The Effect of Being Pregnant during Respiratory Pandemics: A Comparison between 2009/10 Flu and 2020/21 COVID-19 Pandemic in Brazil

Abstract

Pregnant women undergo physiological changes that make them a challenging group of patients during pandemic respiratory diseases, as previously found during H1N1 2009 pandemic and recently ratified in COVID-19 pandemic. We conducted a retrospective cohort analysis on 5888 hospitalized women for H1N1 flu pandemic (2190 pregnant and 3698 non-pregnant) and 64,515 hospitalized women for COVID-19 pandemic (5151 pregnant and 59,364 non-pregnant), from the Brazilian national database, to compare demographic profile, clinical aspects, and mortality in childbearing aged women during both pandemics. Additionally, the effect of being pregnant was compared between both pandemics. In both pandemics, pregnant women were younger than non-pregnant women. Overall, pregnant women had lower frequencies of comorbidities and were less symptomatic. Among hospitalized women, pregnant women presented lower mortality rates than non-pregnant women (9.7% vs. 12.6%, p = 0.002 in the H1N1 pandemic and 9.7% vs. 17.4%, p < 0.001 in the COVID-19 pandemic) and this difference was statistically more pronounced in the COVID-19 pandemic, even after balancing pregnant and non-pregnant groups regarding age and chronic diseases.

Keywords: COVID-19; H1N1 subtype; Influenza A virus; mortality; pregnancy.

Figure 1

Selection of subjects included in the analysis for both H1N1 and COVID-19 pandemics in Brazil.