Factors associated with severe acute respiratory syndrome in pregnant/postpartum women with COVID-19 receiving care at referral centers in northeastern Brazil: Secondary analysis of a cohort study

Abstract

BackgroundAt the beginning of the COVID-19 pandemic, the greater risks associated with the new SARS-CoV-2 pathogen in pregnant women were as yet unclear. This study analyzed factors associated with severe acute respiratory syndrome (SARS) in pregnant/postpartum women with COVID-19. MethodsA prospective and retrospective cohort study was conducted in eight referral centers in northeastern Brazil between April 2020 and December 2021 involving pregnant/postpartum women with a positive COVID-19 RT-PCR test. A multivariate analysis was then conducted using a hierarchical logistic regression model to evaluate the association between the independent variables and the presence of SARS. FindingsOf 611 patients included, 522 were pregnant and 83 were postpartum, at the time of admission. Criteria for SARS were present in 215 patients (35·2%). Factors associated with SARS included overweight and/or obesity (adjusted odds ratio/AOR: 1·95; 95%CI: 1·21–3·12; p = 0·0054), parity ≥2 (AOR: 1·72; 95%CI: 1·21–2·45; p = 0·0025), gestational age <34 weeks (AOR: 3·54; 95%CI: 2·47–5·07; p < 0·0001) and duration of symptoms >7 days (AOR: 1·97; 95%CI: 1·35–2·89; p = 0·0004). SARS increased the likelihood of requiring oxygen therapy (RR = 8·80; 95%CI: 6·25–12·40; p = 0·0000), mechanical ventilation (RR = 8·15; 95%CI: 4·67–14·21; p = 0·0000), and admission to an ICU (RR = 6·54; 95%CI: 4·70–9·11; p = 0·0000), and of maternal near miss (RR = 10·82; 95%CI: 1·20–22·47; p = 0·0000) and maternal death (RR = 8·12; 95%CI: 3·11–21·09; p = 0·0000). InterpretationIn patients with COVID-19, parity ≥2, overweight/obesity, gestational age <34 weeks and duration of symptoms >7 days increased the risk of SARS. Cesarean sections, oxygen therapy, and mechanical ventilation were more common in patients with SARS.