The COVID-19 pandemic in Brazilian pregnant and postpartum women: results from the REBRACO prospective cohort study
Authors: Souza Renato T. , Cecatti Jose G. , Pacagnella Rodolfo C. , Ribeiro-Do-Valle Carolina C. , Luz Adriana G. , Lajos Giuliane J. , Nobrega Guilherme M. , Griggio Thayna B. , Charles Charles M. , Bento Silvana F. , Silveira Carla , Surita Fernanda G. , Miele Maria J. , Tedesco Ricardo P. , Fernandes Karayna G. , Martins-Costa Sérgio H. A. , Peret Frederico J. A. , Feitosa Francisco E. , Mattar Rosiane , Traina Evelyn , Cunha Filho Edson V. , Vettorazzi Janete , Haddad Samira M. , Andreucci Carla B. , Guida José P. , Correa Junior Mario D. , Dias Marcos A. B. , De Oliveira Leandro , Melo Junior Elias F. , Luz Marília G. Q. , Costa Maria Laura ,   REBRACO Study Group, Souza Renato T. , Costa Maria Laura , Cecatti Jose G. , Pacagnella Rodolfo C. , Ribeiro-do-Valle Carolina C. , Luz Adriana G. , Lajos Giuliane J. , Nobrega Guilherme M. , Griggrio Thayna B. , Charles Charles M. , Bento Silvana F. , Silveira Carla , Surita Fernanda G. , Miele Maria J. , Metelus Sherly , Castro Lester , Pabon Stephanie , Silva Amanda D. , Junior Paulo S. R. , Sardinha Thais G. , Japenga Rodolfo R. , Urquiza Erica R. F. , Machado Maíra R. , Simões Marcela Maria , Solda Larissa M. , Freitas-Jesus Juliana Vasconcellos , Soeiro Rachel Esteves , Tedesco Ricardo P. , Fernandes Karayna G. , Peres Patrícia B. , Arbeli Cristiane L. , Quevedo Rafael M. , Yamashita Carolina F. , Corradin Julia D. , Bergamini Isabella , Martins-Costa Sérgio H. A. , Ramos José Geraldo L. , Oppermann Maria Lúcia R. , Quadro Laisa S. , Marins Lina , Paniz Érika V. , Xavier Thaís Vicentini , Peret Frederico J. A. , Almeida Marina H. L. , Moura Bruna F. V. , França Lidiane R. , Vieira Hanna , Aquino Rafael B. , Costa Aline C. , Feitosa Francisco E. , Pinheiro Daisy , Cordeiro Denise , Miná Priscila L. , Dornellas Carol , Mattar Rosiane , Traina Evelyn , Yazaki-Sun Sue , Mota Priscilla , Soares Arimaza C. , Cunha Filho Edson V , Vettorazzi Janete , Machado Ellen , Bergmann Anne , Santos Gustavo Raupp , Haddad Samira M. , Tosetto Aline , Savazoni Sabrina , Andreucci Carla B. , Parreira Bruna E. , Guida José P. , Correa Junior Mario D. , Leal Caio , Amana Rayra , Dias Marcos A. B. , Nakamura-Pereira Marcos , Guerra Bruna O. , Gorga Gabriela , De Oliveira Leandro , Oliveira Kevin F. A. , Makyama Mariana Emi Varicoda , Melo Junior Elias F. , Leite Débora F. , Monteiro Isabella , Luz Marília G. Q. , Pereira Isabela R. , Salustrino Clélia Andrade , Pontes Valéria B. , Silva Franco Roberto Allen , Bilibio João Paolo , Brito Gislânia P. F. , Pinto Hana Paula C. , Oliveira Danielle Leal , Guerra Andrezza A. , Moura Andrea O. , Pantoja Natasha , David Fernanda , Silva Alina 
Published: July 2022

Brazil presented a very high number of maternal deaths and evident delays in healthcare. We aimed at evaluating the characteristics of SARS-CoV-2 infection and associated outcomes in the obstetric population. We conducted a prospective cohort study in 15 Brazilian centers including symptomatic pregnant or postpartum women with suspected COVID-19 from Feb/2020 to Feb/2021. Women were followed from suspected infection until the end of pregnancy. We analyzed maternal characteristics and pregnancy outcomes associated with confirmed COVID-19 infection and SARS, determining unadjusted risk ratios. In total, 729 symptomatic women with suspected COVID-19 were initially included. Among those investigated for COVID-19, 51.3% (n = 289) were confirmed COVID-19 and 48% (n = 270) were negative. Initially (before May 15th), only 52.9% of the suspected cases were tested and it was the period with the highest proportion of ICU admission and maternal deaths. Non-white ethnicity (RR 1.78 [1.04–3.04]), primary schooling or less (RR 2.16 [1.21–3.87]), being overweight (RR 4.34 [1.04–19.01]) or obese (RR 6.55 [1.57–27.37]), having public prenatal care (RR 2.16 [1.01–4.68]), planned pregnancies (RR 2.09 [1.15–3.78]), onset of infection in postpartum period (RR 6.00 [1.37–26.26]), chronic hypertension (RR 2.15 [1.37–4.10]), pre-existing diabetes (RR 3.20 [1.37–7.46]), asthma (RR 2.22 [1.14–4.34]), and anaemia (RR 3.15 [1.14–8.71]) were associated with higher risk for SARS. The availability of tests and maternal outcomes varied throughout the pandemic period of the study; the beginning was the most challenging period, with worse outcomes. Socially vulnerable, postpartum and previously ill women were more likely to present SARS related to COVID-19.