Abstract
To compare hospitalized reproductive age women with COVID-19 who were pregnant, puerperal, or neither one nor the other in terms of demographic and clinical characteristics and disease progression using Brazilian epidemiological data. A retrospective analysis of the records of the Information System of the Epidemiological Surveillance of Influenza of the Health Ministry of Brazil was performed. It included the data of female patients aged 10 to 49 years hospitalized because of severe COVID-19 disease (RT-PCR+ for SARS-CoV-2), from February 17, 2020 to January 02, 2021. They were separated into 3 groups: pregnant, puerperal, and neither pregnant nor puerperal. General comparisons and then adjustments for confounding variables (propensity score matching [PSM]) were made, using demographic and clinical characteristics, disease progression (admission to the intensive care unit [ICU] and invasive or noninvasive ventilatory support), and outcome (cure or death). Deaths were analyzed in each group according to comorbidities, invasive or noninvasive ventilatory support, and admission to the ICU. As many as 40,640 reproductive age women hospitalized for COVID-19 were identified: 3,372 were pregnant, 794 were puerperal, and 36,474 were neither pregnant nor puerperal. Groups were significantly different in terms of demographic data and comorbidities (p<0.0001). Pregnant and puerperal women were less likely to be symptomatic than the women who were neither one nor the other (72.1%, 69.7% and 88.8%, respectively). Pregnant women, however, had a higher frequency of anosmia, and ageusia than the others. After PSM, puerperal women had a worse prognosis than pregnant women with respect to admission to the ICU, invasive ventilatory support, and death, with OR (95% CI) 1.97 (1.55 - 2.50), 2.71 (1.78 - 4.13), and 2.51 (1.79 - 3.52), respectively. Puerperal women were at a higher risk for serious outcomes (need for the ICU, need for invasive and noninvasive ventilatory support, and death) than pregnant women.
Highlights
As many as 40,640 reproductive age women hospitalized for COVID-19 were identified: 3,372 were pregnant, 794 were puerperal, and 36,474 were neither pregnant nor puerperal
Puerperal women were at a higher risk for serious outcomes than pregnant women
COVID-19 is an infectious disease caused by the new coronavirus (SARS-CoV-2), and it has a clinical spectrum ranging from absence of symptoms to severe illness and death
Summary
COVID-19 is an infectious disease caused by the new coronavirus (SARS-CoV-2), and it has a clinical spectrum ranging from absence of symptoms to severe illness and death. Since the beginning of the pandemic, the infection has been studied in the obstetric population to understand its consequences and to prevent adverse maternal-fetal outcomes. The initial publications describing COVID-19 cases in pregnant women in China, Europe, and North America did not report increased severity and deaths compared to the general population [3,4,5,6,7,8,9]. The first maternal deaths were reported in the United Kingdom, Iran, United States, Mexico, and France [15,16,17,18,19]. In Brazil, the high number of maternal deaths due to COVID-19 has been attributed to factors such as high birth rate, poor nutrition and health, difficult access to health services, and insufficient obstetric assistance [20, 21]
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