Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID‐19 in Brazil: a surveillance database analysis

Abstract

Objective To describe clinical characteristics of pregnant and postpartum women with severe COVID‐19 in Brazil and to examine risk factors for mortality. Design Cross‐sectional study based on secondary surveillance database analysis. Setting Nationwide Brazil. Population or sample 978 Brazilian pregnant and postpartum women notified as COVID‐19 Acute Respiratory Distress Syndrome (ARDS) cases with complete outcome (death or cure) up to 18 June 2020. Methods Data was abstracted from the Brazilian ARDS Surveillance System (ARDS‐SS) database. All eligible cases were included. Data on demographics, clinical characteristics, intensive care resources use and outcomes were collected. Risk factors for mortality were examined by multivariate logistic regression. Main outcome measures Case fatality rate. Results We identified 124 maternal deaths, corresponding to a case fatality rate among COVID‐19 ARDS cases in the obstetric population of 12.7%. At least one comorbidity was present in 48.4% of fatal cases compared with 24.9% in survival cases. Among women who died, 58.9% were admitted to ICU, 53.2% had invasive ventilation and 29.0% had no respiratory support. The multivariate logistic regression showed that the main risk factors for maternal death by COVID‐19 were being postpartum at onset of ARDS, obesity, diabetes and cardiovascular disease, whereas white ethnicity had a protective effect. Conclusions Negative outcomes of COVID‐19 in this population are affected by clinical characteristics but social determinants of health also seem to play a role. It is urgent to reinforce containment measures targeting the obstetric population and ensure high quality care throughout pregnancy and the postpartum period. Tweetable abstract A total of 124 COVID‐19 maternal deaths were identified in Brazil. Symptoms onset at postpartum and comorbidities are risk factors.

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

“…A worse prognosis of COVID‐19 disease in association with co‐morbidities was already established for the general population 15 . The increased risk of death during pregnancy when previous co‐morbidities are present was previously described by the study group, 13 as well as in Mexico (particularly diabetes) 16 . Obesity and age 35 years and above were also associated with increased admission to hospital for pregnant women with SARS‐CoV‐2 infection in the UK 17 .…”

“…Figure 1 displays the selection process and COVID‐19 definition criteria. The methods are described elsewhere 13 …”

Patient characteristics associated with SARS‐CoV‐2 infection in parturients admitted for labour and delivery in Massachusetts during the spring 2020 surge: A prospective cohort study

“…With over 1500 documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases per 100 000 residents at the end of June 2020, 1 women in the United States are not well characterised. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] Now that the height of the spring COVID-19 surge is past, after action reports can help elucidate epidemiological factors associated with SARS-CoV-2 infection in pregnant women that may provide insight into patterns of infection which may be relevant for communities that subsequently experience a similar surge in infection. The aim of this study was therefore to determine the prevalence of, and factors associated with, SARS-CoV-2 infection in patients admitted for labour and delivery at four Boston-area hospitals.…”

“…While studies from large cities affected by coronavirus disease 2019 (COVID‐19), including this population, have reported on the prevalence of SARS‐CoV‐2 in the context of universal testing during admission for delivery, patient demographic, social and clinical factors associated with SARS‐CoV‐2 infection in pregnant women in the United States are not well characterised 3‐16 . Now that the height of the spring COVID‐19 surge is past, after action reports can help elucidate epidemiological factors associated with SARS‐CoV‐2 infection in pregnant women that may provide insight into patterns of infection which may be relevant for communities that subsequently experience a similar surge in infection.…”

COVID-19: Uncertainties from Conception to Birth

“…However, social risks and limited access to health care are probably associated to late proper care, potentially contributing to maternal deaths. 69 Finally, childbirth care under COVID-19 is still one of the main concerning aspects. However, it is worth observing that, to date, there is no evidence of the intrapartum transmission of SARS-CoV-2 to the newborn, and vaginal birth with appropriate precaution measures remains the mode of delivery in mild maternal disease.…”