Impact of COVID-19 pandemic on time series of maternal mortality ratio in Bahia, Brazil: analysis of period 2011\u20132020

Rita De Cássia Oliveira De Carvalho-Sauer,Thaissa Piedade Santos,Maria Da Conceição N Costa,Estela Maria Ramos Do Nascimento,Géssica Rodrigues Da Silva,Enny S Paixao,Ediane Maria Filardi Silva,Maria Gloria Teixeira,Mariana Luiza Almeida Barbosa

doi:10.1186/s12884-021-03899-y

Abstract

BackgroundMost studies on the effects of SARS-CoV-2 infection have been conducted with adults and non-pregnant women. Thus, its impacts on maternal health are not yet fully established. This study aimed to verify the relationship between the maternal mortality ratio and the incidence of COVID-19 in the State of Bahia, Brazil, 2020.MethodsThis time-series study used publicly available information in Brazil, to obtain data on maternal deaths and live births in Bahia, State, from January 1, 2011, to December 31, 2020. The time trend of Maternal Mortality Ratio (MMR) was analysed through polynomial regression, of order 6. Expected MMR, monthly (Jan-Dec) and annual values for 2020, were predicted by the additive Holt-Winters exponential smoothing algorithm, with 95% confidence interval, based on the time series of the MMR from 2011 to 2019, and the accuracy of the forecasts for 2020 was assessed by checking the smoothing coefficients and the mean errors. According to the statistical forecast, the MMR values recorded in the year 2020 were compared to those expected.ResultsIn 2020, the annual MMR in Bahia, Brazil, was 78.23/100,000 live births, 59.46% higher than the expected ratio (49.06 [95% CI 38.70–59.90]). The increase in maternal mortality ratio relative to expected values was observed throughout the 2020 months; however, only after May, when the COVID-19 epidemic rose sharply, it exceeded the upper limit of the 95% CI of the monthly prediction. Of the 144 registered maternal deaths in 2020, 19 (13.19%) had COVID-19 mentioned as the cause of death.ConclusionsOur study revealed the increase in maternal mortality, and its temporal relationship with the incidence of COVID-19, in Bahia, Brazil, in 2020. The COVID-19 pandemic may be directly and indirectly related to this increase, which needs to be investigated. An urgent public health action is needed to prevent and reduce maternal deaths during this pandemic, in Brazil.

Highlights

The emergence and global spread of the novel coronavirus, SARS-CoV-2, from December 2019, caused a respiratory disease (COVID-19) pandemic which was already de Carvalho‐Sauer et al BMC Pregnancy Childbirth (2021) 21:423The clinical and epidemiological profile observed, at the beginning of the epidemic in China, showed that elderly (60 years old or more) with comorbidities such as diabetes, hypertension, heart disease, obesity, pneumopathies and immunosuppressed individuals were at higher risk for complications and deaths for COVID19, as has been observed in many countries affected by this pandemic [3,4,5,6]
Our study revealed the increase in maternal mortality, and its temporal relationship with the incidence of COVID-19, in Bahia, Brazil, in 2020
This study shows the rise in maternal mortality ratio in Bahia in 2020, insofar the officially recorded maternal deaths are far higher than the expected number for this year

Summary

Introduction

The emergence and global spread of the novel coronavirus, SARS-CoV-2, from December 2019, caused a respiratory disease (COVID-19) pandemic which was already de Carvalho‐Sauer et al BMC Pregnancy Childbirth (2021) 21:423The clinical and epidemiological profile observed, at the beginning of the epidemic in China, showed that elderly (60 years old or more) with comorbidities such as diabetes, hypertension, heart disease, obesity, pneumopathies and immunosuppressed individuals were at higher risk for complications and deaths for COVID19, as has been observed in many countries affected by this pandemic [3,4,5,6]. With the greater spread of this disease, some authors began to describe the occurrence of severe forms, as well as abortion and deaths, even among pregnant women without comorbidities [7, 8] These findings have been reported in many countries such as the United States, United Kingdom, France, Mexico and Brazil [2, 9,10,11,12], and contributed to subsidise PAHO, to issue an Alert in August 2020, encouraging member countries to redouble efforts to ensure access and continuity of prenatal care, with special attention to the early detection of signs, symptoms, and severity of clinical manifestations of COVID-19 [13]. This study aimed to verify the relation‐ ship between the maternal mortality ratio and the incidence of COVID-19 in the State of Bahia, Brazil, 2020

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