Maternal and perinatal health indicators in Brazil over a decade: assessing the impact of the COVID-19 pandemic and SARS-CoV-2 vaccination through interrupted time series analysis

Rita Carvalho-Sauer; Maria da Conceição Nascimento Costa; Maria Gloria Teixeira; Renzo Flores-Ortiz; Jessidenes Teixeira de Freitas Mendes Leal; Ramon Saavedra; Enny S Paixao

doi:10.1016/j.lana.2024.100774

Maternal and perinatal health indicators in Brazil over a decade: assessing the impact of the COVID-19 pandemic and SARS-CoV-2 vaccination through interrupted time series analysis

Lancet Reg Health Am. 2024 May 23:35:100774. doi: 10.1016/j.lana.2024.100774. eCollection 2024 Jul.

Authors

Rita Carvalho-Sauer¹, Maria da Conceição Nascimento Costa², Maria Gloria Teixeira², Renzo Flores-Ortiz³, Jessidenes Teixeira de Freitas Mendes Leal⁴, Ramon Saavedra¹, Enny S Paixao⁵

Affiliations

¹ State Health Department of Bahia, Institute of Collective Health of the Federal University of Bahia, Brazil.
² Institute of Collective Health of the Federal University of Bahia, Brazil.
³ Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Brazil.
⁴ Municipal Health Department of Salvador, Institute of Collective Health of the Federal University of Bahia, Brazil.
⁵ London School of Hygiene and Tropical Medicine, England.

Abstract

Background: Few studies have evaluated the effects of the Coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, on maternal and perinatal health at a populational level. We investigated maternal and perinatal health indicators in Brazil, focusing on the effects of the COVID-19 pandemic, and SARS-CoV-2 vaccination campaign for pregnant women.

Methods: Utilizing interrupted time series analysis (January 2013-December 2022), we examined Maternal Mortality Ratio, Perinatal Mortality Rate, Preterm Birth Rate, Cesarean Section Rate, and other five indicators. Interruptions occurred at the pandemic's onset (March 2020) and pregnant women's vaccination (July 2021). Results were expressed as percent changes on time series' level and slope.

Findings: The COVID-19 onset led to immediate spikes in Maternal Mortality Ratio (33.37%) and Perinatal Mortality Rate (3.20%) (p < 0.05). From March 2020 to December 2022, Cesarean Section and Preterm Birth Rates exhibited upward trends, growing monthly at 0.13% and 0.23%, respectively (p < 0.05). Post start of SARS-CoV-2 vaccination (July 2021), Maternal Mortality Ratio (-34.10%) and Cesarean Section Rate (-1.87%) promptly declined (p < 0.05). Subsequently, we observed a monthly decrease of Maternal Mortality Ratio (-9.43%) and increase of Cesarean Section Rate (0.25%) (p < 0.05), while Perinatal Mortality Rate and Preterm Birth Rate showed a stationary pattern.

Interpretation: The pandemic worsened all analyzed health indicators. Despite improvements in Maternal Mortality Ratio, following the SARS-CoV-2 vaccination campaign for pregnant women, the other indicators continued to sustain altered patterns from the pre-pandemic period.

Funding: No funding.

Keywords: Apgar score; COVID-19; Cesarean section; Health status indicators; Interrupted time series analysis; Low birth weight; Maternal mortality; Perinatal mortality; Premature birth; Respiratory distress syndrome; SARS-CoV-2.