Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 May 5;23(1):320.
doi: 10.1186/s12884-023-05601-w.

Fetal death as an outcome of acute respiratory distress in pregnancy, during the COVID-19 pandemic: a population-based cohort study in Bahia, Brazil

Rita Carvalho-Sauer #  1   2 , Renzo Flores-Ortiz #  3 , Maria da Conceição N Costa  4 , Maria Gloria Teixeira  4 , Ramon Saavedra  4 , Marla Niag  5 , Enny S Paixao  6
Affiliations
Observational Study

Fetal death as an outcome of acute respiratory distress in pregnancy, during the COVID-19 pandemic: a population-based cohort study in Bahia, Brazil

Rita Carvalho-Sauer et al. BMC Pregnancy Childbirth. .

Abstract

Background: Fetal loss is one of the most serious adverse outcomes of pregnancy. Since the onset of the COVID-19 pandemic, Brazil has recorded an unprecedented number of hospitalizations of pregnant women due to acute respiratory distress (ARD), thereby, we aimed to assess the risk of fetal deaths associated to ARD during pregnancy in Bahia state, Brazil, in the context of the COVID-19 pandemic.

Methods: This is an observational population-based retrospective cohort study, developed with women at or after 20 weeks of pregnancy, residents in Bahia, Brazil. Women who had acute respiratory distress (ARD) in pregnancy during the COVID-19 pandemic (Jan 2020 to Jun 2021) were considered 'exposed'. Women who did not have ARD in pregnancy, and whose pregnancy occurred before the onset of the COVID-19 pandemic (Jan 2019 to Dec 2019) were considered 'non-exposed'. The main outcome was fetal death. We linked administrative data (under mandatory registration) on live births, fetal deaths, and acute respiratory syndrome, using a probabilistic linkage method, and analyzed them with multivariable logistic regression models.

Results: 200,979 pregnant women participated in this study, 765 exposed and 200,214 unexposed. We found four times higher chance of fetal death in women with ARD during pregnancy, of all etiologies (adjusted odds ratio [aOR] 4.06 confidence interval [CI] 95% 2.66; 6.21), and due to SARS-CoV-2 (aOR 4.45 CI 95% 2.41; 8.20). The risk of fetal death increased more when ARD in pregnancy was accompanied by vaginal delivery (aOR 7.06 CI 95% 4.21; 11.83), or admission to Intensive Care Unit (aOR 8.79 CI 95% 4.96; 15.58), or use of invasive mechanical ventilation (aOR 21.22 CI 95% 9.93; 45.36).

Conclusion: Our findings can contribute to expanding the understanding of health professionals and managers about the harmful effects of SARS-CoV-2 on maternal-fetal health and alerts the need to prioritize pregnant women in preventive actions against SARS-CoV-2 and other respiratory viruses. It also suggests that pregnant women, infected with SARS-CoV-2, need to be monitored to prevent complications of ARD, including a careful assessment of the risks and benefits of early delivery to prevent fetal death.

Keywords: COVID-19; COVID-19 pandemic; Fetal death; Pregnancy; Pregnancy complications; Respiratory distress; SARS-CoV-2.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflict of interests.

Figures

Fig. 1
Fig. 1
Flowchart of the database composition for the study 'Fetal death as an outcome of acute respiratory distress in pregnancy, during the COVID-19 pandemic: a population-based cohort study in Bahia, Brazil'. Source: Elaborated by the authors. SINASC = Live Births Information System; SIM = Mortality Information System; SIVEP = Acute Respiratory Syndrome Surveillance System
See this image and copyright information in PMC

References

    1. United Nations Development Programme | UNDP. Coronavirus, COVID-19 pandemic. An integrated global response is an investment in our future. Available at: https://www.undp.org/coronavirus. Accessed 17 Apr 2022.
    1. Mas-Coma S, Jones MK, Marty AM. COVID-19 and globalization. One Health. 2020;9:100132. 10.1016/j.onehlt.2020.100132. - PMC - PubMed
    1. Worldmeters. Coronavirus Update (Live) COVID-19 Coronavirus Pandemic. 2022. Available at: https://www.worldometers.info/coronavirus/. Accessed 30 Dec 2022.
    1. World Health Organization | WHO. Impact of COVID-19 on people’s livelihoods, their health and our food systems - Joint statement by ILO, FAO, IFAD and WHO. 2020. Available at: https://www.who.int/news/item/13-10-2020-impact-of-covid-19-on-people’s-.... Accessed 17 Apr 2022.
    1. World Health Organization | WHO. The impact of COVID-19 on global health goals. 2021. Available at: https://www.who.int/news-room/spotlight/the-impact-of-covid-19-on-global.... Accessed 17 Apr 2022.

Publication types