key: cord-0324921-juqe99cx authors: Serra, F. E.; Francisco, R. P. V.; de Rossi, P.; Brizot, M. d. L.; Rodrigues, A. S. title: COVID-19 outcomes in hospitalized puerperal, pregnant, and neither pregnant nor puerperal women: a population study date: 2021-07-31 journal: nan DOI: 10.1101/2021.07.27.21261163 sha: a5e7594313563bfd56225cf70d83277ae828ff6e doc_id: 324921 cord_uid: juqe99cx Objective To 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. Methods A 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 February 17, 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. Results As 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. Conclusion Puerperal 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. 3 d t h e a b i l i t y o f t h e v i r u s t o d i s s e m i n a t e l e d t h e W o r l d H e a l t h O r g a n i z a t i o n ( W H O ) t o d e c l a r e a 4 4 p a n d e m i c s t a t e i n M a r c h 2 0 2 0 [ 1 ] . T h e h i g h i n c i d e n c e h a s h a d a t r e m e n d o u s s o c i o e c o n o m i c i m p a c t 4 5 w o r l d w i d e . O n e d a y p r i o r t o t h e s u b m i s s i o n o f t h i s a r t i c l e ( J u n e 2 8 , 2 0 2 1 ) , g l o b a l l y , t h e r e w e r e 4 6 m o r e t h a n 1 8 0 m i l l i o n c o n f i r m e d c a s e s o f C O V I D -1 9 a n d 3 , 9 2 3 , 2 3 n a n d 5 5 h e a l t h , d i f f i c u l t a c c e s s t o h e a l t h s e r v i c e s , a n d i n s u f f i c i e n t o b s t e t r i c a s s i s t a n c e [ 2 0 , 2 1 ] . 5 6 S o c i o e c o n o m i c h e t e r o g e n e i t y i n B r a z i l i s r e f l e c t e d i n t h e q u a l i t y o f h e a l t h s e r v i c e s a n d i n t h e 5 7 a v a i l a b i l i t y o f h o s p i t a l a n d I C U b e d s , h a v i n g a g r e a t i m p a c t o n h e a l t h i n d i c a t o r s o f b o t h p r e g n a n t 5 8 a n d p u e r p e r a l w o m e n [ 2 2 , 2 3 ] . U n d e r s t a n d i n g t h e d i s e a s e a n d e v a l u a t i n g w h y t h e p r o g n o s e s o f 5 9 p r e g n a n t a n d p u e r p e r a l w o m e n h a v e b e e n w o r s e i n t h i s p a n d e m i c i s r e l e v a n t . W e d i d n o t f i n d a n y 6 0 s t u d i e s c o m p a r i n g d e m o g r a p h i c a n d c l i n i c a l c h a r a c t e r i s t i c s a n d d i s e a s e p r o g r e s s i o n a m o n g 6 1 p r e g n a n t w o m e n , p u e r p e r a l w o m e n , a n d n e i t h e r p r e g n a n t n o r p u e r p e r a l w o m e n h o s p i t a l i z e d w i t h 6 2 C O V I D -1 9 . T h e r e f o r e , t h e a u t h o r s o f t h e p r e s e n t s t u d y a i m t o c o m p a r e p r e g n a n t w o m e n , p u e r p e r a l 6 3 w o m e n , a n d n e i t h e r p r e g n a n t n o r p u e r p e r a l w o m e n a c c o r d i n g t o d a t a r e l a t e d t o t h e S A R S -C o V -2 6 4 i n f e c t i o n b y u s i n g p o p u l a t i o n s t a t i s t i c s f r o m S I V E P -G r i p e ( S y s t e m o f I n f o r m a t i o n a b o u t 6 5 E p i d e m i o l o g i c a l S u r v e i l l a n c e o f I n f l u e n z a ) o f t h e H e a l t h M i n i s t r y o f B r a z i l . 6 6 6 7 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. M a t e r i a l s a n d m e t h o d s 6 8 A r e t r o s p e c t i v e a n a l y s i s o f t h e s t a t i s t i c s f r o m S I V E P -G r i p e , a B r a z i l i a n n a t i o n a l d a t a b a s e c o n t a i n i n g 6 9 s u r v e i l l a n c e d a t a o n s e v e r e a c u t e r e s p i r a t o r y s y n d r o m e ( S A R 2 ) a n d n o n p r e g n a n t w o m e n 9 0 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 31, 2021. t o c o m p a r e t h e s y m p t o m s b e t w e e n g r o u p s , i n c l u d e d a g e , e t h n i c i t y , c h r o n i c c a r d i o v a s c u l a r d i s e a s e , 1 1 4 a s t h m a , d i a b e t e s , i m m u n o s u p p r e s s i o n , a n d o b e s i t y . T h e s e c o n d o n e , c o m p a r i n g t h e o u t c o m e s , 1 1 5 i n c l u d e d t h e s a m e v a r i a b l e s p l u s s c h o o l i n g , F e d e r a t i v e U n i t o f B r a z i l , a n d r e s p i r a t o r y s y m p t o m s . 