered at their home facility. This possibly contributed to a loss of follow-up of many women regarding their pregnancy and fetal outcomes.
Studies regarding the impact of COVID-19 on the obstetric community are still forthcoming. We found that in our cohort of pregnant women, the Omicron pandemic wave had the mildest impact, and the Delta pandemic wave had the most adverse maternal and fetal outcomes. However, the severity of the wave did not lead to a significant difference in the development of PreE between COVID-19 pandemic waves. The improved outcomes reported in this study and others could be due to decreased virulence of the SARS-CoV-2 strains, vaccine developments, improved medical knowledge and management of the disease, and increased mobilization of efforts and resources to manage the virus better, such as the vaccine and social distancing measures. However, additional studies looking at individual and systemic functions and barriers would need to be evaluated. The current data allow for preparedness of COVID-19 pandemic waves in pregnant women by extrapolation of our data to similar strains the world may encounter in the future.
4. Materials and Methods
This is an Institutional Review Board-approved (IRB 2020-0134) retrospective cohort study conducted at a single center, at the University of Mississippi Medical Center (UMMC) in Jackson, MS. Women who presented to the UMMC in either the outpatient or inpatient setting who had a positive diagnosis or history of COVID-19 during pregnancy were entered into the IRB-approved COVID-19 pregnancy study.
4.1. Inclusion Criteria and Data Extraction
Any pregnant woman, regardless of maternal age, who tested or reported being positive for COVID-19, which was able to be confirmed in the electronic medical record, was included in the study. Any person not meeting the inclusion criteria was excluded. A partial waiver of HIPAA consent was approved in the IRB which allowed for the screening of all pregnant patients at the UMMC for inclusion/exclusion. Electronic medical records of pregnant women who tested positive for SARS-CoV-2 by nasopharyngeal swab from 17 April 2020 to 6 February 2022 were reviewed for inclusion in the COVID-19 pregnancy study. For all eligible women, data from the electronic medical records (EPIC) were abstracted and entered into a secure database using REDCap, Research Electronic Data Capture [29]. There was no documentation of any study participant having multiple cases of COVID-19 during the study time period.
Women were categorized into COVID-19 pandemic waves based on the date of their positive COVID-19 test and the predominant COVID-19 pandemic wave at that time as outlined by the Mississippi State Department of Health (Alpha < 1 July 2021; Delta 1 July 2021–2024 December 2021; Omicron beginning 24 December 2021). The days between COVID-19 infection and the end of pregnancy were determined by the difference in the date of a positive COVID diagnosis and the end of pregnancy. Electronic medical records were reviewed for general demographics; past and current medical history; COVID-19 severity as determined by the National Institute of Health’s Clinical Spectrum of SARS-CoV-2 Infection [30]; the patient’s course and treatments; gestational age at delivery; obstetrical complications such as preterm birth, PreE, and diagnoses of fetal growth restriction, stillbirth, and neonatal death; birthweight; and length of NICU stay for admitted neonates. All obstetrical complications were recorded as listed in the discharge summary. For cases when there were conflicting complications (i.e., PreE vs. superimposed PreE), adjudication was made based on a thorough review of the notes in the medical record and guidelines defined by the American College of Obstetrics and Gynecology by a trained Maternal Fetal Medicine Fellow (G.O.). COVID-19 vaccination status was based on self-reported patient information and information collected from the Mississippi Immunization Information Exchange.
4.2. Statistical Analysis
A variety of different statistical methods were used to assess our data. We used Chi-squared, Fisher’s exact, Kruskal–Wallis, and Wilcoxon Two-Sample tests for categorical data. The median (interquartile range) was used to represent continuous variables. An Analysis of Variance (ANOVA) test was used to compare the mean of different groups. Univariable and multivariable logistic regression and odds ratio estimates were used to assess associations between categories and pandemic waves. Participants (n = 76) with missing delivery records were not included in the delivery and infant analyses. Missing data were excluded from the analysis such that pairwise deletion of missing observations was utilized for statistical modeling. Statistical modeling and testing were completed using SAS version 9.4 (SAS Institute Inc., Cary, NC, USA) and GraphPad Prism version 10.0. A two-sided p < 0.05 was used to indicate statistically significant results.
