Evolution of COVID-19 according to race/skin color in pregnant and puerperal women of reproductive age in Brazil between 2020 and 2024: population-based study
DOI:
https://doi.org/10.17267/2317-3394rpds.2025.e6263Keywords:
COVID-19, Infectious Complication in Pregnancy, Maternal Mortality, Racism, Health Information SystemsAbstract
ABSTRACT | INTRODUCTION: The COVID-19 pandemic has revealed preexisting health disparities. In Brazil, Black women have higher rates of COVID-19-related morbidity and mortality compared to White women. OBJECTIVE: To analyze COVID-19 infection and mortality among Brazilian women of reproductive age by race/skin color. METHOD: This is a population-based, descriptive, exploratory, and documentary cross-sectional study with a quantitative approach. Data from January 2020 to May 2024, collected from the OOBr, were used. The study population included women of reproductive age hospitalized with COVID-19 in Brazil. The variables analyzed were age, race/skin color, region and area of residence, education level, ICU admission, need for respiratory support, and death from COVID-19. Descriptive and bivariate analyses were performed using SPSS v.21 software. RESULTS: The data revealed significant disparities in the clinical course of COVID-19 by race/skin color. Black women had a higher prevalence of hospitalizations, ventilator support, and ICU admissions, while Indigenous women had a lower prevalence. The Southeast region and urban areas recorded the highest number of cases. CONCLUSION: Race/skin color significantly influenced COVID-19-related outcomes in women of reproductive age in Brazil. The identified racial inequalities highlight the need for targeted interventions and public health policies to mitigate these disparities, considering the historical, political, economic, and social issues that contribute to these differences in future public health emergencies.
Downloads
References
Allotey, J., Fernandez, S., Bonet, M., Stallings, E., Yap, M., Kew, T., Zhou, D., Coomar, D., Sheikh, J., Lawson, H., Ansari, K., Attarde, S., Littmoden, M., Banjoko, A., Barry, K., Akande, O., Sambamoorthi, D., van Wely, M., van Leeuwen, E., ... Thangaratinam, S. (2020). Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: Living systematic review and meta-analysis [Manifestaciones clínicas, factores de riesgo y resultados maternos y perinatales de la enfermedad por coronavirus 2019 durante el embarazo: Revisión sistemática continua y metaanálisis]. https://doi.org/10.1136/bmj.m3320
Andrade, L., Santos, G., Sordi, M., Nunes, H., & Parada, C.M.G. (2023). Factores asociados a la evolución de la COVID-19 en mujeres embarazadas: un estudio poblacional brasileño. Revista da Escola de Enfermagem da USP, 57. https://doi.org/10.1590/1980-220X-REEUSP-2023-0042en
Bailey, Z. D., Krieger, N., Agénor, M., Graves, J., Linos, N., & Bassett, M. T. (2017). Structural racism and health inequities in the USA: Evidence and interventions [Racismo estructural y desigualdades en salud en EE. UU.: Evidencias e intervenciones]. The Lancet, 389(10077), 1453–1463. https://doi.org/10.1016/S0140-6736(17)30569-X
Chen, H., Guo, J., Wang, C., Luo, F., Yu, X., Zhang, W., Li, J., Zhao, D., Xu, D., Gong, Q., Liao, J., Yang, H., Hou, W., & Zhang, Y. (2020). Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records [Características clínicas y potencial de transmisión vertical intrauterina de la infección por COVID-19 en nueve mujeres embarazadas: Revisión retrospectiva de registros médicos]. The Lancet, 395, 809–815. https://doi.org/10.1016/S0140-6736(20)30360-3
Ellington, S., Strid, P., Tong, V. T., Woodworth, K., Galang, R. R., Zambrano, L. D., Nahabedian, J., Anderson, K., & Gilboa, S. M. (2020). Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-June 7, 2020 [Características de mujeres en edad reproductiva con infección por SARS-CoV-2 confirmada por laboratorio según el estado de embarazo – Estados Unidos, 22 de enero al 7 de junio de 2020]. Morbidity and mortality weekly report, 69(25), 769–775. https://doi.org/10.15585/mmwr.mm6925a1
