{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T22:54:54Z","timestamp":1772232894367,"version":"3.50.1"},"reference-count":38,"publisher":"FapUNIFESP (SciELO)","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. bras. epidemiol."],"abstract":"<jats:p>ABSTRACT  Objective:  Trends in maternal mortality (MMR) and late maternal mortality ratios (LMMR) were estimated, in periods with and without H1N1 and COVID-19 pandemics, in Rio de Janeiro, Brazil, from 2009 to 2021.  Methods:  Ecological study of temporal trends. Data was obtained from the Mortality and Live Birth Information Systems. The annual MMR and LMMR per 100,000 live births (LB) were calculated and the trends were estimated using the joinpoint regression model.  Results:  In 2009, the MMR was 103.1, reaching 152.4\/100,000 LB in 2021, with an annual reduction of 3.3% (95% confidence interval - 95%CI -5.5; -1.7) until 2019 and an increase of 51.2% (95%CI 23.5; 64.5) in 2020\/21. Excluding the years of the COVID-19 pandemic, it was observed that an annual decline of 3.3% and, with the concomitant exclusion of the years of the H1N1 pandemic, stability. The LMMR were 8.3 (2009) and 22.2 (2021) per 100,000 LB, with an annual growth of 28.2% (95%CI 11.8; 47.8) until 2011, remaining stationary from 2011 to 2015, followed by an increase of 11.7% until 2021; with the exclusion of the final biennium, the trend is upward (3.8%) and also with the exclusion of the initial biennium, the trend became downward (7%) until 2014 and upward (8.2%) from then on.  Conclusion:  There was a change in trend with the separate or joint incorporation of pandemic biennia: without pandemics, maternal mortality would be stationary, despite actions to prevent maternal deaths, and late maternal mortality, would be descending until 2014 and then ascending, crediting itself in part, to improving death investigation.<\/jats:p>","DOI":"10.1590\/1980-549720250037","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T15:03:42Z","timestamp":1753110222000},"source":"Crossref","is-referenced-by-count":0,"title":["Maternal and late mortality trends, emphasizing the H1N1 and COVID-19 pandemics, in the state of Rio de Janeiro, Brazil, from 2009 to 2021"],"prefix":"10.1590","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2948-7782","authenticated-orcid":false,"given":"Ana Lucia de Melo","family":"Bellizzi","sequence":"first","affiliation":[{"name":"Universidade Federal do Rio de Janeiro,  Brazil; Secretaria Estadual de Sa\u00fade do Rio de Janeiro,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5839-4688","authenticated-orcid":false,"given":"Angela Maria","family":"Casc\u00e3o","sequence":"additional","affiliation":[{"name":"Secretaria Estadual de Sa\u00fade do Rio de Janeiro,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7059-4348","authenticated-orcid":false,"given":"Alexandre dos Santos","family":"Brito","sequence":"additional","affiliation":[{"name":"Universidade Federal do Rio de Janeiro,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5493-494X","authenticated-orcid":false,"given":"Sandra Costa","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Universidade Federal Fluminense,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5439-9158","authenticated-orcid":false,"given":"Pauline Lorena","family":"Kale","sequence":"additional","affiliation":[{"name":"Universidade Federal do Rio de Janeiro,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","published-online":{"date-parts":[[2025]]},"reference":[{"key":"ref1","series-title":"Maternal mortality","year":"2023"},{"key":"ref2","series-title":"Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division","year":"2023"},{"key":"ref3","series-title":"Maternal mortality ratio (per 100 000 live births)","year":"2023"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"S71","DOI":"10.1590\/0102-311X00125313","article-title":"Estima\u00e7\u00e3o da raz\u00e3o de mortalidade materna no Brasil, 2008-2011","volume":"30","author":"Szwarcwald CL","year":"2014","journal-title":"Cad Sa\u00fade P\u00fablica"},{"issue":"3","key":"ref5","doi-asserted-by":"crossref","DOI":"10.1590\/0102-311x00195821","article-title":"Tend\u00eancia da mortalidade materna no Estado do Rio de Janeiro, Brasil, entre 2006 e 2018, segundo a classifica\u00e7\u00e3o CID-MM","volume":"38","author":"Mendon\u00e7a IM","year":"2022","journal-title":"Cad Sa\u00fade