Factors associated with the evolution of COVID-19 in pregnant women: a Brazilian population-based study

Andrade, Luis Henrique de; Santos, Gustavo Gonçalves dos; Sordi, Mônica Aparecida de Paula de; Nunes, Hélio Rubens de Carvalho; Parada, Cristina Maria Garcia de Lima

doi:10.1590/1980-220X-REEUSP-2023-0042en

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 57 • 2023 • https://doi.org/10.1590/1980-220X-REEUSP-2023-0042en copy

Factors associated with the evolution of COVID-19 in pregnant women: a Brazilian population-based study^* * Extracted from the dissertation: “Risk factors associated with the severe evolution of COVID-19 in pregnant women: a population-based study”, Universidade Estadual Paulista “Júlio de Mesquita Filho”, 2023.

Factores asociados a la evolución de la COVID-19 en mujeres embarazadas: un estudio poblacional brasileño

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To assess the evolution of COVID-19 among Brazilian pregnant women, identifying sociodemographic and clinical predictors related to admission to ICU - Intensive Care Unit and death.

Method:

Cross-sectional, population-based study, carried out with a secondary database, based on data from the Influenza Epidemiological Surveillance Information System. Descriptive analysis was performed, followed by multiple linear regression with Poisson response, adopting critical p < 0.05.

Results:

Intensive care admission rates of 28.2% and death rates of 9.5% were identified. Region of residence, gestational trimester, number of comorbidities and respiratory signs and symptoms were associated with the risk of admission to intensive care. Age over 34 years, comorbidities, oxygen saturation equal to or less than 95%, admission to intensive care and ventilatory support, invasive or not, increased the risk of death.

Conclusion:

Sociodemographic and clinical predictors showed an association with hospitalization in intensive care and death of pregnant women with COVID-19.

DESCRIPTORS
COVID-19; Pregnancy Complications; Infectious; Pregnancy; Hospitalization; Maternal Death; Intensive Care Units

Characteristics	No	%
Age (years)
≤ 19	440	7.0
20–34	4148	66.1
>34	1688	26.9
Skin color
Brown	3143	50.1
White or yellow	2722	43.3
Black	362	5.8
Indigenous	49	0.8
Region of residence
Southeast	2464	39.3
North East	1313	20.9
South	1053	16.8
North	766	12.2
Midwest	680	10.8
Gestational trimester
First	564	9.0
Second	1765	28.1
Third	3947	62.9
Number of comorbidities
0	4903	78.1
1	1027	16.4
2	266	4.2
≥ 3	80	1.3
Number of signs and symptoms
0–1	1451	23.1
2–4	3805	60.6
≥ 5	1020	16.3
Respiratory symptoms
Dyspnea
No	2593	41.3
Yes	3683	58.7
Respiratory distress
No	3348	53.3
Yes	2928	46.7
Oxygen saturation ≤ 95%
No	3887	61.9
Yes	2389	38.1
Ventilatory support
No	3068	48.9
Yes, non-invasive	2418	38.5
Yes, invasive	790	12.6
Evolution	6276	100
ICU
No	4507	71.8
Yes	1769	28.2
Death
No	5679	90.5
Yes	597	9.5

Prevalences	No	%
Comorbidities	1790	28.5
Diabetes	480	7.6
Obesity	404	6.4
Heart disease	356	5.7
Asthma	226	3.6
Immunosuppression	60	1.0
Hypertensive syndrome	57	0.9
Neurological disease	38	0.6
Lung disease	35	0.6
Kidney disease	34	0.5
Hematological disease	27	0.4
Hypothyroidism	20	0.3
Anemia	14	0.2
Liver disease	13	0.2
Syphilis	8	0.1
Down’s syndrome	5	0.1
Cancer	5	0.1
Arthritis	4	0.1
Thrombosis	4	0.1
Signs and symptoms	16625	264.8
Cough	4466	71.2
Fever	3527	56.2
Odynophagia	1436	22.9
Fatigue	1346	21.4
Loss of smell	1058	16.9
Loss of taste	875	13.9
Myalgia	868	13.8
Nausea or vomiting	794	12.7
Diarrhea	694	11.1
Runny nose	458	7.3
Abdominal pain	443	7.1
Asthenia	140	2.2
Chest pain	110	1.8
Nasal congestion	102	1.6
Backache	66	1.1
Chills	54	0.9
Lack of appetite	53	0.8
Flu like symptoms	50	0.8
Tachycardia	22	0.4
Retro orbital pain	18	0.3
Pain in lower abdomen	17	0.3
Vaginal bleeding	14	0.2
Otalgia	5	0.1
Dysuria	5	0.1
Sweating	4	0.1

