1
|
Sardinha TG, Lajos GJ, Souza RT, Cecatti JG, Luz AG, Oppermann MLR, Pacagnella RC, Ribeiro-Do-Valle CC, Nobrega GM, Griggio TB, Charles CM, Silveira C, Miele MJ, Tedesco RP, Fernandes KG, Martins-Costa SH, Peret FJ, Feitosa FE, Traina E, Cunha Filho EV, Vettorazzi J, Haddad SM, Candreucci CB, Guida JP, Correa Junior MD, Dias MA, Oliveira LG, Melo Junior EF, Da Luz MG, Costa ML. The effect of body mass index on maternal and perinatal outcomes in COVID-19 infection during pregnancy and postpartum: Secondary analysis from the REBRACO cohort study. Int J Gynaecol Obstet 2024; 164:1019-1027. [PMID: 38009566 DOI: 10.1002/ijgo.15250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES To compare maternal and perinatal outcomes among women with obesity, overweight, and normal body mass index, associated with COVID-19 infection during pregnancy and postpartum. METHOD Prospective Cohort Study, within the REBRACO (Brazilian Network of COVID-19 in Pregnancy) multicenter initiative. Confirmed positive cases of SARS-CoV-2 were included, and women categorized into three groups according to their pre-pregnancy BMI: obesity (BMI ≥ 30), overweight (BMI <30 but >25), and normal BMI. Sociodemographic, clinical, and obstetric characteristics and different maternal and perinatal outcomes were compared, and a multiple regression analysis was performed to investigate factors independently associated with adverse maternal and perinatal outcomes. RESULTS Two hundred eighty-nine women positive for SARS-CoV-2 infection were considered, and 202 had available data on maternal BMI for the current analysis. Overall, 72 (35.6%)obese, 68 (33.6%) overweight, and 60 (29.7%) normal BMI. Obesity was associated with increased adverse clinical outcomes including sepsis (P = 0.02), acute respiratory distress syndrome (P = 0.002), and the need for mechanical ventilation (P = 0.044). Considering perinatal outcomes, a multiple regression model confirmed obesity as an independent factor associated with adverse results (adjusted odds ratio 3.73, 95% CI 1.54-9.08). CONCLUSION Obesity and overweight were associated with worse clinical outcomes, severe/critical COVID-19, and adverse perinatal outcomes.
Collapse
Affiliation(s)
- Thais G Sardinha
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Giuliane J Lajos
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Jose G Cecatti
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Adriana G Luz
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | | | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Carolina C Ribeiro-Do-Valle
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Guilherme M Nobrega
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Thayna B Griggio
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Charles M Charles
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Carla Silveira
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Maria J Miele
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | | | | | | | | | | | - Evelyn Traina
- Federal University of São Paulo-UNIFESP/EPM, São Paulo, São Paulo, Brazil
| | | | - Janete Vettorazzi
- Clinics Hospital of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Moinhos de Vento Hospital-HMV, Porto Alegre, Brazil
| | - Samira M Haddad
- Jorge Rossmann Regional Hospital-Sócrates Guanaes Institute, Itanhaém, São Paulo, Brazil
| | | | - José P Guida
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Sumaré State Hospital-HES, Sumaré, São Paulo, Brazil
| | | | - Marcos Ab Dias
- Fernandes Figueira Institute-IFF/Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leandro G Oliveira
- São Paulo State University School of Medicine, Botucatu, São Paulo, Brazil
| | | | | | - Maria Laura Costa
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| |
Collapse
|
2
|
Lima Figueiredo ER, do Socorro Carvalho Miranda C, Viana Campos AC, de Campos Gomes F, Câmara Rodrigues CN, de Melo-Neto JS. Influence of sociodemographic and obstetric factors on maternal mortality in Brazil from 2011 to 2021. BMC Womens Health 2024; 24:84. [PMID: 38302949 PMCID: PMC10835861 DOI: 10.1186/s12905-024-02925-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Obstetric causes are classified as direct (complications of pregnancy, childbirth or the puerperium) or indirect (caused by pregnancy but not directly caused by it). This study aimed to analyze maternal mortality from obstetric causes in Brazil from 2011 to 2021. METHODS This was an ecological study on mortality and live births. The outcomes were the specific risk of mortality from direct and indirect cause adjustment and death during pregnancy and the puerperium. Binary and multiple linear logistic regressions were used to assess the influence of sociodemographic factors and maternal and child health indicators on maternal mortality and time of death (pregnancy and puerperium). RESULTS Regarding mortality during pregnancy and during the puerperium, increased (p = 