A temporal study of Brazilian pregnant and postpartum women vulnerability for COVID-19: Characteristics, risk factors and outcomes

Abstract

Background During the COVID-19 second wave in Brazil, there has been a significant increase in the number of daily cases and deaths, including pregnant and postpartum women. We assess risk factors and outcomes for this priority group compared to the COVID-19 non-pregnant cohort in two epidemic waves. Methods In this retrospective cohort study we evaluated data of hospitalized pregnant, postpartum, and nonpregnant women aged 15-44 years, between epidemiological weeks 2020–8 and 2021–15, who tested positive for SARS-CoV-2, retrieved from the Influenza Epidemiological Surveillance Information System maintained by Ministry of Health of Brazil. We analysed in-hospital case fatality rate, crude and adjusted risk ratios on different outcomes aiming to compare data in two waves. Findings The study included pregnant women ( n = 7,132), postpartum women ( n = 2,405) and nonpregnant women ( n = 76,278) hospitalized with COVID-19. Case fatality rates of pregnant women were lower in both waves compared to nonpregnant women, but higher among postpartum women. The risk for admission to the intensive care unit and invasive mechanical ventilation requirement in both waves was significantly higher among postpartum women compared to nonpregnant women. Cardiac disease, diabetes, obesity, and asthma were the most frequent underlying medical conditions in all patient groups. These comorbidities were significantly less frequent among pregnant women. Interpretation Pregnant women with COVID-19 are at lower risk of poor outcome compared to nonpregnant women. On the other hand, postpartum women are at higher risk of adverse outcomes compared to pregnant and nonpregnant women, especially during the second wave. There was a significant increase in the in-hospital case fatality rate for all patient groups during the second wave of COVID-19. Funding This study was financed in part by CAPES, CNPq, FAPEMIG and UFSJ.

The impact of maternal SARS-CoV-2 infection and COVID-19 vaccination on maternal-fetal outcomes

“… [25] , [50] In addition, pregnant people were admitted to the ICU, mechanical ventilation, and died at higher rates during the second wave of COVID-19 (variant not specified) in Brazil. [52] Overall, there are relatively few large population cohort studies that examine the effects of different variants on maternal-fetal outcomes. Given the diversity of clinical outcomes between variants it may be important in future studies to consider the variant of infection a feature when examining and understanding relative risk of maternal-fetal outcomes following a maternal COIVD-19 infection.…”

Different impact of COVID‐19 on symptomatic pregnant and postpartum women in low‐income countries and low‐ and middle‐income countries

“…The data in the Malawian study was collected from 33 district and central hospitals throughout Malawi 2 . Nationwide data were collected from the Influenza Epidemiological Surveillance Information System (SIVEP‐Gripe) in Brazil 8 . The Turkish study was conducted in a tertiary care hospital specializing in COVID‐19 management 9 .…”

“…The objective of the study was to understand the impact of symptomatic COVID‐19 on pregnant and postpartum women in India and compare the results with the study reported from low‐resource settings in Malawi, Africa, 2 representing LICs. We also compared the case fatality rates (CFRs) from NH, India, with those from Brazil, 8 Turkey, 9 South Africa, 10 and Mexico, 11 representing LMICs. The data in the Malawian study was collected from 33 district and central hospitals throughout Malawi 2 .…”

“…2 Nationwide data were collected from the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) in Brazil. 8 The Turkish study was conducted in a tertiary care hospital specializing in COVID-19 management. 9 In the South African study, the data were collected from referral hospitals.…”

The impact of COVID-19 booster vaccination in the current pregnancy during the Omicron waves on maternal and perinatal outcomes: a multicentre observational study

“…Pregnant women are not more susceptible to SARS-CoV-2 infection, but they may face a more serious COVID-19, because of their unique physiological and immunological status [1].…”