Mortalidade materna: estudo comparado antes e durante a pandemia da Covid-19 no Distrito Federal

Abstract

Introduction: Maternal death is, by definition, any death that occurs during pregnancy, childbirth or up to 42 days after childbirth (puerperium), as long as it is due to a cause related to or aggravated by pregnancy. Most maternal deaths are preventable, as their causes can be diagnosed and treated, preventing unfavorable outcomes. The maternal mortality ratio (MMR) is an indicator that allows, among other things, monitoring and establishing serial comparisons of this phenomenon. There is consensus regarding the importance of MMR in the evaluation of health care systems, as it is directly associated with the quality of health care for women during the pregnancy-puerperal cycle. The indicator Years of Potential Life Lost (YPLL) estimates the average number of years that a person would have lived if they had not died prematurely, as occurs with maternal deaths during women’s reproductive period. The meaning of the YPLL is that the higher it is, the worse the situation of the population under analysis. The health and living conditions of a population reflected in the MMR make controlling maternal deaths a challenge for the development of countries and for this reason, after the frustration of the lack of significant changes in the indicator included among the challenges of the Millennium Development Goals in 2015, it was once again included in the Sustainable Development Goals (SDGs) agreed upon by the WHO/UN. Thus, the SDGs once again challenge countries to reduce the MMR to less than 70 deaths of pregnant and postpartum women for every 100,000 live births. Objectives: To study maternal deaths in the Federal District by comparing the periods before and during the pandemic, describing their regional distribution and their underlying causes, and constructing the MMR and YPLL indicators to measure the importance of these preventable deaths of women. Methodology: Retrospective time-series cohort study that included 134 women who died between 2017 and 2022, divided into 2 groups: 53 deaths that occurred before the pandemic (2017 to 2019) and 81 deaths during the pandemic (2020 to 2022). The variables studied included descriptive variables that allowed characterizing the regional distribution of deaths, place of death by health region, and the demographic characteristics of the victims in addition to the underlying causes described in the death certificate. Two indicators were constructed to analyze the evolution of the phenomenon and its social impacts: the MMR and the complex YPLL indicator. Results: The groups were homogeneous for the parameters evaluated, and no significant differences were recorded when comparing the sociodemographic characteristics of the groups. Medical care provided was greater during the pandemic period when compared to the pre-pandemic period. Regarding epidemiological indicators, there was an increase in MMR and YPLL. Conclusion: COVID-19 had a major impact on the Maternal Mortality Ratio during the pandemic. This increase had a significant impact, increasing YPLL in economically active women. The sociodemographic variables remained unchanged between the periods, with women of reproductive age (30-39 years), brown skin color, without partners, in the postpartum period and living in satellite cities of the Federal District being the most affected. The medical care provided during the pandemic was considered to be greater; however, this analysis assesses care in hospital services and not throughout the entire pregnancy process, as we know that there were changes in the flow of care for pregnant women and suspension of prenatal consultations, which made access to health care difficult for this population. The increase in epidemiological indices reflects the poor health care provided to women during the pregnancy-puerperal period, not only in terms of care, but also in terms of the public policies adopted, which culminated in the tragedy.