0.003) and decreased (p = 0.004) mortality over the years, respectively; residing in the northern region was associated with lower (p < 0.05) and greater (p = 0.035) odds; and the Maternal Mortality Committee was the primary and least active source of investigation, respectively (p < 0.0001). The number of deaths from indirect causes increased with age (p < 0.001) and in the northern region (p = 0.011) and decreased in the white (< 0.05) and stable union (0.002) regions. Specifically, for mortality risk, the age group [women aged 15-19 years presented an increase in cesarean section (p < 0.001) was greater than that of women who had < 4 antenatal visits (p < 0.001)], education [women who completed high school (8 to 11 years) was greater when they had < 4 prenatal visits (p = 0.018)], and marital status [unmarried women had more than 4 antenatal visits (p < 0.001); cesarean birth (p = 0.010) and < 4 antenatal visits (p = 0.009) were predictors of marriage; and women in a stable union who had < 4 prenatal visits and live births to teenage mothers (p < 0.001) were predictors]. Women who had no education (p = 0.003), were divorced (p = 0.036), had cesarean deliveries (p < 0.012), or lived in the north or northeast (p < 0.008) had higher indirect specific mortality risk. CONCLUSIONS Sociodemographic factors and maternal and child health indicators were related to different patterns of obstetric mortality. Obstetric mortality varied by region, marital status, race, delivery, prenatal care, and cause of death.
Collapse
Affiliation(s)
- Eric Renato Lima Figueiredo
- Urogenital System Clinical and Experimental Research Unit, Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, 66075-110, Brazil
| | | | - Ana Cristina Viana Campos
- Laboratory and Observatory in Surveillance and Social Epidemiology, Federal University of the South and Southeast of Pará (Unifesspa), Marabá, PA, 68500-000, Brazil
| | | | - Cibele Nazaré Câmara Rodrigues
- Urogenital System Clinical and Experimental Research Unit, Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, 66075-110, Brazil
| | - João Simão de Melo-Neto
- Urogenital System Clinical and Experimental Research Unit, Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, 66075-110, Brazil.
| |
Collapse
|
3
|
Lamy ZC, Thomaz EBAF, da Silva-Junior AG, Alexandre GC, Alves MTSSDBE, de Carvalho RHDSBF, de Menezes LO, de Oliveira SS, Moraes M, Magalhães YB, Coimbra TRS, Guzman-Barrera LS. Experiences of women in prenatal, childbirth, and postpartum care during the COVID-19 pandemic in selected cities in Brazil: The resignification of the experience of pregnancy and giving birth. PLoS One 2023; 18:e0284773. [PMID: 37146073 PMCID: PMC10162534 DOI: 10.1371/journal.pone.0284773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 04/06/2023] [Indexed: 05/07/2023] Open
Abstract
The COVID-19 pandemic has impacted public and private health systems around the world, impairing good practices in women's health care. However, little is known about the experiences, knowledge, and feelings of Brazilian women in this period. The objective was to analyze the experiences of women, seen at maternity hospitals accredited by the Brazilian Unified Health System (SUS, acronym in Portuguese), regarding health care during pregnancy, childbirth, and postpartum periods, their interpersonal relationships, and perceptions and feelings about the pandemic. This was a qualitative, exploratory research, carried out in three Brazilian municipalities with women hospitalized in 2020, during pregnancy, childbirth, or postpartum period, with COVID-19 or not. For data collection, semi-structured individual interviews (in person, by telephone, or by digital platform) were conducted, recorded and transcribed. The content analysis of thematic modalities was displayed as per the following axes: i) Knowledge about the disease; ii) Search for health care in prenatal, childbirth, and postpartum periods; iii) Experience of suffering from COVID-19; iv) Income and work; and v) Family dynamics and social support network. A total of 46 women were interviewed in São Luís-MA, Pelotas-RS, and Niterói-RJ. Use of media was important to convey information and fight fake news. The pandemic negatively impacted access to health care in the prenatal, childbirth, and postpartum periods, contributing to worsening of the population's social and economic vulnerabilities. Women experienced diverse manifestations of the disease, and psychic disorders were very frequent. Social isolation during the pandemic disrupted the support network of these women, who found social support strategies in communication technologies. Women-centered care-including qualified listening and mental health support-can reduce the severity of COVID-19 cases in pregnant, parturient, and postpartum women. Sustainable employment and income maintenance policies are essential to mitigate social vulnerabilities and reduce risks for these women.