P\u00fablica"},{"key":"ref6","first-page":"S257","article-title":"Maternal mortality by COVID-19 in Brazil","volume":"21","author":"Souza ASR","year":"2021","journal-title":"Rev Bras Sa\u00fade Mater Infant"},{"issue":"10","key":"ref7","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0275333","article-title":"Excess maternal mortality in Brazil: regional inequalities and trajectories during the COVID-19 epidemic","volume":"17","author":"Orellana J","year":"2022","journal-title":"PLoS One"},{"key":"ref8","series-title":"Combate \u00e0 epidemia de H1N1: um hist\u00f3rico de sucesso","year":"2021"},{"issue":"8","key":"ref9","first-page":"1467","article-title":"Risk factors for death from pandemic (H1N1) 2009, southern Brazil","volume":"17","author":"Yokota RTC","year":"2011","journal-title":"Emerg Infect Dis"},{"issue":"1","key":"ref10","first-page":"53","article-title":"Implica\u00e7\u00f5es da influenza A\/H1N1 no per\u00edodo gestacional","volume":"22","author":"Pastore APW","year":"2012","journal-title":"Sci Med"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1002\/ijgo.13300","article-title":"The tragedy of COVID-19 in Brazil: 124 maternal deaths and counting","volume":"151","author":"Takemoto ML","year":"2020","journal-title":"Int J Gynecol Obstet"},{"key":"ref12","series-title":"Orienta\u00e7\u00f5es sobre novos c\u00f3digos de emerg\u00eancia para as causas de morte relacionadas a condi\u00e7\u00f5es que ocorrem no contexto da covid-19","year":"2022"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijregi.2022.11.004","article-title":"Severe maternal morbidity and mortality during the COVID-19 pandemic: a cohort study in Rio de Janeiro","volume":"6","author":"Brendolim M","year":"2023","journal-title":"IJID Reg"},{"key":"ref14","series-title":"O impacto da pandemia por influenza A (H1N1) na mortalidade materna do Munic\u00edpio de S\u00e3o Paulo 2009","author":"Vega CEP","year":"2009"},{"issue":"7","key":"ref15","doi-asserted-by":"crossref","first-page":"651","DOI":"10.3109\/00016349709024605","article-title":"Pregnancy-associated deaths in Finland 1987-1994 - definition problems and benefits of record linkage","volume":"76","author":"Gissler M","year":"1997","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"33","key":"ref16","first-page":"1","article-title":"Maternal mortality and related concepts","volume":"3","author":"Hoyert DL","year":"2007","journal-title":"Vital Health Stat"},{"issue":"3","key":"ref17","article-title":"Mortalidade materna tardia: compara\u00e7\u00e3o de dois comit\u00eas de mortalidade materna no Brasil","volume":"33","author":"Vega CEP","year":"2017","journal-title":"Cad Sa\u00fade P\u00fablica"},{"key":"ref18","article-title":"Maternal mortality committee and death surveillance in Recife in improving information: ex-ante and ex-post evaluation","volume":"23","author":"Carvalho PI","year":"2023","journal-title":"Rev Bras Sa\u00fade Mater Infant"},{"issue":"7","key":"ref19","article-title":"An\u00e1lise de s\u00e9rie temporal: tend\u00eancia da mortalidade materna tardia no Brasil, 2010-2019","volume":"40","author":"Borgonove KCA","year":"2024","journal-title":"Cad Sa\u00fade P\u00fablica"},{"issue":"10033","key":"ref20","doi-asserted-by":"crossref","first-page":"2072","DOI":"10.1016\/S0140-6736(16)30391-9","article-title":"Late maternal deaths: a neglected responsibility","volume":"387","author":"Sliwa K","year":"2006","journal-title":"Lancet"},{"key":"ref21","series-title":"CID-10 Classifica\u00e7\u00e3o Estat\u00edstica Internacional de Doen\u00e7as e Problemas Relacionados \u00e0 Sa\u00fade","year":"1995","edition":"10a revis\u00e3o"},{"key":"ref22","series-title":"Joinpoint"},{"issue":"16","key":"ref23","doi-asserted-by":"crossref","first-page":"3102","DOI":"10.1002\/sim.9407","article-title":"Twenty years since Joinpoint 1.0: two major enhancements, their justification, and impact","volume":"41","author":"Kim HJ","year":"2022","journal-title":"Stat Med"},{"issue":"10","key":"ref24","article-title":"Mortalidade materna no Brasil: an\u00e1lise de tend\u00eancias temporais e agrupamentos espaciais","volume":"29","author":"Oliveira IVG","year":"2024","journal-title":"Ci\u00eanc Sa\u00fade Coletiva"},{"key":"ref25","first-page":"100116","article-title":"Impact of emerging virus pandemics on cause-specific maternal mortality time series: a population-based natural experiment