The high rate of pregnant women dying from COVID-19 is worrying in Brazil: what is the cause?

The impact of COVID-19 on pregnant women did not include this group among those most at risk of contracting the disease during the first wave of the pandemic. However, in the second year of SARS-CoV-2 progression worldwide, whether during pregnancy or postpartum, many infected women suffer from serious illness. And a percentage dies.

In Brazil, more than 1,600 pregnant or postpartum women have succumbed to respiratory disease since the start of the pandemic, according to the Brazilian Obstetrics Observatory.

“Before the start of the pandemic, we already had a maternal mortality rate of 55.3 per 100,000 live births, which is considered extremely high,” said Rossana Pulcineli Vieira Francisco, professor in the Department of Obstetrics and Health. gynecology from the University of São Paulo who is leading the investigation.

And after noting that “it is not possible to say for sure that Brazil is the country where most pregnant and postpartum women die from COVID, because there are not many population studies on the death of COVID among these women, “Francisco added: “We can certainly say that the numbers here are very high.”

Overall, maternal deaths in Brazil were on average 10 per week in the country in 2020, according to an observatory analysis. This year that number has quadrupled to over 40, since mortality in the general population has doubled.

The truth is, the death toll from COVID-19 in Latin America’s most populous country is second highest in absolute terms after the United States, and seventh per capita, according to analysis released by Financial Time.

In the case of pregnant women, experts blame the combination of a strained healthcare system, inadequate and uneven service delivery, lack of experience in treating such patients, and the circulation of a more contagious variant of the virus.

Dr Lílian Cristina Moreira is a pediatrician from Rio de Janeiro and argued that research has shown that about half of pregnant women in some Brazilian states who have died from the coronavirus do not have access to an intensive care unit or intubation. .

“Out of 100 pregnant women diagnosed with COVID, 12 die. It is very big. While in the population, the death rate is 2.8%, ”he said.

Specialists have pointed out that pregnancy suppresses a woman’s immune system, leaving her more vulnerable to infectious diseases, while pressure on the abdominal organs and diaphragm can restrict breathing.. In addition to increased inflammation, the body is under stress.

Although congenital COVID-19 infection is considered rare, mothers without symptoms can pass the virus to newborns. More than 600 Brazilian children under one year old have lost their lives to the disease during the pandemic, according to government data.

Several experts said they did not believe that the Gamma -o P. 1- strain of SARS-CoV-2, which originated in the Amazon, was itself more harmful to pregnant women.. But its higher transmissibility, about double that of previous variants, has caused an increase in infections in recent months that sometimes overwhelms hospitals.

The effective shutdown of many regular health services during the pandemic has also affected the availability of antenatal classes and family planning services, Moreira added, noting: “We believe that pregnant women were more vulnerable due to access to the health system and socio-economic status. Black women and poor women died more ”.

“Even when adequate facilities and equipment are available, medical staff are often not prepared to care for seriously ill pregnant women,” said Marcelo Otsuka, doctor and coordinator of the Brazilian Society of Infectology.

Many health professionals cite the failure of the Brazilian government’s public health policy as a factor. Critics accuse him of being lax, even negligent, in the face of the pandemic that has contributed to its spread.

Faced with growing fears about the delta variant, another highly contagious mutation, experts stress the importance of moving forward with the vaccination of the population (around 14% of the Brazilian population of 212 million is totally immune to the virus).

Brazilian Health Minister Marcelo Queiroga announced last week the resumption of vaccination for pregnant women and new mothers without comorbidity. Notably, inoculations in this group had been limited to people with underlying conditions in May, following the death of a 35-year-old pregnant woman who had been injected with AstraZeneca.

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