Supplementary Materials
The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/women4040035/s1, Table S1: General Demographics; Table S2: Sociodemographic and clinical characteristics for women who had delivery records available for data abstraction vs. those who did not; Table S3: Number of women in each category of comparisons of delivery days between and within pandemic waves; Table S4: Number of women in each category of comparisons for COVID-19 severity between and within pandemic waves.
Author Contributions
Conceptualization, R.M. and K.W.; methodology, R.M.; validation, R.M. and K.W.; formal analysis, G.O. and W.K.Y.; investigation, G.O., data curation, G.O., K.W. and A.S.Z.M.; writing—original draft preparation, G.O.; writing—review and editing, K.W., W.K.Y., A.S.Z.M. and R.M.; supervision, K.W. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of the University of Mississippi Medical Center (IRB 2020-0134, approved 3 June 2020).
Informed Consent Statement
Patient consent was waived as all data were collected retrospectively via an electronic medical record review.
Data Availability Statement
Data are contained within the article or Supplementary Materials.
Conflicts of Interest
The authors declare no conflicts of interest.
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Figure 1.
Comparisons of delivery days (A) and COVID-19 severity between and within pandemic waves (B). Summary statistics for (A) and (B) can be found in Tables S3 and S4, respectively.
Figure 1.
Comparisons of delivery days (A) and COVID-19 severity between and within pandemic waves (B). Summary statistics for (A) and (B) can be found in Tables S3 and S4, respectively.
Table 1.
Mean general demographics for women diagnosed with COVID-19. Summary statistics and data expressed as mean ± s.d. or as n (%).
Table 1.
Mean general demographics for women diagnosed with COVID-19. Summary statistics and data expressed as mean ± s.d. or as n (%).
| Characteristic | Alpha (n = 136) | Delta (n = 95) | Omicron (n = 143) | p Value |
|---|---|---|---|---|
| Maternal Age at Diagnosis (years) | 28.42 ± 5.86 | 27.46 ± 6.49 | 27.12 ± 5.63 | 0.39 |
| Gestational Age at Diagnosis (weeks) | 27.44 ± 9.59 | 30.05 ± 7.05 | 30.03 ± 9.56 | 0.05 |
| Gravida | 2.91 ± 1.84 | 3.34 ± 2.36 | 3.24 ± 2.03 | 0.29 |
| BMI (kg/m2) at Diagnosis | 0.04 | |||
| Underweight (<18.5) | 0/136 (0) | 3/95 (3.16) | 0/143 (0) | |
| Normal (18.5–24.9) | 14/136 (10.3) | 8/95 (8.42) | 19/143 (13.23) | |
| 88Overweight (25.0–29.9) | 35/136 (25.73) | 20/95 (21.05) | 38/143 (26.57) | |
| Class I Obesity (30.0–34.9) | 36/136 (26.47) | 19/95 (20.00) | 29/143 (20.28) | |
| Class II Obesity (35.0–39.9) | 26/136 (19.12) | 18/95 (18.95) | 27/143 (18.88) | |
| Class III Obesity (40 and Above) | 25/136 (18.38) | 27/95 (28.42) | 30/143 (21.04) | |
| Maternal Race | 0.31 | |||
| Black | 78/136 (56.34) | 59/95 (62.11) | 101/143 (70.68) | |
| White | 34/136 (25.00) | 21/95 (22.11) | 18/143 (12.56) | |
