Objective COVID-19 in post-partum women is commonly overlooked. The present study assessed whether puerperium is an independent risk factor of COVID-19 related in-hospital maternal death and whether fatality is preventable in the Brazilian context. Methods We retrospectively studied the clinical data of post-partum/pregnant patients hospitalized with COVID-19 gathered from a national database that registered severe acute respiratory syndromes (SIVEP-Gripe) in Brazil. Logistic regressions were used to examine the associations of in-hospital mortality with obstetric status and with the type of public healthcare provider, adjusting for socio-demographic, epidemiologic, clinical and healthcare-related measures. Results As of 30 November 2021, 1943 (21%) post-partum and 7446 (79%) pregnant patients of age between 15 and 45 years with COVID-19 that had reached the clinical endpoint (death or discharge) were eligible for inclusion. Case-fatality rates for the two groups were 19.8% and 9.2%, respectively. After the adjustment for covariates, post-partum patients had almost twice the odds of in-hospital mortality compared with pregnant patients. Patients admitted to private (not-for-profit) hospitals, those that had an obstetric centre or those located in metropolitan areas were less likely to succumb to SARS-CoV-2 infection. Those admitted to the Emergency Care Unit had similar mortality risk to those admitted to other public healthcare providers. Conclusion We demonstrated that puerperium was associated with an increased odds of COVID-19-related in-hospital mortality. Only part of the risk can be reduced by quality healthcare such as non-profit private hospitals, those that have an obstetric centre or those located in urban areas.

中文翻译：

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更好的医疗保健可以降低 COVID-19 住院产后孕产妇死亡的风险：来自巴西的证据

客观 COVID-19 在产后女性中经常被忽视。本研究评估了产褥期是否是与 COVID-19 相关的院内孕产妇死亡的独立危险因素，以及在巴西情况下死亡是否可以预防。方法 我们回顾性研究了从巴西登记严重急性呼吸综合征 (SIVEP-Gripe) 的国家数据库中收集的因 COVID-19 住院的产后/怀孕患者的临床数据。使用逻辑回归来检查院内死亡率与产科状况和公共医疗保健提供者类型的关联，并调整社会人口统计学、流行病学、临床和医疗保健相关措施。结果 截至 2021 年 11 月 30 日，1943 名 (21%) 名产后和 7446 名 (79%) 年龄在 15 至 45 岁之间的已达到临床终点（死亡或出院）的 COVID-19 孕妇有资格纳入。两组病死率分别为 19.8% 和 9.2%。调整协变量后，产后患者的院内死亡率几乎是怀孕患者的两倍。入住私立（非营利）医院、设有产科中心或位于大都市地区的患者死于 SARS-CoV-2 感染的可能性较小。入住急诊室的患者与入住其他公共医疗机构的患者具有相似的死亡风险。结论 我们证明产褥期与 COVID-19 相关的院内死亡率增加有关。通过优质医疗保健（例如非营利性私立医院、拥有产科中心或位于城市地区的医院）只能降低部分风险。