ABSTRACT
IntroductionThis study compares the clinical characteristics and disease progression of vaccinated and unvaccinated pregnant and postpartum women positive for the original, Gamma, Delta, and Omicron variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using Brazilian epidemiological data. MethodsData of pregnant or postpartum patients with coronavirus disease 2019 (COVID-19) SARS-CoV-2 confirmed using polymerase chain reaction from February 2020 to July 2022 were extracted from a Brazilian national database. The patients were divided based on vaccination status and viral variant (original, Gamma, Delta, and Omicron). The patients demographic data, clinical characteristics, comorbidities, signs, symptoms, and outcomes were retrospectively compared. ResultsData from 10,003 pregnant and 2,361 postpartum women were extracted from the database. Among unvaccinated patients, postpartum women were more likely to be admitted to the intensive care unit (ICU). These patients were more likely to require invasive ventilation when infected with the original, Gamma, and Omicron variants and were more likely to die when infected with the original and Gamma variants. Patients who were vaccinated had reduced adverse outcomes including ICU admission, requirement for invasive ventilation, and death. ConclusionPostpartum women were more likely to develop severe COVID-19 that required ICU admission or invasive ventilatory support or led to death, among all variants, especially when the patients were unvaccinated. Therefore, the risk of severe COVID-19 should not be underestimated after delivery. Vaccinated patients had a lower risk of severe outcomes. Vaccination should be a top priority in pregnant and postpartum patients. WHAT IS ALREADY KNOWN ON THIS TOPICThe obstetric population has a higher risk of adverse outcomes due to coronavirus disease 2019 (COVID-19). Few studies have compared the outcomes of pregnant and postpartum patients or vaccinated and unvaccinated patients; however, no studies have separately investigated the effects of each viral variant. WHAT THIS STUDY ADDSPostpartum women are more likely to have adverse outcomes, including the requirements for intensive care and invasive ventilation and death, compared with pregnant women. Vaccinated women had fewer adverse outcomes. The viral variants did not significantly affect the outcomes of these patients. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE, OR POLICYThe risks of COVID-19 infection should not be underestimated in postpartum women. Postpartum women infected with COVID-19, especially those who are not vaccinated, should be monitored carefully. Vaccination should be a top priority in pregnant and postpartum women.
ABSTRACT
Cardiovascular diseases are a risk factor for severe cases of COVID-19. There are no studies evaluating whether the presence of CVD in pregnant women and in postpartum women with COVID-19 is associated with a worse prognosis. In an anonymized open database of the Ministry of Health, we selected cases of pregnant and postpartum women who were hospitalized due to COVID-19 infection. Among the 1,876,953 reported cases, 3,562 confirmed cases of pregnant and postpartum women were included, of which 602 had CVD. Patients with CVD had an older age (p<0,001), a higher incidence of diabetes (p<0,001) and obesity (p<0,001), a higher frequency of systemic (p<0,001) and respiratory symptoms (p<0,001). CVD was a risk factor for ICU admission (p<0,001), ventilatory support (p=0.004) and orotracheal intubation in the third trimester (OR 1.30 CI95%1.04-1.62). The group CVD had a higher mortality (18.9% vs. 13.5%, p<0,001), with a 32% higher risk of death (OR 1.32 CI95%1.16-1.50). Moreover, the risk was increased in the second (OR 1.94 CI95%1.43-2.63) and third (OR 1.29 CI95%1.04-1.60) trimesters, as well as puerperium (OR 1.27 IC95%1.03-1.56). Hospitalized obstetric patients with CVD and COVID-19 are more symptomatic. Their management demand more ICU admission and ventilatory support and the mortality is higher.
ABSTRACT
ObjectiveTo 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. MethodsA 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 February17, 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. ResultsAs 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. Pregnant and puerperal women were less likely to be symptomatic than the women who were neither one nor the other. Pregnant women, however, had a higher frequency of cough, anosmia, and ageusia. Puerperal women had a worse prognosis than pregnant women with respect to admission to the ICU, invasive ventilatory support, and death. ConclusionPuerperal 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.
