Maternal and perinatal outcomes associated with COVID-19 among pregnant and postpartum women in public and private hospitals in Brazil

Abstract

Introduction Brazil is a country of continental dimensions with a great challenge to ascertain adequate healthcare throughout regions. The country registered increased numbers of maternal deaths and adverse perinatal outcomes in pregnant and postpartum women with COVID-19 infection, rising great concern. There is scarce data on findings among public versus private settings. Objective to compare maternal and perinatal outcomes in pregnant and postpartum women with SARS-CoV-2 infection, among admissions in public and private maternity hospitals during a period before vaccination. Study Design Secondary analysis of the REBRACO initiative, a national multicenter cohort study in Brazil, considering pregnant and postpartum women with suspected or confirmed COVID-19 infections (from February 2020 to February 2021) in 15 maternity centers (2 private and 13 public facilities). Sociodemographic and obstetric characteristics were compared according to the type of hospital care. In addition, clinical, laboratory findings and maternal and perinatal outcomes were compared in both groups. The prevalence ratio (PR) and its 95%CI for each predictor and outcome were calculated. Results Of 559 symptomatic cases tested, 289 confirmed COVID-19 cases were included, with 213 (72.7%) women in public hospitals and 76 (27.3%) women in private hospitals. SARS-CoV-2 infection frequency was not significantly different among groups. Women treated at public hospitals had lower schooling (p < 0.001), and half of them declared that their pregnancy was not planned. There were 13 maternal deaths among women treated at public services and no maternal deaths among pregnant women treated at private hospitals (p-value – 0,024). Pregnant women in public hospitals had higher rates of fever (p-value – 0,041), tachypnea (p-value – 0,003), abnormal laboratory findings in liver enzymes (p-value – 0,005), severe acute respiratory syndrome SARS (p-value 0.014) and their neonates presented more neonatal respiratory distress (p-value – 0,020). Conclusion Adverse maternal and perinatal outcomes were worse in the public hospital group with increased rates of severe acute respiratory syndrome and neonatal respiratory distress. The alarming difference between the number of deaths in patients treated in the public and private sector calls attention to the need to better understand the differences in access to health and other delays experienced by patients of different social levels.