Mortality in pregnancy and the postpartum period in women with severe acute respiratory distress syndrome related to COVID‐19 in Brazil, 2020

Abstract

Objective: To estimate fatality rates due to severe acute respiratory distress syndrome (ARDS) related to COVID-19 in Brazilian women, comparing pregnant and postpartum women with nonpregnant women. Methods:A cross-sectional study of 12 566 pregnant and postpartum women (obstetric group) and 90 025 nonpregnant women (nonobstetric group) aged 15-49 years reported with severe ARDS in 2020. The Brazilian ARDS Surveillance System was used to compare the outcome (death or cure) between the groups, considering age, race, or comorbidities. Results:The mortality rate related to ARDS/COVID-19 in the obstetric group was 7.8% (377/4853) compared with 13.9% (5946/42 915) in the nonobstetric group.Comorbidity was associated with increased fatality cases for both groups, but higher in the nonobstetric group (22.8% vs 13.3%). In the obstetric group, deaths related to COVID-19 were concentrated in the third trimester or postpartum period. If comorbidity was present, deaths by COVID-19 were 4.4 times higher than ARDS due to other etiologies, and twice higher in women who self-reported as black (13.7%) than white women (6.7%). Considering ADRS etiology, deaths by COVID-19 were 3.4-6.7 times higher than any other etiology. Conclusion:ARDS related to COVID-19 in obstetric patients was an important factor for worse clinical outcomes, with 3-6 times higher death rates than other ARDS etiologies. Pregnant and postpartum women with severe ARDS related to COVID-19 had a lower fatality rate than nonpregnant women, even with associated comorbidity.

Factors associated with vaccination against Covid-19 in pregnant and hospitalized postpartum women: A retrospective cohort study

“…Studies published in the context of the Covid-19 pandemic show increased racial inequality, since the black population, in particular, is at greater risk of disparities in access to health services [ 23 ], which has resulted in a higher proportion of cases and deaths from Covid-19 in this population, a problem already evidenced in Brazil and the United States [ 24 – 27 ]. With regard to the obstetric population, a study carried out in 2020 with 12,556 pregnant and postpartum women with SARS due to Covid-19 in Brazil, showed that deaths from Covid-19 were twice as high in women who called themselves black, when compared to white women [ 28 ]. It is known that in Brazil, racial disparities in maternal mortality existed even before the pandemic, when the number of deaths among black, brown and indigenous women was disproportionately higher [ 29 ].…”

Maternal and Perinatal Outcomes of Pregnant Women with SARS-CoV-2 infection: a single center experience

“…lowvs high-income countries, and by the study design, e.g. study inclusion criteria [60][61][62][63][64]. In the WAPM study, the maternal mortality rate was reported to be 0.8% [33].…”

Perfil epidemiológico e obstétrico das mulheres com suspeita ou infecção pelo SARS-CoV-2 em uma maternidade pública

“…Estudos recentes mostraram que gestantes e puérperas infectadas estão mais propensas a necessitar de cuidados intensivos e parte delas, de suporte ventilatório invasivo, levando os pesquisadores a afirmarem que as gestantes podem ter mais complicações do que as não gestantes (Takemoto et al, 2020). Portanto, atenção especial deve ser dada a esse grupo, em virtude de maior morbimortalidade materna, sobretudo no Brasil (Takemoto et al, 2020;Scheler et al, 2021) Tem-se como lacuna do conhecimento a relativa escassez de estudos epidemiológicos em obstetrícia durante a pandemia. Assim, verificou-se a importância de analisar o perfil epidemiológico e obstétrico de mulheres infectadas pelo vírus.…”