{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T11:24:52Z","timestamp":1785237892535,"version":"3.55.0"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2021,12,21]],"date-time":"2021-12-21T00:00:00Z","timestamp":1640044800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-027961"],"award-info":[{"award-number":["INV-027961"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["445881\/2020-8"],"award-info":[{"award-number":["445881\/2020-8"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006182","name":"Funda\u00e7\u00e3o Estadual de Amparo \u00e0 Pesquisa do Estado do Esp\u00edrito Santo","doi-asserted-by":"publisher","award":["007\/2021"],"award-info":[{"award-number":["007\/2021"]}],"id":[{"id":"10.13039\/501100006182","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Mortality rates of pregnant and postpartum women grew in the second COVID-19 pandemic year. Our objective is to understand this phenomenon to avoid further deaths.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We collected data from SIVEP-Gripe, a nationwide Brazilian database containing surveillance data on all severe acute respiratory syndrome caused by COVID-19, between the first notified case (February 2020) until the 17th epidemiological week of 2021. We stratified patients into maternal women (which includes pregnant and postpartum women), non-maternal women and men and divided them by time of diagnosis in two periods: first period (February to December 2020) and second period (the first 17 epidemiological weeks of 2021 before pregnant and postpartum women were vaccinated).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>During the second period, all patients had higher risk of presenting severe COVID-19 cases, but the maternal population was at a higher risk of death (OR of 2.60 CI 95%: 2.28\u20132.97)\u2013almost double the risk of the two other groups. Maternal women also had a higher risk of needing intensive care, intubation and of presenting desaturation in the second period. Importantly, maternal women presented fewer comorbidities than other patient groups, suggesting that pregnancy and postpartum can be an important risk factor associated with severe COVID-19.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Our results suggest that the Gama variant, which has been related to greater virulence, transmissibility and mortality rates leads to more severe cases of COVID-19 for pregnant and postpartum women.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0261492","type":"journal-article","created":{"date-parts":[[2021,12,21]],"date-time":"2021-12-21T18:46:14Z","timestamp":1640112374000},"page":"e0261492","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":38,"title":["Maternal mortality associated with COVID-19 in Brazil in 2020 and 2021: Comparison with non-pregnant women and men"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5220-7383","authenticated-orcid":true,"given":"Beatriz Martinelli Menezes","family":"Gon\u00e7alves","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9981-8069","authenticated-orcid":true,"given":"Rossana Pulcinelli V.","family":"Franco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agatha S.","family":"Rodrigues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,12,21]]},"reference":[{"key":"pone.0261492.ref001","unstructured":"Brazil health service in \u2018worst crisis in its history\u2019 - BBC News. https:\/\/www.bbc.com\/news\/world-latin-america-56424611 (accessed May 21, 2021)."},{"issue":"10226","key":"pone.0261492.ref002","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/S0140-6736(20)30360-3","article-title":"Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records","volume":"395","author":"H Chen","year":"2020","journal-title":"Lancet"},{"issue":"5","key":"pone.0261492.ref003","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1002\/uog.22014","article-title":"Coronavirus in pregnancy and delivery: rapid review.","volume":"55","author":"E Mullins","year":"2020","journal-title":"Ultrasound Obstet Gynecol"},{"key":"pone.0261492.ref004","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/14767058.2020.1763952","article-title":"COVID-19 pneumonia and pregnancy; a systematic review and meta-analysis.","author":"M Kasraeian","year":"2020","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"1","key":"pone.0261492.ref005","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.cmi.2020.10.007","article-title":"Impact of COVID-19 on maternal and neonatal outcomes: a systematic review and meta-analysis","volume":"27","author":"F Di Toro","year":"2021","journal-title":"Clin Microbiol Infect"},{"key":"pone.0261492.ref006","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1111\/aogs.13901","article-title":"Pregnant and postpartum women with SARS-CoV-2 infection in intensive care in Sweden.","volume":"99","author":"J Collin","year":"2020","journal-title":"Acta Obs Gynecol Scand"},{"key":"pone.0261492.ref007","doi-asserted-by":"crossref","first-page":"769","DOI":"10.15585\/mmwr.mm6925a1","article-title":"Characteristics of women of Reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status \u2013 United States, January 22-June 7, 2020.","volume":"69","author":"S Ellington","year":"2020","journal-title":"Morb Mortal Wkly Rep"},{"issue":"6","key":"pone.0261492.ref008","doi-asserted-by":"crossref","first-page":"914.e1","DOI":"10.1016\/j.ajog.2020.06.022","article-title":"Coronavirus disease 2019 in pregnancy was associated with maternal morbidity and preterm birth.","volume":"223","author":"L Sentilhes","year":"2020","journal-title":"Am J Obstet Gynecol"},{"issue":"5","key":"pone.0261492.ref009","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1016\/j.ajog.2020.07.045","article-title":"Are clinical outcomes worse for pregnant women at \u226520 weeks\u2019 gestation infected with coronavirus disease 2019? 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