Obstetric Observatory BRAZIL - COVID-19: 1031 maternal deaths because of COVID-19 and the unequal access to health care services

Francisco, Rossana Pulcineli Vieira; Lacerda, Lucas; Rodrigues, Agatha Sacramento

doi:10.6061/clinics/2021/e3120

Cited by 36 publications

(37 citation statements)

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“…Being able to compare the maternal population to other subgroups allowed us to observe that the effect of COVID-19 related mortality on pregnant and postpartum women was not equally present in the rest of the population during the 2021 pandemic year. This conclusion is different from other studies which analyze the maternal group independently [12][13][14][15][16][17][18][19][20][21][22][23][24]. Therefore, our study is unique in comparing symptoms, comorbidities, and outcomes between the maternal patients and the rest of the population and between the different pandemic years [16].…”

Section: Plos Onecontrasting

confidence: 61%

“…Initially, it had been thought that COVID-19 did not have a higher virulence in obstetric patients [2][3][4][5], however, recent studies have highlighted an elevated risk of complications in pregnant and postpartum women, with greater demand for admission into intensive care unit and need for mechanical ventilation [6][7][8][9][10][11][12]. The maternal mortality rate has had an increase of about 20% in Brazil during 2020, according to recent data [13,14]. In early 2021, the maternal mortality rate seems to be even higher, even though the knowledge about the disease and the treatment tools have evolved.…”

Section: Introductionmentioning

confidence: 99%

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Maternal mortality associated with COVID-19 in Brazil in 2020 and 2021: Comparison with non-pregnant women and men

2021

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Objective Mortality rates of pregnant and postpartum women grew in the second COVID-19 pandemic year. Our objective is to understand this phenomenon to avoid further deaths. Methods We collected data from SIVEP-Gripe, a nationwide Brazilian database containing surveillance data on all severe acute respiratory syndrome caused by COVID-19, between the first notified case (February 2020) until the 17th epidemiological week of 2021. We stratified patients into maternal women (which includes pregnant and postpartum women), non-maternal women and men and divided them by time of diagnosis in two periods: first period (February to December 2020) and second period (the first 17 epidemiological weeks of 2021 before pregnant and postpartum women were vaccinated). Results During the second period, all patients had higher risk of presenting severe COVID-19 cases, but the maternal population was at a higher risk of death (OR of 2.60 CI 95%: 2.28–2.97)–almost double the risk of the two other groups. Maternal women also had a higher risk of needing intensive care, intubation and of presenting desaturation in the second period. Importantly, maternal women presented fewer comorbidities than other patient groups, suggesting that pregnancy and postpartum can be an important risk factor associated with severe COVID-19. Conclusion Our results suggest that the Gama variant, which has been related to greater virulence, transmissibility and mortality rates leads to more severe cases of COVID-19 for pregnant and postpartum women.

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Section: Plos Onecontrasting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Maternal mortality associated with COVID-19 in Brazil in 2020 and 2021: Comparison with non-pregnant women and men

2021

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“… 2 , 6 , 37 In Brazil, pregnant women with COVID‐19 have consistently experienced high mortality rates since the pandemic's early phase. 14 , 16 Notably, pregnant women remain at risk compared with the general population regardless of the variant. 23 Furthermore, meta‐analyses indicate particular vulnerability of LMIC to COVID‐19−related adverse pregnancy/neonatal outcomes, likely reflecting healthcare access disparities.…”

Section: Discussionmentioning

confidence: 99%

“…In Brazil, 1031 maternal deaths occurred among the 11 247 cases of COVID‐19 severe acute respiratory syndrome in pregnant/postpartum women during March 1, 2020–May 5, 2021 (9.2% case‐fatality rate); case‐fatality rates were highest during the second trimester (11.4%) and the postpartum period (18.9%). 16 Among those who died, 22.5% and 33.5% did not have access to an ICU or invasive ventilator support, respectively. Alarmingly, maternal mortality among SARS‐CoV‐2−positive pregnant women rose dramatically in 2021 relative to 2020 in many Latin American countries, including Brazil (from 9.0 to 36.4 per 100 000 live new births), Paraguay (from .7 to 60.1), and Colombia (from 7.7 to 24.4), among others.…”