| Hispanic | 20/136 (14.71) | 12/95 (12.63) | 20/143 (13.98) | |
| Asian | 1/136 (0.74) | 0/95 (0) | 1/143 (0.69) | |
| NAI/PI/Hawaiian | 0/136 (0) | 0/95 (0) | 1/143 (0.69) | |
| Other Race | 3/136 (2.21) | 3/95 (3.16) | 2/143 (1.40) | |
| Trimester of Diagnosis | 0.24 | |||
| First | 13/132 (9.83) | 4/93 (4.30%) | 12/143 (8.39%) | |
| Second | 46/132 (34.85) | 36/93 (38.71%) | 39/143 (27.27%) | |
| Third | 73/132 (55.30) | 53/93 (56.99%) | 92/143 (64.34%) | |
| COVID-19 Severity | 0.001 | |||
| Asymptomatic | 54/110 (49.1) | 30/86 (34.9) | 68/136 (50) | |
| Mild | 37/110 (33.6) | 35/86 (40.1) | 63/136 (46.3) | |
| Moderate | 4/110 (3.6) | 10/86 (11.6) | 3/136 (2.2) | |
| Severe | 10/110 (9.1) | 4/86 (4.7) | 2/136 (1.5) | |
| Critical | 5/110 (4.6) | 7/86 (8.1) | 0/136 (0) | |
| Development of PreE | 0.47 | |||
| Yes | 12/97 (12.4) | 14/77 (18.2) | 23/124 (18.5) | |
| No | 85/97 (87.6) | 63/77 (81.8) | 101/124 (81.5) | |
| Gestational Age at Delivery (weeks; n = 298) | 36.54 ± 4.15 | 35.62 ± 4.31 | 37.28 ± 2.69 | 0.008 |
| Preterm birth | 0.08 | |||
| Yes | 36/97 (37.1) | 27/77 (35.1) | 30/124 (24.2) | |
| No | 61/97 (62.9) | 50/77 (64.9) | 94/124 (75.8) | |
| Infant Birthweight (grams) | 2861.72 ± 838.64 | 2699.38 ± 882.72 | 2946.73 ± 623.90 | 0.09 |
| COVID-19 Vaccination | 0.76 | |||
| Not Applicable | 56/136 (41.18) | 0/95 (0) | 0/143 (0) | |
| Unknown | 74/136 (54.42) | 90/95 (94.74) | 97/143 (67.83) | |
| At Least 1 Shot | 6/136 (4.4) | 5/95 (5.26) | 46/143 (32.17) |
Abbreviations: BMI—body mass index; NAI—Native American Indian; PI—Pacific Islander; PreE—preeclampsia. Other race refers to a racial group not listed in the table.
Table 2.
Complications at delivery among women delivering within the different COVID-19 pandemic waves. Summary statistics and data represented as n (%).
Table 2.
Complications at delivery among women delivering within the different COVID-19 pandemic waves. Summary statistics and data represented as n (%).
| Complication at Delivery | Alpha (n = 97) | Delta (n = 77) | Omicron (n = 124) | p Value |
|---|---|---|---|---|
| 0.36 | ||||
| None | 70/97 (72.2) | 58/77 (75.3) | 97/124 (78.2) | |
| Postpartum Hemorrhage | 10/97 (10.3) | 4/77 (5.2) | 8/124 (6.5) | |
| Placental Abruption | 1/97 (1.0) | 2/77 (2.6) | 1/124 (0.8) | |
| PPROM | 2/97 (2.1) | 3/77 (3.9) | 9/124 (7.3) | |
| Other | 12/97 (12.4) | 7/77 (9.1) | 6/124 (4.8) | |
| Multiple | 2/97 (2.1) | 3/77 (3.9) | 3/124 (2.4) |
Other: shoulder dystocia, elevated postpartum blood pressure, breech delivery, placenta Previa. Multiple—more than one complication.
Table 3.
Data are represented as mean ± s.d. or n (%). Statistics were not calculated between the Alpha and Delta pandemic waves due to the low number of infant deaths in the Delta pandemic wave.
Table 3.
Data are represented as mean ± s.d. or n (%). Statistics were not calculated between the Alpha and Delta pandemic waves due to the low number of infant deaths in the Delta pandemic wave.
