REPERCUSSÕES DA COVID-19 NA MORTALIDADE MATERNA NO ESTADO DO MATO GROSSO DO SUL

Abstract

Introduction: The clinical-epidemiological profile for women and pregnant women in the COVID-19 pandemic had repercussions on morbidity and mortality that were understood from the second two months onwards and after the first “wave” of the disease, when evidence about the relationship between changes in pregnancy and puerperal demonstrated an increase in incidence of deaths for this growing portion of the population. Objective: To analyze the repercussions on the epidemiological profile of maternal mortality after the start of the COVID-19 pandemic. Method: Two methodological stages were carried out. The first was an integrative review of mortality during the COVID-19 pandemic at a global level through data collection in a structured protocol using the P (population), V (variable of interest), and O (outcome). The second stage was an observational study with a cross-sectional, quantitative design to analyze maternal mortality in the state of Mato Grosso do Sul (MS), two years before the pandemic (2018 and 2019) and two years after its start (2020 and 2021), with data obtained from the State Department of Health database from Maternal Death Declarations and Maternal Death Investigation Forms: summary, conclusions, and recommendations (Sheet M5). The data were tabulated in Microsoft Excel, and, with the help of the statistical software R-Studio, socioeconomic characteristics were analyzed, as well as general ones, such as comorbidities, death during pregnancy or postpartum period, place of occurrence, necropsy, macro-region, and the period of occurrence of the death, with the application of the chi-square test. The Maternal Mortality Ratio (MMR) and the Potential Years of Life Lost (YPLL) were also analyzed. Prevalence for the period of death and unadjusted prevalence ratios were calculated using the Poisson regression model. Results: In the first stage, 15 publications were selected, which occurred between the years 2020 and 2022, with the highest proportion in the year 2021. Two articles highlighted the epidemiological weeks and peaks in maternal deaths between epidemiological weeks 17 and 30 of the year 2020. The studies showed an increase in the MMR between the years 2020 and 2021. The risk and lethality rate were identified as increasing, and the clinical profile of maternal deaths was related to the age group over 35 years old and pre-existing comorbidities. Only one study linked iron deficiency with clinical worsening. In the second stage, 118 maternal deaths were analyzed; 51 occurred between 2018 and 2019 and 67 between 2020 and 2021. The MMR increased from 57.97 to 80.25. The PYLL increased from 1,774.41 to 2,237.34. Postpartum women had high mortality rates. Respiratory disease had a prevalence ratio of 2.18 (CI = 1.34–3.52). The results highlight the vulnerability of women in the pregnancy and puerperal cycle to diseases with high contagion and high virulence, such as COVID-19. Conclusion: Maternal deaths were impacted by the emergence of the pandemic, increasing the MMR, which had been declining in previous years. It was demonstrated with statistical tests that respiratory diseases were influential in deaths. Pregnant women and especially postpartum women should be prioritized globally, and in the state of MS, with health actions to expand assistance and prevent diseases for this population, regarding the emergence of highly transmissible diseases.