Factors Associated with Severe Acute Respiratory Syndrome in Pregnant/Postpartum Women with COVID-19 Receiving Care at Referral Centers in Northeastern Brazil: A Cohort Study

Background: The physiological changes of pregnancy increase the risk of contracting COVID-19 and of developing its complications; nevertheless, knowledge on the clinical course of the disease is limited. This study analyzed factors associated with severe acute respiratory syndrome (SARS) in pregnant/postpartum women with COVID-19.Methods: A prospective and retrospective cohort study was conducted in eight referral centers in northeastern Brazil between April 2020 and December 2021 involving pregnant/postpartum women with a positive COVID-19 RT-PCR test. Statistical analysis was performed using Epi-Info, version 7.2.5, and Medcalc, version 20.112.Findings: Of 611 patients included, 522 were pregnant and 83 were postpartum, at the time of admission. Criteria for SARS were present in 215 patients (35·2%). Factors associated with SARS included overweight and/or obesity (adjusted odds ratio/AOR: 1·95; 95%CI: 1·21–3·12; p=0·0054), parity ≥2 (AOR: 1·72; 95%CI: 1·21–2·45; p=0·0025), gestational age <34 weeks (AOR: 3·54; 95%CI: 2·47–5·07; p7 days (AOR: 1·97; 95%CI: 1·35–2·89; p=0·0004). SARS increased the likelihood of requiring oxygen therapy (RR=8·80; 95%CI: 6·25–12·40; p=0·0000), mechanical ventilation (RR=8·15; 95%CI: 4·67–14·21; p=0·0000), and admission to an ICU (RR=6·54; 95%CI: 4·70–9·11; p=0·0000), and of maternal near miss (RR=10·82; 95%CI: 1·20–22·47; p=0·0000) and maternal death (RR=8·12; 95%CI: 3·11–21·09; p=0·0000).Interpretation: In patients with COVID-19, parity ≥2, overweight/obesity, gestational age 7 days increased the risk of SARS. Cesarean sections, oxygen therapy, and mechanical ventilation were more common in patients with SARS.Funding: National Council for Scientific and Technological Development (CNPq).Declaration of Interest: None to declare. Ethical Approval: The institutional review board approved the study protocol under reference CAAE58466822.0.0000.5201.