Impact of the COVID-19 pandemic on the Maternal Mortality Ratio: a time series study in Bahia, Brazil.

Abstract BackgroundLittle is known about the effects of the COVID-19 pandemic on maternal mortality in Brazil. Therefore the objective of this study is to assess the impact of the COVID-19 pandemic on the maternal mortality in the State of Bahia, Brazil.MethodsThis study used state databases for data on maternal deaths and live births in Bahia, Brazil, from January 1, 2011 to September 30, 2020. The time trend of MMR was analyzed through polynomial regression analysis, of order 6. Predict monthly (Jan-Sep) and annual values,​​for 2020, were estimated by the additive Holt-Winters exponential smoothing algorithm, with 95% confidence interval, and the accuracy MMR forecasts for 2020 was assessed by checking the smoothing coefficients and the mean errors.ResultsBetween January 1 and September 30, 2020, the MMR in Bahia, Brazil, was 79.51/100,000 live births, 60.7% higher than the expected ratio (49.48 [95% CI 60.27-38.70]). The increase on maternal mortality ratio relative to expected values was observed throughout the 2020 months. However, only from May, when the COVID-19 epidemic rose sharply, it exceeded the upper limit of the 95% CI of the monthly prediction. In August, we can observe a dramatical decrease in the maternal mortality ratio, followed by an increase in September. Of the 109 registered maternal deaths in 2020, 16 (14.7%) had COVID-19 related to the causes of death.ConclusionsThe COVID-19 pandemic is causing devastating consequences for maternal mortality, in Bahia, Brazil. An urgent public health action is needed to prevent and reduce maternal deaths during this pandemic, in Brazil.