Maternal Deaths from COVID-19 in Brazil: Increase during the Second Wave of the Pandemic

Abstract

Objective To compare death rates by COVID-19 between pregnant or postpartum and nonpregnant women during the first and second waves of the Brazilian pandemic.

Methods In the present population-based evaluation data from the Sistema de Informação da Vigilância Epidemiológica da Gripe (SIVEP-Gripe, in the Portuguese acronym), we included women with c (ARDS) by COVID-19: 47,768 in 2020 (4,853 obstetric versus 42,915 nonobstetric) and 66,689 in 2021 (5,208 obstetric versus 61,481 nonobstetric) and estimated the frequency of in-hospital death.

Results We identified 377 maternal deaths in 2020 (first wave) and 804 in 2021 (second wave). The death rate increased 2.0-fold for the obstetric (7.7 to 15.4%) and 1.6-fold for the nonobstetric groups (13.9 to 22.9%) from 2020 to 2021 (odds ratio [OR]: 0.52; 95% confidence interval [CI]: 0.47–0.58 in 2020 and OR: 0.61; 95%CI: 0.56–0.66 in 2021; p < 0.05). In women with comorbidities, the death rate increased 1.7-fold (13.3 to 23.3%) and 1.4-fold (22.8 to 31.4%) in the obstetric and nonobstetric groups, respectively (OR: 0.52; 95%CI: 0.44–0.61 in 2020 to OR: 0.66; 95%CI: 0.59–0.73 in 2021; p < 0.05). In women without comorbidities, the mortality rate was higher for nonobstetric (2.4 times; 6.6 to 15.7%) than for obstetric women (1.8 times; 5.5 to 10.1%; OR: 0.81; 95%CI: 0.69–0.95 in 2020 and OR: 0.60; 95%CI: 0.58–0.68 in 2021; p < 0.05).

Conclusion There was an increase in maternal deaths from COVID-19 in 2021 compared with 2020, especially in patients with comorbidities. Death rates were even higher in nonpregnant women, with or without comorbidities.

Resumo

Objetivo Comparar as taxas de mortalidade por COVID-19 entre gestantes ou puérperas e não gestantes durante a primeira e segunda ondas da pandemia brasileira.

Métodos Na presente avaliação dos dados do Sistema de Informação da Vigilância Epidemiológica da Gripe (SIVEP-Gripe), incluímos mulheres com síndrome respiratória aguda grave por COVID-19: 47.768 em 2020 (4.853 obstétricas versus 42.915 não obstétricas) e 66.689 em 2021 (5.208 obstétricas versus 61.481 não obstétricas) e estimamos a frequência de óbito intra-hospitalar.

Resultados Identificamos 377 óbitos maternos em 2020 e 804 em 2021. A taxa de mortalidade por COVID-19 aumentou 2,0 vezes no grupo obstétrico (de 7,7 para 15,4%) e 1,6 vezes no grupo não obstétrico (de 13,9 para 22,9%) de 2020 a 2021 (odds ratio [OR]: 0,52; intervalo de confiança [IC] 95%: 0,47–0,58 em 2020 e OR: 0,61; IC95%: 0,56–0,66 em 2021; p < 0,05). Em mulheres com comorbidades, a taxa de óbitos aumentou 1,7 vezes (de 13,3 para 23,3%) e 1,4 vezes (de 22,8 para 31,4%) para os grupos obstétricos e não obstétricos, respectivamente (OR: 0,52; IC95%: 0,44–0,61 em 2020 para OR: 0,66; IC95%: 0,59–0,73 em 2021; p < 0,05). Em mulheres sem comorbidades, a taxa de mortalidade foi maior para as não obstétricas (2,4 vezes; de 6,6% para 15,7%) do que para mulheres obstétricas (1,8 vezes; de 5,5 para 10,1%; OR: 0,81; IC95%: 0,69–0,95 em 2020 e OR: 0,60; IC95%: 0,58–0,68 em 2021; p < 0,05).

Conclusão Houve aumento das mortes maternas por COVID-19 em 2021 em relação a 2020, principalmente naquelas com comorbidades. As taxas de mortalidade foram ainda maiores em mulheres não grávidas, com ou sem comorbidades.

Keywords

COVID-19 - SARS-CoV-2 - coronavirus - pregnancy - acute respiratory distress syndrome - maternal death - maternal mortality - mortality rate - case-fatality

Palavras-chave

COVID-19 - SARS-CoV-2 - coronavírus - gestação - síndrome respiratória aguda grave - morte materna - mortalidade materna - taxa de mortalidade

Contributions

Scheler C. A. and Discacciati M. G.: conception and design, analysis and interpretation of data, writing of the manuscript, critical review of the intellectual content, final approval of the version to be published. Scheler C. and Discacciati M. contributed equally to the present paper. Vale D. and Surita F. G.: analysis and interpretation of data, writing of the manuscript, critical review of the intellectual content, final approval of the version to be published. Lajo G.: analysis and interpretation of data. Teixeira J.: conception and design, analysis and interpretation of data, writing of the manuscript, critical review of the intellectual content, final approval of the version to be published.