Franco, V. F., Rodrigues, A. S., Rosa Junior, E. R., Godói, L. G., Monroy, N. A. J., Costa, R. A., & Francisco, R. P. V. (2022). Demographic and epidemiological characteristics of pregnant and postpartum women who died from severe acute respiratory syndrome in Brazil: A retrospective cohort study comparing COVID-19 and nonspecific etiologic causes [Características demográficas y epidemiológicas de mujeres embarazadas y puérperas que murieron por síndrome respiratorio agudo grave en Brasil: Estudio de cohorte retrospectivo comparando COVID-19 y causas etiológicas inespecíficas]. PLoS ONE, 17(10), e0274797. https://doi.org/10.1371/journal.pone.0274797
Knight, M., Bunch, K., Vousden, N., Morris, E., Simpson, N., Gale, C., O’Brien, P., Quigley, M., Brocklehurst, P., & Kurinczuk, J. J. (2020). Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population-based cohort study [Características y resultados de mujeres embarazadas ingresadas en hospitales con infección confirmada por SARS-CoV-2 en el Reino Unido: Estudio de cohorte poblacional nacional]. BMJ, 369, m2107. https://doi.org/10.1136/bmj.m2107
Ko, J. Y., DeSisto, C. L., Simeone, R. M., Ellington, S., Galang, R. R., Oduyebo, T., Gilboa, S. M., Lavery, A. M., Gundlapalli, A. V., & Shapiro-Mendoza, C. K. (2021). Adverse Pregnancy Outcomes, Maternal Complications, and Severe Illness Among US Delivery Hospitalizations With and Without a Coronavirus Disease 2019 (COVID-19) Diagnosis [Resultados adversos del embarazo, complicaciones maternas y enfermedad grave en hospitalizaciones por parto en EE. UU. con y sin diagnóstico de COVID-19]. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 73(Suppl 1), S24–S31. https://doi.org/10.1093/cid/ciab344
Leal, M. C., Gama, S. G. N., Pereira, A. P. E., Pacheco, V. E., Carmo, C. N., & Santos, R. V. (2017). El color del dolor: inequidades raciales en la atención pre-natal y partos en Brasil. Cadernos de Saúde Pública, 33(Suppl 1). https://doi.org/10.1590/0102-311X00078816
Liu, D., Li, L., Wu, X., Zheng, D., Wang, J., Yang, L., & Zheng, C. (2020). Pregnancy and perinatal outcomes of women with coronavirus disease (COVID-19) pneumonia: A preliminary analysis [Embarazo y resultados perinatales de mujeres con neumonía por enfermedad por coronavirus (COVID-19): Un análisis preliminar]. American Journal of Roentgenology, 215(1). https://doi.org/10.2214/AJR.20.23072
Liu, Y., Chen, H., Tan, W., Kuang, Y., Tang, K., Luo, Y., Guo, Y., Yang, M., Wang, Q., & Zhang, X. (2021). Clinical characteristics and outcome of SARS-CoV-2 infection during pregnancy [Características clínicas y desenlace de la infección por SARS-CoV-2 durante el embarazo]. Journal of Infection, 82(6), e9–e10. https://doi.org/10.1016/j.jinf.2021.03.030
Lokken, E. M., Huebner, E. M., Taylor, G. G., Hendrickson, S., Vanderhoeven, J., Kachikis, A., Coler, B., Walker, C. L., Sheng, J. S., Al-Haddad, B. J. S., McCartney, S. A., Kretzer, N. M., Resnick, R., Barnhart, N., Schulte, V., Bergam, B., Ma, K. K., Albright, C., Larios, V., … Washington State COVID-19 in Pregnancy Collaborative. (2021). Disease severity, pregnancy outcomes, and maternal deaths among pregnant patients with severe acute respiratory syndrome coronavirus 2 infection in Washington State [Gravedad de la enfermedad, resultados del embarazo y muertes maternas entre pacientes embarazadas con infección por el coronavirus del síndrome respiratorio agudo severo 2 en el estado de Washington]. American journal of obstetrics and gynecology, 225(1), 77.e1–77.e14. https://doi.org/10.1016/j.ajog.2020.12.1221
Nakamura-Pereira, M., Amorim, M. M. R., Pacagnella, R. C., Takemoto, M. L. S., Penso, F. C. C., Rezende-Filho, J., & Leal, M. C. (2020). COVID-19 and Maternal Death in Brazil: An Invisible Tragedy [COVID-19 y muerte materna en Brasil: Una tragedia invisible]. Revista Brasileira de Ginecologia e Obstetrícia, 42(8), 445-447. https://doi.org/10.1055/s-0040-1715138
Observatório Obstétrico Brasileiro (OOBr). (2024). Banco de dados do Observatório Obstétrico Brasileiro [Base de datos del Observatorio Obstétrico Brasileño]. https://observatorioobstetrico.org.br
Poteat, T., Millett, G. A., Nelson, L. E., & Beyrer, C. (2020). Understanding COVID-19 risks and vulnerabilities among Black communities in America: The lethal force of syndemics [Comprensión de los riesgos y vulnerabilidades de la COVID-19 entre las comunidades negras en Estados Unidos: La fuerza letal de las sindemias]. Annals of Epidemiology, 47, 1–3. https://doi.org/10.1016/j.annepidem.2020.05.004