Variable	Bivariate analysis			Multiple regression
Variable	RR	CI95%	P	RR	CI95%	P
Age years)
> 34	1.23	1.11–1.36	<0.001	1.09	0.98–1.21	0.100
≤ 19	0.61	0.48–0.77	<0.001	0.78	0.62–0.99	0.044
20–34	1
Skin color
Indigenous	0.39	0.17–0.87	0.021	0.73	0.32–1.65	0.452
Black	0.89	0.72–1.09	0.255
Brown	0.82	0.74–0.90	<0.001	0.94	0.84–1.06	0.324
White/yellow	1
Region
Southeast	1.49	1.26–1.75	<0.001	1.25	1.04–1.49	0.016
South	1.23	1.02–1.48	0.034	1.02	0.83–1.27	0.821
Midwest	1.21	0.98–1.48	0.079	1.04	0.84–1.29	0.701
North East	1.02	0.84–1.23	0.855	1.22	1.01–1.47	0.042
North	1
Gestational trimester
Third	1.30	1.08–1.58	0.007	1.41	1.16–1.70	<0.001
Second	1.60	1.31–1.95	<0.001	1.09	1.15–1.71	0.001
First	1
Number of comorbidities	1.30	1.22–1.38	<0.001	1.14	1.07–1.22	<0.001
Respiratory symptoms
Dyspnea	2.79	2.49–3.14	<0.001	1.79	1.56–2.04	<0.001
Respiratory distress	1.95	1.77–2.15	<0.001	1.14	1.03–1.28	0.015
Oxygen saturation < 95%	2.97	2.69–3.27	<0.001	2.12	1.89–2.38	<0.001
Number of signs/symptoms	1.01	0.98–1.04	0.422

Variable	Bivariate analysis			Logistic regression
Variable	RR	CI95%	P	RR	CI95%	P
Age years)
> 34	1.49	1.25–1.76	<0.001	1.21	1.02–1.44	0.027
≤ 19	0.55	0.36–0.86	0.008	0.89	0.57–1.39	0.605
20–34	1
Color
Indigenous	0.94	0.35–2.53	0.905	1.25	0.45–3.48	0.671
Black	1.27	0.91–1.78	0.156	1.17	0.83–1.65	0.360
Brown	1.16	0.98–1.38	0.079	1.14	0.93–1.39	0.213
White/yellow	1
Region
Southeast	0.84	0.66–1.06	0.148	0.72	0.55–0.94	0.016
South	0.65	0.48–0.87	0.004	0.60	0.42–0.84	0.003
Midwest	0.76	0.55–1.05	0.098	0.80	0.58–1.11	0.179
North East	0.67	0.51–0.89	0.005	0.84	0.63–1.11	0.219
North	1
gestational trimester
Third	0.83	0.62–1.09	0.177
Second	1.12	0.84–1.50	0.432
First	1
Number of comorbidities	1.48	1.34–1.63	<0.001	1.17	1.06–1.30	0.003
Respiratory symptoms
Dyspnea	3.05	2.48–3.74	<0.001	1.08	0.86–1.35	0.531
Respiratory distress	2.49	2.09–2.96	<0.001	1.15	0.94–1.39	0.169
Oxygen saturation ≤95%	3.77	3.16–4.49	<0.001	1.24	1.01–1.53	0.038
Number of signs and symptoms	0.96	0.92–1.01	0.097	0.94	0.89–0.99	0.010
Intensive care admission	9.43	7.75–11.47	<0.001	2.49	1.93–3.21	<0.001
Ventilatory support
Yes, invasive	27.54	20.72–36.62	<0.001	10.25	7.11–14.8	<0.001
Yes, non-invasive	3.76	2.76–5.12	<0.001	2.44	1.73–3.43	<0.001
No	1

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Luis Henrique de Andrade, Av. Prof. Montenegro S/N, Jardim Botucatu, 18618-687 – Botucatu, SP, Brazil, lh.andrade@unesp.br