Rita de Cássia Oliveira de Carvalho-Sauer1,2, Maria da Conceição N Costa2,3, Maria Gloria Teixeira2,3, Estela Maria Ramos do Nascimento4, Ediane Maria Filardi Silva1, Mariana Luiza Almeida Barbosa5, Géssica Rodrigues da Silva5, Thaissa Piedade Santos5, Enny S Paixao6,7. 1. Núcleo Regional de Saúde Leste, Bahia State Health Secretariat, Santo Antônio de Jesus, Bahia, Brazil. 2. Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil. 3. Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil. 4. Bahia State Health Secretariat, Salvador, Bahia, Brazil. 5. Federal University of Recôncavo of Bahia, Santo Antônio de Jesus, Bahia, Brazil. 6. Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil. enny.cruz@lshtm.ac.uk. 7. London School of Hygiene and Tropical Medicine, London, UK. enny.cruz@lshtm.ac.uk.
Abstract
BACKGROUND: Most 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. METHODS: This 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. RESULTS: In 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. CONCLUSIONS: Our 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.
BACKGROUND: Most 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. METHODS: This 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. RESULTS: In 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. CONCLUSIONS: Our 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.
Authors: Cesar G Victora; Estela M L Aquino; Maria do Carmo Leal; Carlos Augusto Monteiro; Fernando C Barros; Celia L Szwarcwald Journal: Lancet Date: 2011-05-09 Impact factor: 79.321
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Authors: Enny S Paixao; Kerry L M Wong; Flavia Jôse Oliveira Alves; Vinicius de Araújo Oliveira; Thiago Cerqueira-Silva; Juracy Bertoldo Júnior; Tales Mota Machado; Elzo Pereira Pinto Junior; Viviane S Boaventura; Gerson O Penna; Guilherme Loureiro Werneck; Laura C Rodrigues; Neil Pearce; Mauricio L Barreto; Manoel Barral-Netto Journal: BMC Med Date: 2022-04-05 Impact factor: 8.775