Fatores associados à gravidade e à letalidade materna em mulheres internadas por COVID-19 no estado do Ceará, 2020 e 2021

Abstract

The objective of this study was to identify the factors associated with Covid-19 severity and death in pregnant and postpartum women hospitalized in the stateof Ceará in the years 2020 and 2021. This is a cross-sectional study of a secondary database containing 1,105 cases of pregnant and postpartum women hospitalized for Covid-19. STATA 15.1® was used for data description and analysis, considering a significance level of 95%. For variables with p-value less than 0.25 in the bivariate analysis we performed a multivariate analysis using robust Poisson regression. Skin color brown (RP: 0.53; 95%CI: 0.33-0.83; p=0.005) and not using ventilatory support (RP=0.08; 95%CI: 0.01-0.42; p=0.003) were protective for death. On the other hand, having been admitted to cities without a regional hospital (RP= 2.98; 95%CI: 1.85-4.8; p<0.001), being in puerperium (RP= 3.25; 95%CI: 2.10-5.01; p<0.001), presenting O2 saturation lower than 95% (RP= 3.27; 95%CI: 1.55-6.89; p=0.002) and making use of invasive ventilatory support (PR= 3.55; 95% CI: 2.09-6.01; p<0.001) were related to higher lethality in the study population. Hospitalization in the year 2021 (RR=1.54; 95%CI: 1.20-1.97) and during the second wave (RR=1.50; 95% CI: 1.16-1.94) were significantly associated with severity. Hospitalization in the municipality of Sobral (RP= 0.61; 95%CI: 0.43-0.86; p=0.005) was a protective factor for severity, while hospitalization during the second wave (RP=1.63; 95%CI: 1.27-2.09; p<0.001), puerperium (RP= 2.27; 95%CI: 1.79- 2, 88; p<0.001), presence of fever (PR= 1.44; 95%CI: 1.06-1.97; p=0.019), dyspnea (PR= 2.81; 95%CI: 1.91-4.12; p=0.001) and saturation <95% (PR= 1.49; CI: 1.12-1.99; p=0.006) increased the prevalence of severity in obstetric patients. Ceará stood out in number of cases and maternal deaths in Brazil. Social inequities are prevalent and challenging and interfere with maternal health, knowing the factors that associate with unfavorable maternal outcomes can help direct