The impact of COVID-19 on maternal death and fetal death, a cohort study in Brazil

by Ana Paula Brioschi dos Santos, Creuza Rachel Vicente, João Paulo Cola, Luana Fiengo Tanaka, Juliana Rodrigues Tovar Garbin, Larissa Soares Dell’Antonio, Cristiano Soares da Silva Dell’Antonio, Angelica Espinosa Miranda

Objective

The study aimed to evaluate the risk of maternal death and fetal death among pregnant women infected with SARS-CoV-2.

Methods

This is a retrospective cohort study among pregnant women with secondary data from the National Live Births System (Sistema Nacional de Nascidos Vivos), National Mortality System (Sistema Nacional de Mortalidade), and e-SUS Health Surveillance System (Sistema e-SUS Vigilância em Saúde). Pregnant women confirmed for COVID-19 had positive RT-PCR between March 2020 and May 2021, pregnant women without COVID-19 were those without notification for disease. Maternal death, fetal death, and stillbirth were assessed as primary outcomes.

Results

We included 68,673 pregnant women not notified as suspected of COVID-19 and 1,386 with a confirmed diagnosis of COVID-19. Among pregnant women with COVID-19, 1013 (73.0%) were aged 20 to 34 years, 655 (47.2%) were brown, 907 (65.4%) had ≥ 8 years of education, in the third trimester of pregnancy (41.5%), undergoing cesarean section (64.5%). In adjusted analyses, COVID-19 in pregnancy had a higher risk of maternal death (relative risk [RR] 18.73–95% confidence interval [95%CI] 11.07–31.69), fetal death/stillbirth (RR 1.96–95%CI 1.18–3.25), preterm birth [RR 1.18–95%CI 1.01–1.39], cesarean delivery (RR 1.07–95%CI 1.02–1.11), and cesarean delivery occurring before the onset of labor (RR 1.33–95%CI 1.23–1.44).

Conclusion

COVID-19 may contribute to unfavorable pregnancy outcomes. Results showed that pregnant women infected with SARS-CoV-2 had a higher risk of maternal death, fetal death/stillbirth, preterm birth, cesarean delivery, and cesarean section occurring before the onset of labor.