The COVID-19 pandemic in Brazilian pregnant and postpartum women: results from the REBRACO prospective cohort study
Renato T. Souza, José Guilherme Cecatti, Rodolfo C. Pacagnella, Carolina C. Ribeiro‐do‐Valle, Adriana Gomes Luz, Giuliane Jesus Lajos, Guilherme de Moraes Nobrega, Thayna B. Griggio, Charles M. Charles, Silvana Ferreira Bento, Carla Silveira, Fernanda G. Surita, Maria J. Miele, Ricardo Porto Tedesco, Karayna Gil Fernandes, Sergio Martins-Costa, Frederico J. A. Peret, Francisco Edson de Lucena Feitosa, Rosiane Mattar, Évelyn Trainá, Edson V. Cunha Filho, Janete Vettorazzi, Samira M. Haddad, Carla Betina Andreucci, José Paulo de Siqueira Guida, Mário Dias Corrêa Júnior, Marcos Augusto Bastos Dias, Leandro De Oliveira, Elias F. Melo, Marília G. Q. Luz, Maria Laura Costa, REBRACO Study Group, Renato T. Souza, Maria Laura Costa, José Guilherme Cecatti, Rodolfo C. Pacagnella, Carolina C. Ribeiro-do-Valle, Adriana Gomes Luz, Giuliane Jesus Lajos, Guilherme de Moraes Nobrega, Thayna B. Griggrio, Charles M. Charles, Silvana Ferreira Bento, Carla Silveira, Fernanda G. Surita, Maria J. Miele, Sherly Metelus, Lester Castro, Stephanie Pabón, Amanda D. Silva, S.R. Paulo, Thais G. Sardinha, Rodolfo R. Japenga, Erica R. F. Urquiza, Maíra Rocha Machado, Marcela Maria SimÕes, Larissa M. Solda, Juliana Vasconcellos Freitas-Jesus, Rachel Esteves Soeiro, Ricardo Porto Tedesco, Karayna Gil Fernandes, Patrícia B. Peres, Cristiane L. Arbeli, Rafael M. Quevedo, Carolina F. Yamashita, Julia D. Corradin, Isabella Bergamini, Sérgio H. A. Martins-Costa, José Geraldo Lopes Ramos, Maria Oppermann, Laisa S. Quadro, Lina Rigodanzo Marins, Érika Vieira Paniz, T. Xavier, Frederico J. A. Peret, Marina H. L. Almeida, Bruna F. V. Moura, Lidiane R. França, Hanna Vieira, Rafael B. Aquino, Aline Carvalho da Costa, Francisco E. Feitosa, Daisy de Lucena Feitosa Lins Pinheiro, Denise Cordeiro, Priscila L. Miná, Carol Dornellas, Rosiane Mattar, Evelyn Traina, Sue Yazaki Sun, Priscilla Mota, Arimaza Contarini Soares, Edson V. Cunha Filho, Janete Vettorazzi, Ellen Machado, Anne Bergmann, Gustavo Raupp dos Santos, Samira M. Haddad, Aline Tosetto, Sabrina Savazoni, Carla B. Andreucci
Abstract
Brazil presented a very high number of maternal deaths and evident delays in healthcare. We aimed at evaluating the characteristics of SARS-CoV-2 infection and associated outcomes in the obstetric population. We conducted a prospective cohort study in 15 Brazilian centers including symptomatic pregnant or postpartum women with suspected COVID-19 from Feb/2020 to Feb/2021. Women were followed from suspected infection until the end of pregnancy. We analyzed maternal characteristics and pregnancy outcomes associated with confirmed COVID-19 infection and SARS, determining unadjusted risk ratios. In total, 729 symptomatic women with suspected COVID-19 were initially included. Among those investigated for COVID-19, 51.3% (n = 289) were confirmed COVID-19 and 48% (n = 270) were negative. Initially (before May 15th), only 52.9% of the suspected cases were tested and it was the period with the highest proportion of ICU admission and maternal deaths. Non-white ethnicity (RR 1.78 [1.04-3.04]), primary schooling or less (RR 2.16 [1.21-3.87]), being overweight (RR 4.34 [1.04-19.01]) or obese (RR 6.55 [1.57-27.37]), having public prenatal care (RR 2.16 [1.01-4.68]), planned pregnancies (RR 2.09 [1.15-3.78]), onset of infection in postpartum period (RR 6.00 [1.37-26.26]), chronic hypertension (RR 2.15 [1.37-4.10]), pre-existing diabetes (RR 3.20 [1.37-7.46]), asthma (RR 2.22 [1.14-4.34]), and anaemia (RR 3.15 [1.14-8.71]) were associated with higher risk for SARS. The availability of tests and maternal outcomes varied throughout the pandemic period of the study; the beginning was the most challenging period, with worse outcomes. Socially vulnerable, postpartum and previously ill women were more likely to present SARS related to COVID-19.