Impact of the COVID-19 Pandemic on Births, Vaginal Deliveries, Cesarian Sections, and Maternal Mortality in a Brazilian Metropolitan Area: A Time-Series Cohort Study

Abstract

The COVID-19 pandemic posed a worldwide challenge, leading to radical changes in healthcare. The primary objective of the study was to assess the impact of the COVID-19 pandemic on birth, vaginal delivery, and cesarian section (c-section) rates. The secondary objective was to compare the maternal mortality before and after the pandemic. Patients and Methods: Time-series cohort study including data of all women admitted for childbirth (vaginal delivery or c-section) at the maternities in the Public Health System of Federal District, Brazil, between March 2018 and February 2022, using data extracted from the Hospital Information System of Brazilian Ministry of Health (SIH/DATASUS) on September 30, 2022. Causal impact analysis was used to evaluate the impact of COVID-19 on birth, vaginal delivery, and c-section using the CausalImpact R package, and a propensity score matching was used to evaluate the effect on maternal mortality rate using the Easy R (EZR) software. Results: There were 150,617 births, and considering total births, the effect of the COVID-19 pandemic was not statistically significant (absolute effect per week: 5.5, 95% CI: −24.0−33.4). However, there was an increase in c-sections after COVID-19 (absolute effect per week: 18.1; 95% CI: 11.9−23.9). After propensity score matching, the COVID-19 period was associated with increased maternal mortality (OR: 3.22, 95% CI: 1.53−6.81). The e-value of the adjusted OR for the association between the post-COVID-19 period and maternal mortality was 5.89, with a 95% CI: 2.43, suggesting that unmeasured confounders were unlikely to explain the entirety of the effect. Conclusion: Our study revealed a rise in c-sections and maternal mortality during the COVID-19 pandemic, possibly due to disruptions in maternal care. These findings highlight that implementing effective strategies to protect maternal health in times of crisis and improve outcomes for mothers and newborns is crucial.

Impact of the COVID-19 Pandemic on Elective and Emergency Surgeries, and Postoperative Mortality in a Brazilian Metropolitan Area: A Time-Series Cohort Study

“…Causal impact analysis considers various factors, including seasonality, by modeling the pre-intervention period with a Bayesian structural time series model, capturing seasonal components, trends, and other time-varying covariates and patterns in the model. [25][26][27] As a control variable in the model, the causal impact analysis of the COVID-19 pandemic on elective, emergency, and overall surgeries, as well as mortality, was adjusted for the estimated population of the FD on each epidemiological week.…”

“…Therefore, the SIH/DATASUS is extensively utilized in epidemiological studies in Brazil. [23][24][25] The variables collected from the SIH/DATASUS were age, sex, type of surgery (emergency or elective), site of surgery (digestive, orthopedic/trauma, gynecological/mammary, renal/urinary tract, skin/soft tissue, head/neck, neurological, thoracic, cardiovascular, transplant, and endocrine), admission and discharge date, hospital length-of-stay (LOS), and discharge status (survivor or non-survivor).…”