| Maternal Deaths | |||
|---|---|---|---|
| Alpha (n = 5) | Delta (n = 6) | p Value | |
| Maternal age at diagnosis (years) | 26.60 ± 2.88 | 34.00 ± 5.29 | 0.02 |
| Maternal race | 1 | ||
| Black | 4/5 (80) | 3/6 (50) | |
| Hispanic | 0/5 (0) | 2/6 (33.3) | |
| White | 1/5 (20) | 1/6 (16.7) | |
| BMI at diagnosis (kg/m2) | 42.31 ± 11.01 | 44.24 ± 18.57 | 0.84 |
| Gestational age at diagnosis (weeks) | 23.28 ± 11.88 | 27.18 ± 5.24 | 0.48 |
| Maternal comorbidities | |||
| Diabetes | 2/5 (40) | 2/6 (33.3) | 1 |
| Chronic hypertension | 2/5 (40) | 2/6 (33.3) | 1 |
| COVID-19 severity classification range | 0.45 | ||
| Asymptomatic/mild | 1/5 (20) | 0/6 (0) | |
| Moderate | 0/5 (0) | 0/6 (0) | |
| Severe/critical | 4/5 (80) | 6/6 (100) | |
| Hospital length of stay (days) | 19.80 ± 29.47 | 17.33 ± 12.36 | 0.86 |
| Gestational age at delivery (weeks) | 37.03 ± 2.64 | 28.08 ± 4.63 | 0.009 |
| Average infant birthweight (grams) | 2680 ± 489.1 | 972 ± 358.5 | 0.0005 |
| Infant Deaths | |||
| Alpha (n = 6) | Delta (n = 2) | ||
| Maternal age at diagnosis (years) | 31.83 ± 4.54 | 34.00 ± 4.24 | - |
| Maternal race | - | ||
| Black | 2/6 (33.3) | 2/2 (100) | |
| Hispanic | 2/6 (33.3) | 0/2 (0) | |
| White | 2/6 (33.3) | 0/2 (0) | |
| Gestational age at diagnosis (weeks) | 26.02 ± 5.91 | 32.90 ± 9.19 | - |
| BMI at diagnosis (kg/m2) | 40.72 ± 14.94 | 48.53 ± 13.79 | - |
| Maternal comorbidities | - | ||
| Diabetes | 0/6 (0) | 1/2 (50) | |
| Chronic hypertension | 3/6 (50) | 1/2 (50) | |
| COVID-19 severity classification range | - | ||
| Asymptomatic/mild | 5/6 (83.3) | 2/2 (100) | |
| Moderate | 0/6 (0) | 0/2 (0) | |
| Severe/critical | 1/6 (16.7) | 0/2 (0) | |
| Gestational age at delivery (weeks) | 32.87 ± 5.24 | 33.40 ± 9.62 | - |
| Preterm birth | - | ||
| Yes | 4/6 (66.7) | 1/2 (50) | |
| No | 2/6 (33.3) | 1/2 (50) | |
| Intrauterine growth restriction | - | ||
| Yes | 5/6 (83.3) | 1/2 (50) | |
| No | 1/6 (16.7) | 1/2 (50) | |
| Average infant birthweight (grams) | 1745 ± 911.5 | 1782 ± 1813 | - |
| Infant gender | - | ||
| Male sex | 4/6 (66.7) | 1/2 (50) | |
| Female sex | 2/6 (33.3) | 1/2 (50) | |
| NIUC admission | - | ||
| Not applicable | 2/6 (33.3) | 1/2 (50) | |
| Yes | 4/6 (66.7) | 1/2 (50) | |
| Length of stay (days) | 29.75 ± 39.84 | 167 | - |
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Ohaegbulam, G.; Wallace, K.; Yimer, W.K.; Moustafa, A.S.Z.; Morris, R. The Impact of COVID-19 Pandemic Waves on Maternal Health and Infant Outcomes—A Retrospective Cohort Study. Women 2024, 4, 469-479. https://doi.org/10.3390/women4040035
AMA Style
Ohaegbulam G, Wallace K, Yimer WK, Moustafa ASZ, Morris R. The Impact of COVID-19 Pandemic Waves on Maternal Health and Infant Outcomes—A Retrospective Cohort Study. Women. 2024; 4(4):469-479. https://doi.org/10.3390/women4040035
Chicago/Turabian StyleOhaegbulam, Gail, Kedra Wallace, Wondwosen K. Yimer, Ahmed S. Z. Moustafa, and Rachael Morris. 2024. "The Impact of COVID-19 Pandemic Waves on Maternal Health and Infant Outcomes—A Retrospective Cohort Study" Women 4, no. 4: 469-479. https://doi.org/10.3390/women4040035
APA StyleOhaegbulam, G., Wallace, K., Yimer, W. K., Moustafa, A. S. Z., & Morris, R. (2024). The Impact of COVID-19 Pandemic Waves on Maternal Health and Infant Outcomes—A Retrospective Cohort Study. Women, 4(4), 469-479. https://doi.org/10.3390/women4040035