using national vital statistics, Argentina 1980-2017","volume":"6","author":"Critto ME","year":"2021","journal-title":"Lancet Reg Health Am"},{"issue":"8","key":"ref26","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1001\/jamapediatrics.2021.1050","article-title":"Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: The INTERCOVID Multinational Cohort Study","volume":"175","author":"Villar J","year":"2021","journal-title":"JAMA Pediatr"},{"issue":"10","key":"ref27","first-page":"1","article-title":"Deaths: final data for 2020","volume":"72","author":"Kochanek KD","year":"2023","journal-title":"Natl Vital Stat Rep"},{"issue":"4","key":"ref28","article-title":"Fertility trends during successive novel infectious disease outbreaks: Zika and COVID-19 in Brazil","volume":"38","author":"Marteleto LJ","year":"2022","journal-title":"Cad Saude P\u00fablica"},{"key":"ref29","series-title":"Sa\u00fade Brasil 2011: uma an\u00e1lise da situa\u00e7\u00e3o de sa\u00fade e a vigil\u00e2ncia da sa\u00fade da mulher","first-page":"345","volume-title":"Mortalidade materna no Brasil: principais causas de morte e tend\u00eancias temporais no per\u00edodo de 1990 a 2010","year":"2012"},{"issue":"6","key":"ref30","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1055\/s-0042-1748975","article-title":"Maternal deaths from COVID-19 in Brazil: increase during the second wave of the pandemic","volume":"44","author":"Scheler CA","year":"2022","journal-title":"Rev Bras Ginecol Obstet"},{"key":"ref31","article-title":"COVID-19 en la mortalidad materna, perinatal y neonatal de cuatro localidades de Bogot\u00e1. Estudio descriptivo","volume":"97","author":"Ardila-Pereira L","year":"2023","journal-title":"Rev Esp Salud P\u00fablica"},{"issue":"4","key":"ref32","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1590\/S1415-790X2004000400008","article-title":"A mortalidade materna nas capitais brasileiras: algumas caracter\u00edsticas e estimativa de um fator de ajuste","volume":"7","author":"Laurenti R","year":"2004","journal-title":"Rev Bras Epidemiol"},{"issue":"9","key":"ref33","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0160642","article-title":"Late maternal deaths and deaths from sequelae of obstetric causes in the Americas from 1999 to 2013: a trend analysis","volume":"11","author":"Cosio FG","year":"2016","journal-title":"PLoS One"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s12963-020-00207-2","article-title":"Monitoring the progress of health-related sustainable development goals (SDGs) in Brazilian states using the Global Burden of Disease indicators","volume":"18","author":"Machado DB","year":"2020","journal-title":"Popul Health Metr"},{"issue":"10053","key":"ref35","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1016\/S0140-6736(16)31470-2","article-title":"Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015","volume":"388","year":"2016","journal-title":"Lancet"},{"key":"ref36","series-title":"Informa\u00e7\u00e3o em sa\u00fade: o papel do m\u00e9dico","author":"Laurenti R","year":"2017"},{"key":"ref37","series-title":"Informa\u00e7\u00e3o SUS. Dados SUS. Estat\u00edsticas vitais - \u00f3bitos e nascimentos"},{"key":"ref38","series-title":"ICD-11 International Classification of Diseases for Mortality and Morbidity Statistics. Eleventh Revision","year":"2022"}],"container-title":["Revista Brasileira de Epidemiologia"],"original-title":["Tend\u00eancia da mortalidade materna e materna tardia, com \u00eanfase nas pandemias de H1N1 e COVID-19, estado do Rio de Janeiro, Brasil, de 2009 a 2021"],"link":[{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_pdf&pid=S1415-790X2025000100429&tlng=en","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T15:03:47Z","timestamp":1753110227000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S1415-790X2025000100429&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":38,"alternative-id":["S1415-790X2025000100429"],"URL":"https:\/\/doi.org\/10.1590\/1980-549720250037","relation":{"is-translation-of":[{"id-type":"doi","id":"10.1590\/1980-549720250037.2","asserted-by":"subject"},{"id-type":"doi","id":"10.1590\/1980-549720250037.2","asserted-by":"object"}]},"ISSN":["1980-5497","1415-790X"],"issn-type":[{"value":"1980-5497","type":"electronic"},{"value":"1415-790X","type":"print"}],"subject":[],"published":{"date-parts":[[2025]]},"article-number":"e250037"}}