Bahia State Health Department, Núcleo Regional de Saúde Leste, Avenida Esperança, 406. Maria Preta. Santo Antônio de Jesus., 44435-500, Bahia, Brazil.
Institute of Collective Health, Federal University of Bahia, Bahia, Brazil.
BMC Pregnancy Childbirth. 2023 May 5;23(1):320. doi: 10.1186/s12884-023-05601-w.
Fetal loss is one of the most serious adverse outcomes of pregnancy. Since the onset of the COVID-19 pandemic, Brazil has recorded an unprecedented number of hospitalizations of pregnant women due to acute respiratory distress (ARD), thereby, we aimed to assess the risk of fetal deaths associated to ARD during pregnancy in Bahia state, Brazil, in the context of the COVID-19 pandemic.
This is an observational population-based retrospective cohort study, developed with women at or after 20 weeks of pregnancy, residents in Bahia, Brazil. Women who had acute respiratory distress (ARD) in pregnancy during the COVID-19 pandemic (Jan 2020 to Jun 2021) were considered 'exposed'. Women who did not have ARD in pregnancy, and whose pregnancy occurred before the onset of the COVID-19 pandemic (Jan 2019 to Dec 2019) were considered 'non-exposed'. The main outcome was fetal death. We linked administrative data (under mandatory registration) on live births, fetal deaths, and acute respiratory syndrome, using a probabilistic linkage method, and analyzed them with multivariable logistic regression models.
200,979 pregnant women participated in this study, 765 exposed and 200,214 unexposed. We found four times higher chance of fetal death in women with ARD during pregnancy, of all etiologies (adjusted odds ratio [aOR] 4.06 confidence interval [CI] 95% 2.66; 6.21), and due to SARS-CoV-2 (aOR 4.45 CI 95% 2.41; 8.20). The risk of fetal death increased more when ARD in pregnancy was accompanied by vaginal delivery (aOR 7.06 CI 95% 4.21; 11.83), or admission to Intensive Care Unit (aOR 8.79 CI 95% 4.96; 15.58), or use of invasive mechanical ventilation (aOR 21.22 CI 95% 9.93; 45.36).
Our findings can contribute to expanding the understanding of health professionals and managers about the harmful effects of SARS-CoV-2 on maternal-fetal health and alerts the need to prioritize pregnant women in preventive actions against SARS-CoV-2 and other respiratory viruses. It also suggests that pregnant women, infected with SARS-CoV-2, need to be monitored to prevent complications of ARD, including a careful assessment of the risks and benefits of early delivery to prevent fetal death.
流产是妊娠最严重的不良结局之一。自 COVID-19 大流行以来，巴西因急性呼吸窘迫（ARD）而住院的孕妇数量前所未有，因此，我们旨在评估巴西巴伊亚州 COVID-19 大流行期间妊娠合并 ARD 与胎儿死亡的风险。
这是一项观察性基于人群的回顾性队列研究，研究对象为妊娠 20 周或以上、居住在巴西巴伊亚州的妇女。妊娠合并急性呼吸窘迫（ARD）的妇女被视为“暴露”。妊娠期间未发生 ARD，且妊娠发生在 COVID-19 大流行之前（2019 年 1 月至 2019 年 12 月）的妇女被视为“非暴露”。主要结局是胎儿死亡。我们使用概率链接方法将活产、胎儿死亡和急性呼吸窘迫综合征的行政数据（强制性登记）进行了链接，并使用多变量逻辑回归模型对其进行了分析。
共有 200979 名孕妇参与了这项研究，其中 765 名暴露，200214 名未暴露。我们发现，妊娠合并 ARD 的所有病因（调整后的优势比[aOR] 4.06 95%置信区间[CI] 2.66；6.21）和 SARS-CoV-2 导致的胎儿死亡的几率高 4 倍。妊娠合并 ARD 时，阴道分娩（aOR 7.06 95%CI 4.21；11.83）、入住重症监护病房（aOR 8.79 95%CI 4.96；15.58）或使用有创机械通气（aOR 21.22 95%CI 9.93；45.36）时，胎儿死亡的风险增加更多。
我们的研究结果有助于扩大卫生专业人员和管理人员对 SARS-CoV-2 对母婴健康的有害影响的认识，并提醒需要优先为孕妇提供预防 SARS-CoV-2 和其他呼吸道病毒的措施。它还表明，感染 SARS-CoV-2 的孕妇需要进行监测，以预防 ARD 的并发症，包括仔细评估早期分娩的风险和益处，以防止胎儿死亡。
