# Mortality, intensive care unit admission, and ventilatory support in pregnant and nonpregnant women with COVID-19 in Brazil: a paired observational study

## TL;DR

This study compares the severity of COVID-19 outcomes in pregnant and nonpregnant women in Brazil, finding higher mortality and ICU use in nonpregnant women, with vaccination offering significant protection for pregnant women.

## Contribution

The study introduces a paired observational analysis of pregnant and nonpregnant women with COVID-19 in Brazil, highlighting the protective effect of vaccination in pregnant women.

## Key findings

- Nonpregnant women had higher mortality, ICU admission, and ventilatory support use compared to pregnant women.
- Pregnant women in the second trimester had increased odds of ICU admission compared to nonpregnant women.
- Vaccination significantly reduced ICU admission odds for pregnant women in all trimesters.

## Abstract

To compare mortality, intensive care unit (ICU) admission, and use of invasive ventilatory support in hospitalized pregnant and nonpregnant women with severe acute respiratory syndrome due to Coronavirus-2 in Brazil.

It is a cross-sectional study developed with data from the Brazilian Surveillance of Severe Acute Respiratory Syndrome (SARS), Ministry of Health. Three outcomes were investigated: mortality, ICU admission, and use of invasive ventilatory support among COVID-19 cases. Hospitalized pregnant and nonpregnant women were paired according to age group, geographic region, and epidemiological week (33,113 nonpregnant women; 15,567 pregnant women) from March 2020 to March 2022. Associations between pregnancy status and outcomes were analyzed using conditional logistic regression. For 2021 data, an interaction term with vaccination status (no/yes) was included.

Mortality (17.6 vs 7.9%), ICU admission (30.3 vs 26.1%), and invasive ventilatory support use (46.6 vs 38.5%) were higher among nonpregnant women, respectively. ICU admission was highest in the second trimester of pregnancy (32.6%). Being in the second trimester increased the likelihood of ICU admission (OR=1.26; 95%CI 1.15–1.39) compared to nonpregnant women. The odds of ICU admission was lower among vaccinated pregnant women in the first (OR=0.71; 95%CI 0.51–0.96), second (OR=0.74; 95%CI 0.62–0.88), and third trimesters (OR=0.65; 95%CI 0.57–0.74).

All three outcomes were more frequent among hospitalized nonpregnant women, except for ICU admission in the second trimester. COVID-19 vaccination has proven to be an important protective measure, particularly for pregnant women in the second and third trimesters.