Worldwide maternal deaths due to COVID‐19: A brief review

Nakamura‐Pereira, Marcos; Andreucci, Carla Betina; Menezes, Mariane de Oliveira; Knobel, Roxana; Takemoto, Maíra Libertad Soligo

doi:10.1002/ijgo.13328

Cited by 46 publications

(46 citation statements)

References 9 publications

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“…The COVID-19 pandemic inflicted an overwhelming burden upon the Brazilian obstetric population 1,2 . It is estimated that it has already been responsible for a 20% increase in maternal mortality rate in the country in 2020 3 .…”

Section: Tablementioning

confidence: 99%

Higher case fatality rate among obstetric patients with COVID-19 in the second year of pandemic in Brazil: do new genetic variants play a role?

Takemoto

Nakamura‐Pereira

et al. 2021

Preprint

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Background: In Brazil, a 20% increase in maternal mortality rate due to COVID-19 is projected for 2020. On January 4, 2021, the P.1 SARS-CoV-2 genetic variant was firstly identified in the country and recent data has indicated an association with higher hospitalization rates and mortality. The impact of P.1 variant in the obstetric population remains unclear. Methods: We carried out a preliminary analysis of sociodemographic and clinical characteristics of COVID-19 confirmed maternal deaths (between 10-50 years old) comparing cases reported to the Brazilian official severe acute respiratory syndrome (SARS) surveillance system (SS) in 2020 with those from 2021 (until April 12, 2021). This preliminary analysis employed methods described in previous reports from our group. Results: 803 maternal deaths out of 8,248 COVID-19 maternal SARS cases with a recorded outcome were reported to the SARS-SS since March 2020. Case fatality rate was significantly higher in 2021 (15.6% vs 7.4%). The first three months of 2021 already account for 46.2% of all deaths occurred in the 13-months analysed period. COVID-19 fatal cases from 2021 had a lower proportion of at least one risk factor or comorbidity as compared to 2020 but had a higher frequency of obesity. There were no significant differences in terms of age, type of residence area (urban, rural, or peri-urban), type of funding of the notification unit (public vs. private), COVID-19 diagnostic criteria, pregnancy status (pregnancy or postpartum), cardiovascular disease or diabetes. The proportion of hospitalization, ICU admission, and respiratory support before death was also not significantly different. Conclusion: Case fatality rate was increased in the three first months of 2021 when compared to 2020. Once variables related to health care access and demographics are not significantly different and women seem to be healthier in the 2021 sample, such difference may be related to the circulation of more aggressive genetic variants in the country.

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Section: Tablementioning

confidence: 99%

Higher case fatality rate among obstetric patients with COVID-19 in the second year of pandemic in Brazil: do new genetic variants play a role?

Takemoto

Nakamura‐Pereira

et al. 2021

Preprint

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“…During pregnancy, there seem to be an increased risk of hospitalization, admission to the intensive care unit (ICU), and mechanical ventilation, although no increment in maternal mortality was observed outside Brazil. [6][7][8] On attempts to understand the Brazilian context, the Brazilian Group for Studies of COVID-19 and Pregnancy 4,5,[9][10][11] hypothesized that social risks and barriers to access to health care could play a role in maternal deaths. The aim of the present study was to analyze risk factors for adverse outcomes in pregnant and postpartum women with COVID-19 in Brazil, analyzing access to health care and social risk factors.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for adverse outcomes among pregnant and postpartum women with acute respiratory distress syndrome due to COVID‐19 in Brazil

Menezes

Takemoto

Nakamura‐Pereira

et al. 2020

Intl J Gynecology & Obste

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Objective: To evaluate whether clinical and social risk factors are associated with negative outcomes for COVID-19 disease among Brazilian pregnant and postpartum women. Methods: A secondary analysis was conducted of the official Acute Respiratory Syndrome Surveillance System database. Pregnant and postpartum women diagnosed with COVID-19 ARDS until July 14, 2020, were included. Adverse outcomes were a composite endpoint of either death, admission to the intensive care unit (ICU), or mechanical ventilation. Risk factors were examined by multiple logistic regression. Results: There were 2475 cases of COVID-19 ARDS. Among them, 23.8% of women had the composite endpoint and 8.2% died. Of those who died, 5.9% were not hospitalized, 39.7% were not admitted to the ICU, 42.6% did not receive mechanical ventilation, and 25.5% did not have access to respiratory support. Multivariate analysis showed that postpartum period, age over 35 years, obesity, diabetes, black ethnicity, living in a peri-urban area, no access to Family Health Strategy, or living more than 100 km from the notification hospital were associated with an increased risk of adverse outcomes. Conclusion: Clinical and social risk factors and barriers to access health care are associated with adverse outcomes among maternal cases of COVID-19 ARDS in Brazil.