Section: Epidemiology and Outcomes Of Covid‐19 During Pregnancymentioning

confidence: 99%

COVID‐19 disease and vaccination in pregnant and lactating women

Sáfadi

Spinardi²,

Swerdlow

et al. 2022

American J Rep Immunol

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Background More than 325,000 cases of coronavirus disease 2019 (COVID‐19) have been reported among pregnant women in the Americas. Aims This review examines the impact of COVID‐19 in pregnant women and describes available evidence on the safety, effectiveness, and immune response(s) to vaccination among pregnant and lactating women. Content Multiple studies indicate that pregnant women are more susceptible to adverse COVID‐19 outcomes, including hospitalization, intensive care unit admission, and invasive ventilation than non‐pregnant women with COVID‐19. Furthermore, COVID‐19 in pregnancy is associated with adverse maternal and neonatal outcomes. Adverse COVID‐19 outcomes appear to disproportionately affect pregnant women from low‐ and middle‐income countries, likely reflecting inequities in access to quality healthcare. Despite the absence of safety and efficacy data from randomized clinical trials in this subpopulation, observational studies and data from pregnancy registries thus far have demonstrated that vaccination of pregnant or lactating women against COVID‐19 is safe, effective, and results in robust immune responses including transfer of antibodies to the newborn via the placenta and breast milk, respectively. Implications These data support vaccination recommendations intending to help protect these vulnerable individuals against COVID‐19 and its sequelae. Randomized clinical studies will further evaluate the safety and immunogenicity of COVID‐19 vaccines in these populations. This review examines the impact of COVID‐19 in pregnant women and describes available evidence on the safety, effectiveness, and immune response(s) to vaccination among pregnant and lactating women.

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“…The coronavirus disease 2019 (COVID-19) pandemic has had deleterious effects among the obstetric population [ 1 , 2 , 3 , 4 , 5 ], especially in low- and middle-income countries. In Brazil, a total of 1511 maternal deaths were documented in 2021, corresponding to a 329% increase from figures in 2020 [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 Vaccines Confer Protection in Hospitalized Pregnant and Postpartum Women with Severe COVID-19: A Retrospective Cohort Study

et al. 2022

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The coronavirus disease 2019 (COVID-19) pandemic has had deleterious effects among the obstetric population. Pregnant and postpartum women constitute a high-risk group for severe COVID-19. Vaccination reduces the risk of infection, but it is not known whether women who become infected despite vaccination have a milder course of disease than those who had not been vaccinated. This retrospective cohort study evaluated whether vaccination reduces the severity of COVID-19 infection, as measured by severe maternal morbidity and mortality among hospitalized pregnant and postpartum individuals. A total of 2284 pregnant and postpartum women hospitalized with severe COVID-19 were included. Those who did and who did not receive COVID-19 vaccination were compared. The rates of intensive care unit admission, intubation, and mortality were significantly lower among subjects in the vaccinated group (p < 0.001, p < 0.001 and p < 0.001, respectively). The numbers of patients who needed to be vaccinated to avoid one case of intensive care unit admission, intubation, or death due to COVID-19 were 7, 7, and 9, respectively. The COVID-19 vaccine offers protective effects against intensive care unit admission, intubation, and death in hospitalized pregnant and postpartum women with severe SARS-CoV-2-induced SARS.

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Obstetric Observatory BRAZIL - COVID-19: 1031 maternal deaths because of COVID-19 and the unequal access to health care services

Cited by 36 publications

References 1 publication

Maternal mortality associated with COVID-19 in Brazil in 2020 and 2021: Comparison with non-pregnant women and men

Maternal mortality associated with COVID-19 in Brazil in 2020 and 2021: Comparison with non-pregnant women and men

COVID‐19 disease and vaccination in pregnant and lactating women

COVID-19 Vaccines Confer Protection in Hospitalized Pregnant and Postpartum Women with Severe COVID-19: A Retrospective Cohort Study

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