A mortalidade materna no contexto da COVID-19 em Minas Gerais, Brasil

Abstract

Introduction: The COVID-19 pandemic negatively impacted maternal mortality indicators in Brazil. Differential risks in maternal mortality can be observed according to socioeconomic and demographic factors. Objective: Investigate changes in the Maternal Mortality Ratio (MMR) during the COVID-19 pandemic according to sociodemographic, obstetric care and regional characteristics in Minas Gerais, Brazil and the correlation of MMR with socioeconomic indicators of the macro-region of residence. Methods: Ecological time-series study with data from the Mortality Information System. The MMR in 2010-2019 and 2020-2021 was compared according to age, education, race/color, number of prenatal consultations, trimester of prenatal care initiation and health macro-region. The correlation between MMR and socioeconomic variables (Gross Domestic Product per capita, Brazilian Deprivation Index and percentage of young people with incomplete primary education) of the macro-region was evaluated using the Pearson coefficient. Additionally, we describe the percentage increase in maternal deaths after investigating the deaths of women of childbearing age and how this changed the distribution of causes of maternal deaths in both periods. Results: 1,488 death certificates were evaluated. The MMR increased by 62.5% during the pandemic, especially in women aged 20 to 34 years (64.5%), with lower education (134.9%), white race/color (77.7%), with fewer prenatal consultations (102.2%), who started prenatal care in the first trimester (58.1%) and residents in the Northwest macro-region (241%). However, the MMR were higher in women aged 35 years or older (125.1 per 100,000 live births), black women (90.5), with lower education (151.5), fewer prenatal consultations (181 .2) and residents in the Northeast macro-region (122.3). The MMR increased with the increase in the Brazilian Deprivation Index (R=0.73; p=0.0029) and reduced with the increase in education (R=0.68; p=0.0079) in 2010-2019. We did not find correlations between socioeconomic indicators and MMR during the pandemic. In 2020-2021, indirect causes of maternal deaths predominated (54.5%), due to COVID-19, responsible for 40.2% of the total causes of deaths. The percentage of deaths of women of childbearing age investigated was 94% (2010-2019) and 92.8% (2020-2021) and the increase in maternal deaths after the investigation was 35.7% (2010-2019) and 70.6% (2020-2021). Conclusions: Deaths from COVID-19 caused a significant increase in the MMR. Groups with lower MMR experienced greater changes in MMR during the pandemic period. In new health crises, recognizing pregnant and postpartum women as a risk group in the face of epidemics related to respiratory infections, continuous monitoring of cases and deaths in the obstetric population, and prioritization in vaccination campaigns are among the measures that could reduce maternal deaths.