Price-Haywood, E. G., Burton, J., Fort, D., & Seoane, L. (2020). Hospitalization and mortality among Black patients and White patients with COVID-19 [Hospitalización y mortalidad entre pacientes negros y blancos con COVID-19]. New England Journal of Medicine, 382(26), 2534–2543. https://doi.org/10.1056/NEJMsa2011686
Riley, T., Sully, E., Ahmed, Z., & Biddlecom, A. (2020). Estimates of the potential impact of the COVID-19 pandemic on sexual and reproductive health in low- and middle-income countries [Estimaciones del impacto potencial de la pandemia de COVID-19 en la salud sexual y reproductiva en países de ingresos bajos y medios]. International Perspectives on Sexual and Reproductive Health, 46, 73–76. https://doi.org/10.1363/46e902
Santos, D. S., Menezes, M. O., Andreucci, C. B., Nakamura-Pereira, M., Knobel, R., Katz, L., Salgado, H. O., Amorim, M. M. R., & Takemoto, M. L. S. (2021). Disproportionate impact of coronavirus disease 2019 (COVID-19) among pregnant and postpartum Black women in Brazil through structural racism lens [Impacto desproporcionado de la COVID-19 entre mujeres negras embarazadas y en el posparto en Brasil desde la perspectiva del racismo estructural]. Clinical Infectious Diseases, 72(11), 2068–2069. https://doi.org/10.1093/cid/ciaa1066
Silva, I. L., Barreto, R. A. R., Soares, B. K. P., Matias, A. D., & Souza, F. M. L. C. (2021). Preditores da mortalidade materna por COVID-19: Revisão integrativa [Predictores de la mortalidad materna por COVID-19: Revisión integradora]. Research, Society and Development, 10(10), e435101018888. https://doi.org/10.33448/rsd-v10i10.18888
Souza, A. S. R., & Amorim, M. M. R. (2020). Mortalidade materna pela COVID-19 no Brasil [Mortalidad materna por COVID-19 en Brasil]. Revista Brasileira de Saúde Materno Infantil, 20(Suppl 1), 533–537. https://doi.org/10.1590/1806-9304202100S100014
Takemoto, M. L. S., Menezes, M. O., Andreucci, C. B., Knobel, R., Sousa, L. A. R., Katz, L., Fonseca, E. B., Magalhães, C. G., Oliveira, W. K., Rezende-Filho, J., Melo, A. S. O., & Amorim, M. M. R. (2020a). Maternal mortality and COVID-19 [Mortalidad materna y COVID-19]. The Journal of Maternal-Fetal & Neonatal Medicine, 35(12), 2355–2361. https://doi.org/10.1080/14767058.2020.1786056
Takemoto, M. L. S., Menezes, M. O., Andreucci, C. B., Nakamura-Pereira, M., Amorim, M. M. R., Katz, L., & Knobel, R. (2020b). The tragedy of COVID-19 in Brazil: 124 maternal deaths and counting [La tragedia de la COVID-19 en Brasil: 124 muertes maternas y contando]. International Journal of Gynecology & Obstetrics, 151(1), 154–156. https://doi.org/10.1002/ijgo.13300
Wang, L., Wang, Y., Ye, D., & Liu, Q. (2020). Review of the 2019 novel coronavirus (SARS-CoV-2) based on current evidence [Revisión del nuevo coronavirus de 2019 (SARS-CoV-2) basada en la evidencia actual]. International journal of antimicrobial agents, 55(6), 105948. https://doi.org/10.1016/j.ijantimicag.2020.105948
Wang, X., Zhou, Z., Zhang, J., Zhu, F., Tang, Y., & Shen, X. (2020). A case of 2019 novel coronavirus in a pregnant woman with preterm delivery [Un caso de nuevo coronavirus de 2019 en una mujer embarazada con parto prematuro]. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciaa200
Webb Hooper, M., Nápoles, A. M., & Pérez-Stable, E. J. (2020).COVID-19 and Racial/Ethnic Disparities [COVID-19 y disparidades raciales/étnicas]. JAMA, 323(24), 2466–2467. https://doi.org/10.1001/jama.2020.8598
World Health Organization. (2020). Coronavirus disease 2019 (COVID-19): Situation report – 51 [Enfermedad por coronavirus 2019 (COVID-19): Informe de situación – 51]. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_1
Yu, N., Li, W., Kang, Q., Xiong, Z., Wang, S., Lin, X., Liu, Y., Xiao, J., Liu, H., Deng, D., Chen, S., Zeng, W., Feng, L., & Wu, J. (2020). Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: A retrospective, single-centre, descriptive study [Características clínicas y resultados obstétricos y neonatales de pacientes embarazadas con COVID-19 en Wuhan, China: Un estudio retrospectivo, unicéntrico y descriptivo]. The Lancet Infectious Diseases, 20(5), 559–564. https://doi.org/10.1016/S1473-3099(20)30176-6
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Gustavo Gonçalves dos Santos, Beatriz María Bermejo-Gil, Leticia López Pedraza, Giovana Aparecida Gonçalves Vidotti
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License.