1 1 6 T h e a n a l y (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 31, 2021. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 31, 2021. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. A r e m a r k a b l e f a c t r e l a t e d t o h o s p i t a l -a c q u i r e d C O V I D -1 9 i s t h a t p r e g n a n t w o m e n d e v e l o p e d t h e 1 5 0 d i s e a s e l e s s f r e q u e n t l (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 31, 2021. T a b l e 4 . C o m p a r i s o n o f t h e d e a t h r a t e s o f p r e g n a n t , p u e r p e r a l , a n d n e i t h e r p r e g n a n t n o r 1 8 8 p u e r p e r a l r e p r o d u c t i v e a g e w o m e n b e f o r e a n d a f t e r p r o p e n s i t y s c o r e m a t c h i n g a c c o r d i n g t o 1 8 9 c o m o r b i d i t i e s , I C U a d m i s s i o n , a n d v e n t i l a t o r y s u p p o r t -B r a z i l , F e b r u a r y 1 7 , 2 0 2 0 -J a n u a r y 0 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. p r e g n a n t w o m e n h a d a n o s m i a a n d d y s g e u s i a s i g n i f i c a n t l y m o r e f r e q u e n t l y t h a n t h e o t h e r t w o 2 2 2 g r o u p s . 2 2 3 I n a s t u d y w i t h t h e B r a z i l i a n p o p u l a t i o n i n v o l v i n g 2 , 4 7 5 p r e g n a n t a n d p u e r p e r a l w o m e n w i t h S A R S , 2 2 4 7 2 s t u d y h a s t h e f o l l o w i n g s t r o n g p o i n t s : 1 ) t h e u s e o f a n a t i o n a l d a t a b a s e w i t h a l a r g e s a m p l e s i z e 2 4 6 n u m b e r a n d n o d u p l i c a t e s ; 2 ) p a t i e n t s w h o w e r e h o s p i t a l i z e d d u e t o s e v e r e a c u t e r e s p i r a t o r y 2 4 7 s y n d r o m e , w h i c h w a s c o n f i r m e d b y t h e R T -P C R l a b o r a t o r y t e s t ; 3 ) d i s c r i m i n a t i o n b e t w e e n p r e g n a n t 2 4 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 31, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 31, 2021. K a s r a e i a n M , Z a r e M , V a f a e i H , A s a d i N , F a r a j i A , B a z r a f s h a n K , e t a l . C O V I D -1 9 p n e u m o n i a a n d 2 9 3 p r e g n a n c y ; a s y s t e m a t i c r e v i e w a n d m e t a -a n a l y s i s . J M a t e r n F e t a l N e o n a t a l M e d . 2 0 2 0 ; 1 -8 . 2 9 4 6 . Z a i g h a m M , A n d e r s s o n O . M a t e r n a l a n d p e r i n a t a l o u t c o m e s w i t h C O V I D -1 9 : A s y s t e m a t i c r e v i e w 2 9 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 1 3 . Z a m b r a n o L D , E l l i n g t o n S , S t r i d P , G a l a n g R R , O d u y e b o T , T o n g V T , e t a l . U p d a t e : C h a r a c t e r i s t i c s 3 1 6 o f S y m p t o m a t i c W o m e n o f R e p r o d u c t i v e A g e w i t h L a b o r a t o r y -C o n f i r m e d S A R S -C o V -2 I n f e c t i o n b y 3 1 7 P r e g n a n c y S t a t u s -U n i t e d S t a t e s , J a n u a r y 2 2 -O c t o b e r 3 , 2 0 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 31, 2021. ; https://doi.org/10.1101/2021.07.27.21261163 doi: medRxiv preprint 2 1 . M e n e z e s M O , T a k e m o t o M L S , N a k a m u r a -P e r e i r a M , K a t z L , A m o r i m M M R , S a l g a d o H O , e t a l . 3 3 8 R i s k f a c t o r s f o r a d v e r s e o u t c o m e s a m o n g p r e g n a n t a n d p o s t p a r t u m w o m e n w i t h a c u t e r e s p i r a t o r y 3 3 9 d i s t r e s s s y n d r o m e d u e t o C O V I D -1 9 i All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 31, 2021. ; https://doi.org/10. 1101 /2021 was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity