Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID‐19 in Brazil: a surveillance database analysis

Takemoto, Maira L.S.; Menezes, Mariane O.; Andreucci, Carla B.; Knobel, Roxana; Sousa, Liduína A.R.; Katz, Leila; Fonseca, Eduardo B.; Nakamura‐Pereira, Marcos; Magalhães, Claudia G.; Diniz, Carmen S.G.; Melo, Adriana S.O.; Amorim, Melania M.R.; Menezes, Mariane O.

OBJECTIVE: To describe clinical characteristics of pregnant and postpartum women with severe COVID‐19 in Brazil and to examine risk factors for mortality DESIGN: Cross‐sectional study based on secondary surveillance database analysis SETTING: Nationwide Brazil POPULATION OR SAMPLE: 978 Brazilian pregnant and postpartum women notified as COVID‐19 Acute Respiratory Distress Syndrome (ARDS) cases with complete outcome (death or cure) until June 18, 2020 METHODS: Data was abstracted from the Brazilian ARDS Surveillance System (ARDS‐SS) database. All eligible cases were included. Data on demographics, clinical characteristics, intensive care resources use and outcomes were collected. Risk factors for mortality were examined by multivariate logistic regression. MAIN OUTCOME MEASURES: Case fatality rate RESULTS: We identified 124 maternal deaths, corresponding to a case fatality rate among COVID‐19 ARDS cases in the obstetric population of 12.7%. At least one comorbidity was present in 48.4% of fatal cases compared to 24.9% in survival cases. Among women who died, 58.9% were admitted to ICU, 53.2% had invasive ventilation and 29.0% had no respiratory support. The multivariate logistic regression showed that the main risk factors for maternal death by COVID‐19 were postpartum at onset of ARDS, obesity, diabetes, and cardiovascular disease, while white ethnicity had a protective effect. CONCLUSIONS: Negative outcomes of COVID‐19 in this population are affected by clinical characteristics, but social determinants of health also seem to play a role. It is urgent to reinforce containment measures targeting obstetric population and ensure high quality care throughout pregnancy and postpartum period.