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Clinical characteristics and risk factors for maternal deaths due to COVID-19 in Brazil: A nationwide population-based cohort study.

Siqueira, Thayane Santos, Souza, Edyankya Karolyne Gomes, Martins-Filho, Paulo Ricardo, Silva, José Rodrigo Santos, Gurgel, Ricardo Queiroz, Cuevas, Luis ORCID: https://orcid.org/0000-0002-6581-0587 and Santos, Victor Santana (2022) 'Clinical characteristics and risk factors for maternal deaths due to COVID-19 in Brazil: A nationwide population-based cohort study.'. Journal of Travel Medicine, Vol 29, Issue 3, taab199.

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Abstract

Background

Monitoring the characteristics and associated factors for death among pregnant and postpartum women with coronavirus disease 19 (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 risk 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 hazard ratio, HR 1.4 (95% confidence interval, 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], hypoxaemia 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 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.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WC Communicable Diseases > Virus Diseases > Viral Respiratory Tract Infections. Respirovirus Infections > WC 506 COVID-19
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1093/jtm/taab199
SWORD Depositor: JISC Pubrouter
Depositing User: JISC Pubrouter
Date Deposited: 31 Mar 2022 13:38
Last Modified: 29 Jun 2022 11:06
URI: https://archive.lstmed.ac.uk/id/eprint/19919

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