Influenza & COVID-19 Obstetric and Perinatal Epidemiology Study in India (ICOPE)

Influenza & COVID-19 Obstetric and Perinatal Epidemiology (ICOPE) Study in India

This study will be conducted as a prospective cohort study, enrolling all eligible women in their first trimester of pregnancy during a baseline visit during week 6-13 of pregnancy at Government Medical College Hospital, Nagpur. The Hospital provides primary, secondary, and tertiary care and the obstetric department delivers about 10,000 babies a year. The hypothesis is that co-infection of other respiratory viruses (ORV), particularly COVID-19 and Influenza increases the risk of adverse pregnancy outcomes in mothers and babies and could address the current standard of care in India to not vaccinate pregnant women during pregnancy, by either encouraging vaccination against both viruses before planning a pregnancy or during pregnancy based on global data supporting the safety of this strategy.

Study Overview

• Status: Recruiting
• Conditions: COVID-19; Influenza; SARS-COV-2 Infection; Infant Morbidity; Perinatal Morbidity; Other Respiratory Viruses
• Intervention / Treatment: Other: Exposures

Detailed Description

All pregnant women enrolled in the study will receive standard of care throughout their pregnancy, labor and delivery and post-partum to discharge. Wherever possible, study visits will coincide with regular antenatal (ANC) care and blood draws will be added to standard blood draws during ANC, labor and delivery and postpartum care. Women will be counselled about procedure to reduce the risk of acquiring ORV during pregnancy. Since this study is observational, we do not anticipate any specific safety concerns with study interviews and procedures, but the investigators will monitor potential adverse events to determine if they are likely or possibly study related.

PRIMARY OBJECTIVE: Determine the prevalence, incidence, and maximal severity of symptomatic or asymptomatic COVID-19 in pregnant women to day 42 postpartum/after miscarriage on maternal outcomes. Secondary analysis will evaluate whether influenza/Other Respiratory Viruses (ORV) infection or COVID-19 vaccination modifies or mediates this risk.

SECONDARY OBJECTIVE: Determine the effect of maternal COVID-19 infection on the fetus and/or neonate during pregnancy through day 7 of life. Secondary analysis will focus on whether influenza/ORV or vaccination modifies, and pre-term birth mediates this risk.

EXPLORATORY OBJECTIVE: Characterize patterns and trajectories of host response/ inflammatory biomarkers as potential mediators of COVID-19 ± Influenza and ORV infection on progression to severe illness in pregnant women/mothers admitted to Government Medical College hospital with COVID-19. Modifiers include COVID-19 , Influenza and other ORV vaccinations.

• Study Type: Observational
• Enrollment (Estimated): 10000

Contacts and Locations

• Study Contact: Name: Patricia Hibberd, MD PhD; Phone Number: 617-358-2046; Email: plh0@bu.edu
• Study Contact Backup: Name: Aboli Goghari, MPH; Phone Number: 617-358-2310; Email: agoghari@bu.edu

Study Locations

• India
  • Nagpur, India
    • Recruiting
    • Government. Medical College Hospital
    • Contact: Archana Patel, MD
• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02118
      • Recruiting
      • Boston University School of Public Health, Global Health
      • Contact: Patricia Hibberd, MD PhD; Email: plh0@bu.edu
      • Contact: Aboli Goghari, MPH; Email: agoghari@bu.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

The study population is pregnant women in their first trimester of pregnancy who present to the outpatient antenatal care clinic at Government Medical College Hospital in Nagpur, India. Women will be aged 18-50 and can be from any race or ethnic group.

Description

Inclusion Criteria:

Women aged 18 to 50 years registering for antenatal care (ANC) at Government Medical College Hospital (GMC) Nagpur, India

• Estimated Gestational Age at registration <14 weeks based on ultrasound report at the baseline study visit;
• Intends to receive pregnancy, labor and delivery and neonatal care at GMC;
• Plans to live within the city limits of Nagpur throughout their pregnancy and labor and delivery to facilitate access to GMC for evaluation of ILI and COVID-19 symptoms;
• Willing to be contacted two times per week by call or text for ILI/ COVID-19 symptom screening and return to GMC for evaluation and an NP swab/evaluation if symptoms are reported;
• Willing to take temperature with the provided digital thermometer, and maintain a symptom diary after training;
• Willing to provide information on pregnancy and neonatal outcomes if care occurs outside GMC;
• Willing to permit venous blood draws on at least 4 timepoints --1) Baseline study visit, 2)28-34 weeks, 3) 37 weeks - prior to delivery and 4) after delivery;
• Willing to permit blood draws if hospitalized at GMC for COVID-19 infection;
• Willing to consent to participate in the study

Exclusion Criteria:

• Anyone who is deemed to have limited decision-making capacity as defined by Boston University IRB i.e. Substantial impairment of cognitive functions (e.g. attention, comprehension, memory, and intellect), or conditions that might affect their cognitive functions.
• Anyone who is deemed to have limited capacity to consent as defined by Boston University Institutional Review Board (IRB) i.e. The ability to provide legally effective consent to enroll in a research study (AAHRPP definition).

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Influenza & COVID-19 Obstetric and Perinatal Epidemiology (ICOPE); Pregnant women in their first trimester of pregnancy who present to the outpatient antenatal care clinic at Government Medical College Hospital in Nagpur, India.	Other: Exposures; COVID-19, Influenza and ORV impact on the pregnant woman, her fetus and newborn

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Maternal composite adverse outcome variable	The maternal composite variable includes any of following 3 outcomes: Preterm labour, defined as hospitalization for the management of onset of labor before fetus age 37 weeks, regardless of when birth occurs;; Pre-eclampsia with severe features, defined as the new onset of systolic blood pressure >160 mm Hg and/or diastolic blood pressure >110 mm Hg and proteinuria (World Health Organization (WHO) definition);; Mortality at any time between enrolment and day 42 post-partum/after miscarriage.	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Perinatal composite adverse outcome variable	The perinatal adverse outcomes includes any of the following 3 outcomes: Preterm birth, defined as gestational age of <37 weeks at birth, based on gestational age dating by ultrasound obtained before study enrolment;; Neonatal critical illness, defined as any sign of critical illness in the newborn and/or continued hospitalization after day 7 of life;; Perinatal Mortality, defined as fetal mortality after week 20 of pregnancy through neonatal death by day 7 of life	1 year

Collaborators and Investigators

• Sponsor: Boston University
• Collaborators: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); Lata Medical Research Foundation, Nagpur
• Investigators: Principal Investigator: Patricia Hibberd, MD PhD, Boston University School of Public Health, Global Health; Principal Investigator: Archana Patel, MD, Lata Medical Research Foundation, Nagpur India

Study record dates

Study Major Dates

• Study Start (Actual): December 26, 2023
• Primary Completion (Estimated): June 1, 2028
• Study Completion (Estimated): June 1, 2028

Study Registration Dates

• First Submitted: December 12, 2023
• First Submitted That Met QC Criteria: December 12, 2023
• First Posted (Actual): December 13, 2023

Study Record Updates

• Last Update Posted (Actual): November 28, 2025
• Last Update Submitted That Met QC Criteria: November 26, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: Postpartum; Pregnant women; Antenatal care; Government Medical College Hospital, Nagpur, India; Covid-19 vaccination
• Additional Relevant MeSH Terms: Respiratory Tract Infections; Infections; Orthomyxoviridae Infections; RNA Virus Infections; Virus Diseases; Respiratory Tract Diseases; Lung Diseases; Pneumonia, Viral; Pneumonia; Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; COVID-19; Influenza, Human
• Other Study ID Numbers: H-43541; UG1HD078439 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No