# Factors Associated with Maternal Mortality from COVID-19 in Pernambuco, Brazil (2020–2021): A Case–Control Study

## TL;DR

This study identifies factors linked to maternal deaths from COVID-19 in Pernambuco, Brazil, highlighting the postpartum period and low oxygen saturation as key risks.

## Contribution

The study provides a regional analysis of maternal mortality from COVID-19, identifying specific clinical and sociodemographic risk factors in Pernambuco.

## Key findings

- The postpartum period was strongly associated with maternal death from COVID-19.
- Low oxygen saturation and higher parity increased the risk of death.
- Fever was found to be a possible protective factor against maternal death.

## Abstract

Background: The COVID-19 pandemic has contributed to the increase in maternal mortality due to the direct effects of the viral infection and the indirect effects caused by the overload of health services, and the resulting economic and social crises. This study aims to analyze sociodemographic, gestational, and clinical factors associated with maternal deaths from COVID-19 in Pernambuco between 2020 and 2021. Method: The study included 37 cases (deaths) and 112 controls (survivors). Crude and adjusted odds ratios were estimated using conditional and Firth’s penalized logistic regression models, respectively, to evaluate sociodemographic, gestational, and clinical factors. Results: In the bivariate analysis, the main factors associated with maternal death from COVID-19 were ≤8 years of schooling, the postpartum period, multiparity, oxygen saturation below 95%, obesity, and diabetes mellitus. The presence of fever and cough was associated with a lower probability of death. The independent factors that remained associated with maternal death were the postpartum period (aOR: 80.78; 95% CI: 16.54–394.37), parity ≥ 1 (aOR: 5.74; 95% CI: 1.16–28.22), and oxygen saturation below 95% (aOR: 7.16; 95% CI: 1.37–37.44), with fever acting as a possible protective factor (aOR: 0.08; 95% CI: 0.01–0.42). Factors such as obesity and diabetes were not independent predictors in the final multivariable model. Conclusions: The findings reinforce that maternal death is a multifactorial phenomenon. The relevance of this investigation lies in identifying clinical and obstetric vulnerability profiles in a region heavily impacted by the health crisis. Knowledge gained from past crises contributes to the improvement of public health strategies and clinical management protocols, aiming to mitigate preventable maternal deaths in future public health emergencies.