Collapse
Affiliation(s)
- Zeni Carvalho Lamy
- Public Health Department, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Nobrega GM, Guida JP, Novaes JM, Solda LM, Pietro L, Luz AG, Lajos GJ, Ribeiro-do-Valle CC, Souza RT, Cecatti JG, Mysorekar IU, Dias TZ, Laura Costa M. Role of biomarkers (sFlt-1/PlGF) in cases of COVID-19 for distinguishing preeclampsia and guiding clinical management. Pregnancy Hypertens 2023; 31:32-37. [PMID: 36525933 PMCID: PMC9719935 DOI: 10.1016/j.preghy.2022.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/11/2022] [Accepted: 11/28/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVES To analyze soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factors (PlGF) concentrations and their ratio in pregnant and postpartum women with suspected COVID-19, and further investigate conditions associated with an increased ratio (sFlt-1/PlGF > 38), including preeclampsia (PE) and severe acute respiratory syndrome (SARS). STUDY DESIGN The present study is a secondary analysis of a prospective cohort. Blood samples were collected at time of COVID-19 investigation and the serum measurements of sFlt-1 and PlGF were performed. Clinical background, SARS-CoV-2 infection characteristics, maternal and perinatal outcomes were further analyzed. MAIN OUTCOME MEASURES Serum measurements of sFlt-1 and PlGF; obstetrics and clinical outcomes. RESULTS A total of 97 SARS-CoV-2 unvaccinated women with suspected infection were considered, 76 were COVID-19 positive cases and 21 COVID-19 negative. Among COVID-19 positive cases, 09 presented with SARS and 11 were diagnosed with PE, of which 6 had SARS-CoV-2 infection in first and second trimester (04 with sFlt-1/PlGF ≥ 38) and 05 with PE and COVID-19 diagnosed at the same time, during third trimester (03 with sFlt-1/PlGF ≥ 38). Five presented with PE with severe features. sFlt-1/PlGF ratio was significantly higher in the COVID-19 positive/PE positive group compared to COVID-19 positive/PE negative group (p-value = 0.005), with no increase in cases complicated by SARS. CONCLUSIONS sFlt-1/PlGF ratio could be a useful tool for differential diagnosis and adequate counseling among cases of COVID-19 and PE, especially if severe disease. COVID-19 early in pregnancy could potentially be a risk factor for PE later during gestation.
