{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T23:28:22Z","timestamp":1774049302452,"version":"3.50.1"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T00:00:00Z","timestamp":1692230400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"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>The study aimed to evaluate the risk of maternal death and fetal death among pregnant women infected with SARS-CoV-2.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This is a retrospective cohort study among pregnant women with secondary data from the National Live Births System (<jats:italic>Sistema Nacional de Nascidos Vivos<\/jats:italic>), National Mortality System (<jats:italic>Sistema Nacional de Mortalidade<\/jats:italic>), and e-SUS Health Surveillance System (<jats:italic>Sistema e-SUS Vigil\u00e2ncia em Sa\u00fade<\/jats:italic>). Pregnant women confirmed for COVID-19 had positive RT-PCR between March 2020 and May 2021, pregnant women without COVID-19 were those without notification for disease. Maternal death, fetal death, and stillbirth were assessed as primary outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We included 68,673 pregnant women not notified as suspected of COVID-19 and 1,386 with a confirmed diagnosis of COVID-19. Among pregnant women with COVID-19, 1013 (73.0%) were aged 20 to 34 years, 655 (47.2%) were brown, 907 (65.4%) had \u2265 8 years of education, in the third trimester of pregnancy (41.5%), undergoing cesarean section (64.5%). In adjusted analyses, COVID-19 in pregnancy had a higher risk of maternal death (relative risk [RR] 18.73\u201395% confidence interval [95%CI] 11.07\u201331.69), fetal death\/stillbirth (RR 1.96\u201395%CI 1.18\u20133.25), preterm birth [RR 1.18\u201395%CI 1.01\u20131.39], cesarean delivery (RR 1.07\u201395%CI 1.02\u20131.11), and cesarean delivery occurring before the onset of labor (RR 1.33\u201395%CI 1.23\u20131.44).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>COVID-19 may contribute to unfavorable pregnancy outcomes. Results showed that pregnant women infected with SARS-CoV-2 had a higher risk of maternal death, fetal death\/stillbirth, preterm birth, cesarean delivery, and cesarean section occurring before the onset of labor.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0290343","type":"journal-article","created":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T17:26:50Z","timestamp":1692293210000},"page":"e0290343","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":24,"title":["The impact of COVID-19 on maternal death and fetal death, a cohort study in Brazil"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9701-0314","authenticated-orcid":true,"given":"Ana Paula","family":"Brioschi dos Santos","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Creuza Rachel","family":"Vicente","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4972-4686","authenticated-orcid":true,"given":"Jo\u00e3o Paulo","family":"Cola","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2086-7491","authenticated-orcid":true,"given":"Luana Fiengo","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliana Rodrigues Tovar","family":"Garbin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Larissa Soares","family":"Dell\u2019Antonio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6568-1300","authenticated-orcid":true,"given":"Cristiano Soares da Silva","family":"Dell\u2019Antonio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelica Espinosa","family":"Miranda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,8,17]]},"reference":[{"key":"pone.0290343.ref001","author":"JOHNS HOPKINS UNIVERSITY UNIVERSITY MEDICINE, J. 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