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. 2020 Dec;151(3):415-423.
doi: 10.1002/ijgo.13407. Epub 2020 Oct 24.

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

Mariane O Menezes  1 , Maíra L S Takemoto  1 , Marcos Nakamura-Pereira  2 , Leila Katz  3 , Melania M R Amorim  3 , Heloisa O Salgado  4 , Adriana Melo  5 , Carmen S G Diniz  6 , Liduina A R de Sousa  7 , Claudia G Magalhaes  1 , Roxana Knobel  8 , Carla B Andreucci  9 ; Brazilian Group of Studies for COVID-19, Pregnancy
Affiliations

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

Mariane O Menezes et al. Int J Gynaecol Obstet. 2020 Dec.

Abstract

Objective: To evaluate whether clinical and social risk factors are associated with negative outcomes for COVID-19 disease among Brazilian pregnant and postpartum women.

Methods: A secondary analysis was conducted of the official Acute Respiratory Syndrome Surveillance System database. Pregnant and postpartum women diagnosed with COVID-19 ARDS until July 14, 2020, were included. Adverse outcomes were a composite endpoint of either death, admission to the intensive care unit (ICU), or mechanical ventilation. Risk factors were examined by multiple logistic regression.

Results: There were 2475 cases of COVID-19 ARDS. Among them, 23.8% of women had the composite endpoint and 8.2% died. Of those who died, 5.9% were not hospitalized, 39.7% were not admitted to the ICU, 42.6% did not receive mechanical ventilation, and 25.5% did not have access to respiratory support. Multivariate analysis showed that postpartum period, age over 35 years, obesity, diabetes, black ethnicity, living in a peri-urban area, no access to Family Health Strategy, or living more than 100 km from the notification hospital were associated with an increased risk of adverse outcomes.

Conclusion: Clinical and social risk factors and barriers to access health care are associated with adverse outcomes among maternal cases of COVID-19 ARDS in Brazil.

Keywords: COVID-19; Health services accessibility; Health status indicators; Maternal death.

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Conflict of interest statement

The authors have no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of case selection. Abbreviations: ARDS‐SS, Acute Respiratory Syndrome Surveillance System; RT‐PCR, reverse transcription polymerase chain reaction.
Figure 2
Figure 2
Cases of COVID‐19‐related ARDS among pregnant and postpartum women by region and epidemiological week and total confirmed cases in Brazil. Abbreviation: ARDS, acute respiratory distress syndrome.
Figure 3
Figure 3
Maternal symptoms at diagnosis of COVID‐19 ARDS. *Statistically significant at P<0.05.
See this image and copyright information in PMC

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