Abstract
Background
Monitoring the characteristics and associated factors for death among pregnant and postpartum women with COVID-19 is necessary. We investigated the clinical characteristics and risk factors associated with maternal deaths in a nationwide cohort of Brazil.
Methods
This was a population-based cohort of all pregnant and postpartum women hospitalised with COVID-19 notified to the Sistema de Informação de Vigilância Epidemiológica da Gripe of Brazil (SIVEP-Gripe), from February 2020 to September 2021. The primary outcome was time to in-hospital death, with risks factors analysed with univariable and multivariable Cox proportional hazards regression models.
Results
Cumulative observation time was 248 821 person-days from hospital admission to the end of follow-up for 15 105 individuals. There were 1858 deaths (12.3%) for a maternal mortality rate of 7.5 (95% CI 7.1–7.8) per 1000 patients-days. The cumulative mortality increased over time. Black/Brown ethnicity had a higher risk of death than women self-identifying as White. Women in the North, Northeast, Central-West and Southeast regions had higher risk of death than women in the South region. The characteristics independently associated with death were a postpartum status on admission (adjusted HR 1.4 [95%CI 1.2–1.6]), pre-existing clinical conditions (adjusted HRs 1.2 [95%CI 1.1–1.3] for one and 1.3 [95%CI 1.1–1.5] for two comorbidities), hypoxemia on admission (adjusted HR 1.2 [95%CI 1.1–1.4]) and requiring non-invasive (adjusted HR 2.6 [95%CI 2.1–3.3]) or invasive ventilatory support (adjusted HR 7.1 [95%CI 5.6–9.2]).
Conclusion
In Brazil, the in-hospital maternal mortality rate due to COVID-19 is high and the risk of death increases with the length of hospitalisation. Socio-demographic and biological factors are associated with an increased risk of maternal death. The presence of respiratory signs and symptoms should be considered as an early markers of disease severity and an adequate management is necessary. Our findings reinforce the need for vaccination of pregnant and postpartum women against COVID-19.
Keywords: COVID-19 Maternal Mortality Risk factors Cohort study Brazil
Contributor Information
Thayane Santos Siqueira, Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil; Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil.
de Edyankya Karolyne Gomes Souza, Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil; Department of Nursing, Federal University of Alagoas, Arapiraca, Brazil.
Paulo Ricardo Martins-Filho, Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil; Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Brazil.
José Rodrigo Santos Silva, Department of Statistics and Actuarial Sciences, Federal University of Sergipe, Aracaju, Brazil.
Ricardo Queiroz Gurgel, Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil; Division of Paediatrics, Department of Medicine, Federal University of Sergipe, Aracaju, Brazil.
Luis Eduardo Cuevas MTropMed, Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
Victor Santana Santos, Health Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil; Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil; Department of Nursing, Federal University of Alagoas, Arapiraca, Brazil; Health Science Graduate Program, Federal University of Alagoas, Maceió, Brazil.
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