Publication History

Received: 21 February 2022

Accepted: 04 March 2022

Article published online:
01 June 2022

• References

• 1 Ministério da Saúde.. Painel de casos de COVID-19 no Brasil [Internet]. 2021 [cited 2021 Dec 9]. Available from: https://covid.saude.gov.br
• 2 Pfitscher LC, Cecatti JG, Pacagnella RC, Haddad SM, Parpinelli MA, Souza JP. et al; Brazilian Network for Surveillance of Severe Maternal Morbidity Group. Severe maternal morbidity due to respiratory disease and impact of 2009 H1N1 influenza A pandemic in Brazil: results from a national multicenter cross-sectional study. BMC Infect Dis 2016; 16: 220
• 3 Cirelli JF, Surita FG, Costa ML, Parpinelli MA, Haddad SM, Cecatti JG. The burden of indirect causes of maternal morbidity and mortality in the process of obstetric transition: a cross-sectional multicenter study. Rev Bras Ginecol Obstet 2018; 40 (03) 106-114
• 4 Takemoto MLS, Menezes MO, Andreucci CB, Knobel R, Sousa LAR, Katz L. et al. Maternal mortality and COVID-19. J Matern Fetal Neonatal Med 2020; 16: 1-7
• 5 Takemoto M, Menezes MO, Andreucci CB, Knobel R, Katz L, Fonseca EB. et al; Brazilian Group for Studies of COVID-19 and Pregnancy. Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID-19 in Brazil: a surveillance database analysis. BJOG 2020; 127 (13) 1618-1626
• 6 Menezes MO, Takemoto MLS, Nakamura-Pereira M, Katz L, Amorim MMR, Salgado HO. et al; Brazilian Group of Studies for COVID-19, Pregnancy. Risk factors for adverse outcomes among pregnant and postpartum women with acute respiratory distress syndrome due to COVID-19 in Brazil. Int J Gynaecol Obstet 2020; 151 (03) 415-423
• 7 Hessami K, Homayoon N, Hashemi A, Vafaei H, Kasraeian M, Asadi N. COVID-19 and maternal, fetal and neonatal mortality: a systematic review. J Matern Fetal Neonatal Med 2020; 1-6
• 8 Ministério da Saúde.. Sistema de Informação da Vigilância Epidemiológica da gripe- SIVEP-GRIPE [Internet]. 2020 [cited 2021 May 15] Available from: http://sistemas.saude.rj.gov.br/tabnetbd/sivep_gripe/SIVEP_Gripe.pdf
• 9 Discacciati MG, Teixeira JC. Databank-obstetrics-COVID19-Brazil. Mendeley Data , version 2. 2021;
• 10 Discacciati MG. Databank-COVID19-preg_postpartum-2021-brasil-May2021. Mendeley Data , version 1. 2021;
• 11 Ministério da Saúde.. DATASUS. [SINASC: Brazilian Information System on Live Births] [Internet]. 2019 [cited 2021 Feb 2]. Portuguese. Available from: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sinasc/cnv/nvuf.def
• 12 Sutton D, Bertozzi-Villa C, Lasky J, Fuchs K, Friedman A. Outcomes and epidemiology of COVID-19 infection in the obstetric population. Semin Perinatol 2020; 44 (07) 151283
• 13 Heath PT, Le Doare K, Khalil A. Inclusion of pregnant women in COVID-19 vaccine development. Lancet Infect Dis 2020; 20 (09) 1007-1008
• 14 Breslin N, Baptiste C, Gyamfi-Bannerman C, Miller R, Martinez R, Bernstein K. et al. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM 2020; 2 (02) 100118
• 15 Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A. et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: The INTERCOVID Multinational Cohort Study. JAMA Pediatr 2021; 175 (08) 817-826
• 16 Knight M, Bunch K, Vousden N, Morris E, Simpson N, Gale C. et al; UK Obstetric Surveillance System SARS-CoV-2 Infection in Pregnancy Collaborative Group. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ 2020; 369: m2107
• 17 Khalil A, Kalafat E, Benlioglu C, O'Brien Pat, Morris E, Draycott T. et al. SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of clinical features and pregnancy outcomes. EClinicalMedicine 2020; 25: 100446
• 18 Faria NR, Mellan TA, Whittaker C, Claro IM, Candido DS, Mishra S. et al. Genomics and epidemiology of the P.1 SARS-CoV-2 lineage in Manaus, Brazil. Science 2021; 372 (6544): 815-821
• 19 Ministério da Saúde.. COVID-19 Vacinação Doses Aplicadas [Internet]. 2021 [cited 2021 Sep 7]. Available from: https://infoms.saude.gov.br/extensions/DEMAS_C19_Vacina_v2/DEMAS_C19_Vacina_v2.html
• 20 Brillo E, Tosto V, Gerli S, Buonomo E. COVID-19 vaccination in pregnancy and postpartum. J Matern Fetal Neonatal Med 2021; 1-20
• 21 Ministério da Saúde. Secretaria de Vigilância em Saúde.. Departamento de Imunização e Doenças Transmissíveis. Coordenação-Geral do Programa Nacional de Imunizações. Nota Técnica N° 467/2021-CGPNI/DEIDT/SVS/MS. Trata das orientações da vacinação dos grupos de pessoas com comorbidades, pessoas com deficiência permanente e gestantes e puérperas na Campanha Nacional de Vacinação contra a Covid-19 [Internet]. 2021 [cited 2021 Sep 7]. Available from: https://www.gov.br/saude/pt-br/media/pdf/2021/abril/27/nota-tecnica-467-2021-cgpni-deidt-svs-ms.pdf