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“…Table 2 shows total 9 cases of maternal mortality due to COVID-19 pneumonia recorded among 871 cases reflecting 0.01 (1.03%) prevalence of maternal mortality in our study. 6 of 9 cases (66%) (case 1, 3,4,7,8,9) were between 25 and 35 years of age which is a most common reproductive age. Normal BMI noted in 6 cases (case1, 3,5,6,7,9).…”

Section: Resultsmentioning

confidence: 99%

“…6 of 9 cases (66%) (case 1, 3,4,7,8,9) were between 25 and 35 years of age which is a most common reproductive age. Normal BMI noted in 6 cases (case1, 3,5,6,7,9). Most of mortality cases 5 out of 9 were from middle socioeconomic class.…”

Section: Resultsmentioning

confidence: 99%

Prevalence of Maternal Mortality and Clinical Course of Maternal Deaths in COVID-19 Pneumonia-A Cross-Sectional Study

Asalkar

Thakkarwad

Rumani

et al. 2021

J Obstet Gynecol India

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Introduction After initial studies suggested that pregnant women were not at a higher risk of complications due to COVID‐19 infection. Recent investigations from Sweden and the US have indicated that pregnant and postpartum women are at increased risk of severe complications associated with COVID‐19. This study aims to find out the prevalence of maternal mortality and the clinical course of maternal mortality cases due to COVID-19 pneumonia. Methodology A cross-sectional study was conducted from May 1st, 2020, to April 30th, 2021, at Postgraduate Institute and YCM Hospital Pimpri Pune (Maharashtra), a dedicated COVID hospital during COVID pandemic. During study period, all pregnant women who were diagnosed to have COVID-19 infection by RT PCR/Rapid Antigen Test were admitted and were enrolled for the study. Aim To audit the maternal mortality due to COVID-19 infection. Primary To estimate the prevalence of maternal mortality due to COVID-19 infection in obstetric patients. Secondary To systematically study and analyze the clinical course of infection in mothers who had mortality due to COVID-19 pneumonia. Data collected in standard format regarding Demography, clinical presentation, need for ICU/HDU, CXR findings, laboratory parameters and cases with maternal mortality were studied in detail to fulfill the study objectives. Results Among 871 COVID-19 cases diagnosed during pregnancy, nine patients had maternal mortality due to covid pneumonia. There was no obvious obstetric cause for mortality in these cases. The prevalence of maternal mortality was 0.01 (1.03%). Cases with maternal mortality were mostly in 3rd Trimester (5 of 9 cases) and presented with moderate to severe illness with breathlessness and myalgia in all 9 cases, cough and fever in 7 out of 9 cases, Tachypneoa was noted in all patients. Saturation below 90 in 6 cases and below 94 in 3 cases. Chest X-ray showed bilateral lung affection in all 9 cases. Leukocytosis with raised N:L ratio was predominantly seen, thrombocytopenia noted in 5 cases and elevated levels of acute phase reactants and inflammatory markers such as CRP, S. ferritin, ESR, LDH, D-dimer and S. fibrinogen was observed. None of the study participants received vaccine for COVID-19. Conclusions COVID-19 pneumonia is an additional toll for maternal mortality. Obstetric patients in 2nd and 3rd trimester having COVID-19 infection with late presentation to hospital, moderate to severe disease (RR > 30 min), with raised inflammatory markers (N:L ratio, CRP, Ferritin, d-Dimer, etc.) at presentation, having bilateral lung affection are at risk of poor maternal outcome.

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Worldwide maternal deaths due to COVID‐19: A brief review

Abstract: 160 maternal deaths due to COVID‐19 have been reported worldwide, most of them in middle‐income countries, representing a barrier to reducing maternal mortality.

Cited by 46 publications

References 9 publications

Higher case fatality rate among obstetric patients with COVID-19 in the second year of pandemic in Brazil: do new genetic variants play a role?

Higher case fatality rate among obstetric patients with COVID-19 in the second year of pandemic in Brazil: do new genetic variants play a role?

Risk factors for adverse outcomes among pregnant and postpartum women with acute respiratory distress syndrome due to COVID‐19 in Brazil

Prevalence of Maternal Mortality and Clinical Course of Maternal Deaths in COVID-19 Pneumonia-A Cross-Sectional Study

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