Time series analysis of comprehensive maternal deaths in Brazil during the COVID-19 pandemic

• Published in: Scientific reports 2024-10, Vol.14 (1), p.23960-10, Article 23960
• Main Authors: Cambou, Mary Catherine, David, Hollie, Moucheraud, Corrina, Nielsen-Saines, Karin, Comulada, Warren Scott, Macinko, James
• Format: Article
• Language: English
• Subjects: 631/250/255; 692/700/478; Adult; Births; Brazil; Brazil - epidemiology; Comprehensive maternal deaths; COVID-19; COVID-19 - epidemiology; COVID-19 - mortality; Databases, Factual; Female; Humanities and Social Sciences; Humans; Maternal Death - statistics & numerical data; Maternal mortality; Maternal Mortality - trends; Mortality; multidisciplinary; Pandemics; Pregnancy; SARS-CoV-2 - isolation & purification; Science; Science (multidisciplinary); Time series analysis
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-024-74704-x

The effects of the COVID-19 pandemic on comprehensive maternal deaths in Brazil have not been fully explored. Using publicly available data from the Brazilian Mortality Information (SIM) and Information System on Live Births (SINASC) databases, we used two complementary forecasting models to predict estimates of maternal mortality ratios using maternal deaths (MMR) and comprehensive maternal deaths (MMRc) in the years 2020 and 2021 based on data from 2008 to 2019. We calculated national and regional standardized mortality ratio estimates for maternal deaths (SMR) and comprehensive maternal deaths (SMRc) for 2020 and 2021. The observed MMRc in 2021 was more than double the predicted MMRc based on the Holt-Winters and autoregressive integrated moving average models (127.12 versus 60.89 and 59.12 per 100,000 live births, respectively). We found persisting sub-national variation in comprehensive maternal mortality: SMRc ranged from 1.74 (95% confidence interval [CI] 1.64, 1.86) in the Northeast to 2.70 (95% CI 2.45, 2.96) in the South in 2021. The observed national estimates for comprehensive maternal deaths in 2021 were the highest in Brazil in the past three decades. Increased resources for prenatal care, maternal health, and postpartum care may be needed to reverse the national trend in comprehensive maternal deaths.