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Maternal deaths with coronavirus disease 2019: a different outcome from low- to middle-resource countries?

2020; Elsevier BV; Volume: 223; Issue: 2 Linguagem: Inglês

10.1016/j.ajog.2020.04.023

1097-6868

Melânia Maria Ramos Amorim, Maíra Libertad Soligo Takemoto, Eduardo Borges da Fonseca,

Maternal Mental Health During Pregnancy and Postpartum

Physiological adaptations in normal pregnancy increase the susceptibility of mothers to microorganisms (bacteria and viruses) and their products. In particular, activation of the innate limb of immune response is thought to increase generation of reactive oxygen radicals by granulocytes and monocytes1Naccasha N. Gervasi M.T. Chaiworapongsa T. et al.Phenotypic and metabolic chacateristics of monocytes and granulocytes in normal pregnancy and maternal infection.Am J Obstet Gynecol. 2001; 185: 1118-1123Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar and predisposes to a cytokine storm. This has been invoked to explain the increased fatality rate of pregnant women affected by severe acute respiratory syndrome (SARS), Middle East respiratory syndrome, ebola, influenza, and H1N1.2Rasmussen S.A. Smulian J.C. Lednicky J.A. Wen T.S. Jamieson D.J. Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know.Am J Obstet Gynecol. 2020; ([Epub ahead of print])Abstract Full Text Full Text PDF PubMed Scopus (766) Google Scholar,3Cirelli J.F. Surita F.G. Costa M.L. Parpinelli M.A. Haddad S.M. Cecatti J.G. The burden of indirect causes of maternal morbidity and mortality in the process of obstetric transition: A cross-sectional multicenter study. A importâcia das causas indiretas da morbidade e mortalidade maternas no processo de transição obstétrica: um estudo multicêntrico transversal.Rev Bras Ginecol Obstet. 2018; 40: 106-114PubMed Google Scholar During the H1N1 pandemic, pregnancy, childbirth, and the postpartum period were considered risk factors for disease worsening and maternal death. In Brazil, H1N1 influenza was the main cause of indirect maternal death in 2009–2010.3Cirelli J.F. Surita F.G. Costa M.L. Parpinelli M.A. Haddad S.M. Cecatti J.G. The burden of indirect causes of maternal morbidity and mortality in the process of obstetric transition: A cross-sectional multicenter study. A importâcia das causas indiretas da morbidade e mortalidade maternas no processo de transição obstétrica: um estudo multicêntrico transversal.Rev Bras Ginecol Obstet. 2018; 40: 106-114PubMed Google Scholar However, in the case of coronavirus disease 2019 (COVID-19) and on the basis of a few case series from China, Europe, and the United States, it is thought that pregnant women may not be more likely to experience severe symptoms from this disease than the general population and there were no reported maternal deaths.2Rasmussen S.A. Smulian J.C. Lednicky J.A. Wen T.S. Jamieson D.J. Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know.Am J Obstet Gynecol. 2020; ([Epub ahead of print])Abstract Full Text Full Text PDF PubMed Scopus (766) Google Scholar A new picture may now be emerging from Brazil, Iran, and Mexico, raising the possibility of increased risk of maternal death from COVID-19; in Brazil there is evidence of 5 maternal deaths out of 1947 total deaths from COVID-19, in Iran 2 of 3800,4Karimi-Zarchi M. Neamatzadeh H. Dastgheib S.A. et al.Vertical transmission of coronavirus Disease 19 (COVID-19) from infected pregnant mothers to neonates: a review.Fetal Pediatr Pathol. 2020; 0 ([Epub ahead of print]): 1-5Crossref Scopus (3) Google Scholar and in Mexico 2 of 486 (Table). It is therefore possible that in developing as opposed to developed countries, high birth rates and limited resources for healthcare provision will uncover the increased risk for maternal death because of COVID-19 and emphasize the need for appropriate measures for adequate prenatal and postnatal care. At the present time, professional organizations have not emphasized that pregnant women exposed to severe acute respiratory syndrome coronavirus 2 may be at an increased risk for adverse outcome; however, it is important that obstetricians and gynecologists be aware that data from countries other than the USA and Europe seem to suggest an increased risk to pregnant mothers. We hope that the scientific community remains open minded and vigilant about this.TableCoronavirus disease 2019-related maternal deaths worldwide until April 10, 2020CountryMaternal deathsSymptoms onsetMoment of deathComorbiditiesSourceIran2 of 3800 reported total deathsPregnancyPostpartumNot reportedKarimi-Zarchi et al 2020Brazil5 of 1947 reported total deathsNot reportedPostpartumaMode of delivery: elective cesarean deliveryNot reportedBrazilian Ministry of HealthNot reportedPostpartumaMode of delivery: elective cesarean deliveryNot reportedBrazilian Ministry of HealthPostpartum (6 days after elective cesarean delivery)Postpartum (7 days)AbsentLocal mediabhttps://www.folhadelondrina.com.br/geral/mulher-de-28-anos-morre-por-covid-19-sete-dias-apos-parto-na-bahia-2985448e.htmlPregnancy (admitted 32 weeks, emergency CS 2 days later)Postpartum (2 days)AbsentLocal mediachttps://epoca.globo.com/brasil/gravida-morre-de-covid-19-em-recife-bebe-sobrevive-24353787Pregnancy (admitted 32 weeks, emergency CS)PostpartumAbsentLocal mediadhttps://www.agazeta.com.br/brasil/no-rio-mulher-morre-de-covid-19-dez-dias-apos-dar-a-luz-prematuramente-0420Mexico2 of 486 reported total deathsPregnancy (35 weeks)PostpartumObesity, hypertensionLocal mediaeLópez-Gatell: Desafortunadamente mueren dos embarazadas por covid-19 | CNN [Internet]. 2020 [cited 2020 Apr 10]. Available from: https://cnnespanol.cnn.com/video/mueren-mujeres-embarazadas-covid-coronavirus-mexico-gatell-informe-sot-perspectivas-mexico.Not reportedNot reportedObesity, gestational diabetesMexico Ministry of HealthAmorim. Maternal deaths with COVID-19. Am J Obstet Gynecol 2020.a Mode of delivery: elective cesarean deliveryb https://www.folhadelondrina.com.br/geral/mulher-de-28-anos-morre-por-covid-19-sete-dias-apos-parto-na-bahia-2985448e.htmlc https://epoca.globo.com/brasil/gravida-morre-de-covid-19-em-recife-bebe-sobrevive-24353787d https://www.agazeta.com.br/brasil/no-rio-mulher-morre-de-covid-19-dez-dias-apos-dar-a-luz-prematuramente-0420e López-Gatell: Desafortunadamente mueren dos embarazadas por covid-19 | CNN [Internet]. 2020 [cited 2020 Apr 10]. Available from: https://cnnespanol.cnn.com/video/mueren-mujeres-embarazadas-covid-coronavirus-mexico-gatell-informe-sot-perspectivas-mexico. Open table in a new tab Amorim. Maternal deaths with COVID-19. Am J Obstet Gynecol 2020. The authors thank the members of the Brazilian group of COVID-19 and pregnancy for all efforts in searching this reliable information (Carla Betina Andreucci, MD, PhD; Mariane de Oliveira Menezes, CPM, MSc; Leila Katz, MD, PhD; Roxana Rnobel, MD, PhD; and Adriana Melo, MD, PhD). This communication has been published in the middle of the COVID-19 pandemic and is available via expedited publication to assist patients and healthcare providers.