Collapse
Affiliation(s)
- Guilherme M. Nobrega
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Jose P. Guida
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Juliana M. Novaes
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Larissa M. Solda
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Luciana Pietro
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil,Institute of Health Sciences, Paulista University, Brazil
| | - Adriana G. Luz
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Giuliane J. Lajos
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Carolina C. Ribeiro-do-Valle
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Jose G. Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Indira U. Mysorekar
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX 77030, USA,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Tabata Z. Dias
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Maria Laura Costa
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
| |
Collapse
|
5
|
Olsen AL, Woller A. Citizens' economic recovery models for a pandemic. PLoS One 2023; 18:e0266531. [PMID: 36735669 PMCID: PMC9897534 DOI: 10.1371/journal.pone.0266531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/22/2022] [Indexed: 02/04/2023] Open
Abstract
The COVID-19 pandemic brought sudden economic devastation and forced countries to respond with policies to counter the looming economic crisis. What policy response do citizens prefer to combat an economic decline due to a pandemic? We study the preferences of citizens regarding economic policy and changes in these preferences as the pandemic unfolded in Denmark. Denmark passed early and comprehensive legislation with broad support from all political parties to counter the economic crisis caused by the pandemic. We employ a large nationally representative two-wave panel of Danish citizens (N = 12,131) drawn from the administrative registers, from which data was collected at the onset of the economic shock and immediately prior to economic recovery. In both waves the same subjects describe their preferred economic solution to COVID-19 in open-text format. We generate a simple dictionary method to uncover a set of distinct laymen economic policy responses. First, we find that citizens formulated a diverse set of policy interventions. Second, citizens become markedly stronger proponents of economic intervention as the crisis unfolded. Finally, we show how differences in economic preferences across partisanship vanished during the crisis.
Collapse
Affiliation(s)
- Asmus Leth Olsen
- Dept Political Science, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Anders Woller
- Dept Political Science, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
6
|
Orellana J, Jacques N, Leventhal DGP, Marrero L, Morón-Duarte LS. Excess maternal mortality in Brazil: Regional inequalities and trajectories during the COVID-19 epidemic. PLoS One 2022; 17:e0275333. [PMID: 36264994 PMCID: PMC9584504 DOI: 10.1371/journal.pone.0275333] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has exceeded 6 million known disease-related deaths and there is evidence of an increase in maternal deaths, especially in low- and middle-income countries. We aimed to estimate excess maternal deaths in Brazil and its macroregions as well as their trajectories in the first 15 months of the COVID-19 epidemic. METHODS This study evaluated maternal deaths from the Mortality Information System of the Ministry of Health, with excess deaths being assessed between March 2020 and May 2021 by quasi-Poisson generalized additive models adjusted for overdispersion. Observed deaths were compared to deaths expected without the pandemic, accompanied by 95% confidence intervals according to region, age group, and trimester of occurrence. Analyses were conducted in R version 3.6.1 and RStudio version 1.2.1335. RESULTS There were 3,291 notified maternal deaths during the study period, resulting in a 70% excess of deaths regardless of region, while in the North, Northeast, South and Southeast regions, excess deaths occurred regardless of age group. Excess deaths occurred in the March-May 2021 trimester regardless of region and age group. Excess deaths were observed in the Southeast region for the 25-36-year-old age group regardless of the trimester assessed, and in the North, Central-West and South regions, the only period in which excess deaths were not observed was September-November 2020. Excess deaths regardless of trimester were observed in the 37-49-year-old age group in the North region, and the South region displayed explosive behavior from March-May 2021, with a 375% excess of deaths. CONCLUSIONS Excess maternal deaths, with geographically heterogenous trajectories and consistently high patterns at the time of the epidemic's greatest impact, reflect not only the previous effect of socioeconomic inequalities and of limited access to maternal health services, but most of all the precarious management of Brazil's health crisis.
Collapse
Affiliation(s)
- Jesem Orellana
- Leônidas and Maria Deane Institute, Oswaldo Cruz Foundation, Manaus, Amazonas, Brazil
- * E-mail:
| | - Nadège Jacques
- Postgraduate Program in Epidemiology, Department of Social Medicine, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | - Lihsieh Marrero
- Department of Nursing, Amazonas State University, Manaus, Amazonas, Brazil
| | - Lina Sofía Morón-Duarte
- Global Institute of Clinical Excellence, Keralty, Bogotá, Distrito Capital, Colombia
- Translational Research Group, Sanitas University Foundation, Bogotá, Distrito Capital, Colombia
| |
Collapse
|