Maternal Deaths from COVID-19 in Brazil: Increase during the Second Wave of the Pandemic

Abstract

Objective To compare death rates by COVID-19 between pregnant or postpartum and nonpregnant women during the first and second waves of the Brazilian pandemic.

Methods In the present population-based evaluation data from the Sistema de Informação da Vigilância Epidemiológica da Gripe (SIVEP-Gripe, in the Portuguese acronym), we included women with c (ARDS) by COVID-19: 47,768 in 2020 (4,853 obstetric versus 42,915 nonobstetric) and 66,689 in 2021 (5,208 obstetric versus 61,481 nonobstetric) and estimated the frequency of in-hospital death.

Results We identified 377 maternal deaths in 2020 (first wave) and 804 in 2021 (second wave). The death rate increased 2.0-fold for the obstetric (7.7 to 15.4%) and 1.6-fold for the nonobstetric groups (13.9 to 22.9%) from 2020 to 2021 (odds ratio [OR]: 0.52; 95% confidence interval [CI]: 0.47–0.58 in 2020 and OR: 0.61; 95%CI: 0.56–0.66 in 2021; p < 0.05). In women with comorbidities, the death rate increased 1.7-fold (13.3 to 23.3%) and 1.4-fold (22.8 to 31.4%) in the obstetric and nonobstetric groups, respectively (OR: 0.52; 95%CI: 0.44–0.61 in 2020 to OR: 0.66; 95%CI: 0.59–0.73 in 2021; p < 0.05). In women without comorbidities, the mortality rate was higher for nonobstetric (2.4 times; 6.6 to 15.7%) than for obstetric women (1.8 times; 5.5 to 10.1%; OR: 0.81; 95%CI: 0.69–0.95 in 2020 and OR: 0.60; 95%CI: 0.58–0.68 in 2021; p < 0.05).

Conclusion There was an increase in maternal deaths from COVID-19 in 2021 compared with 2020, especially in patients with comorbidities. Death rates were even higher in nonpregnant women, with or without comorbidities.

Resumo

Objetivo Comparar as taxas de mortalidade por COVID-19 entre gestantes ou puérperas e não gestantes durante a primeira e segunda ondas da pandemia brasileira.

Métodos Na presente avaliação dos dados do Sistema de Informação da Vigilância Epidemiológica da Gripe (SIVEP-Gripe), incluímos mulheres com síndrome respiratória aguda grave por COVID-19: 47.768 em 2020 (4.853 obstétricas versus 42.915 não obstétricas) e 66.689 em 2021 (5.208 obstétricas versus 61.481 não obstétricas) e estimamos a frequência de óbito intra-hospitalar.

Resultados Identificamos 377 óbitos maternos em 2020 e 804 em 2021. A taxa de mortalidade por COVID-19 aumentou 2,0 vezes no grupo obstétrico (de 7,7 para 15,4%) e 1,6 vezes no grupo não obstétrico (de 13,9 para 22,9%) de 2020 a 2021 (odds ratio [OR]: 0,52; intervalo de confiança [IC] 95%: 0,47–0,58 em 2020 e OR: 0,61; IC95%: 0,56–0,66 em 2021; p < 0,05). Em mulheres com comorbidades, a taxa de óbitos aumentou 1,7 vezes (de 13,3 para 23,3%) e 1,4 vezes (de 22,8 para 31,4%) para os grupos obstétricos e não obstétricos, respectivamente (OR: 0,52; IC95%: 0,44–0,61 em 2020 para OR: 0,66; IC95%: 0,59–0,73 em 2021; p < 0,05). Em mulheres sem comorbidades, a taxa de mortalidade foi maior para as não obstétricas (2,4 vezes; de 6,6% para 15,7%) do que para mulheres obstétricas (1,8 vezes; de 5,5 para 10,1%; OR: 0,81; IC95%: 0,69–0,95 em 2020 e OR: 0,60; IC95%: 0,58–0,68 em 2021; p < 0,05).

Conclusão Houve aumento das mortes maternas por COVID-19 em 2021 em relação a 2020, principalmente naquelas com comorbidades. As taxas de mortalidade foram ainda maiores em mulheres não grávidas, com ou sem comorbidades.

Keywords

COVID-19 - SARS-CoV-2 - coronavirus - pregnancy - acute respiratory distress syndrome - maternal death - maternal mortality - mortality rate - case-fatality

Palavras-chave

COVID-19 - SARS-CoV-2 - coronavírus - gestação - síndrome respiratória aguda grave - morte materna - mortalidade materna - taxa de mortalidade

Contributions

Scheler C. A. and Discacciati M. G.: conception and design, analysis and interpretation of data, writing of the manuscript, critical review of the intellectual content, final approval of the version to be published. Scheler C. and Discacciati M. contributed equally to the present paper. Vale D. and Surita F. G.: analysis and interpretation of data, writing of the manuscript, critical review of the intellectual content, final approval of the version to be published. Lajo G.: analysis and interpretation of data. Teixeira J.: conception and design, analysis and interpretation of data, writing of the manuscript, critical review of the intellectual content, final approval of the version to be published.

Publication History

Received: 21 February 2022

Accepted: 04 March 2022

Article published online:
01 June 2022

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