Efeitos da pandemia de covid-19 em indicadores de mortalidade da mulher e da criança nos primeiros 1000 dias

Abstract

Objective: To analyze the temporal trend of the Maternal Mortality Ratio (MMR) and of the Fetal (FMR) and Infant Mortality Ratio (IMR) in Brazil and in the macro-regions, from 2017 to 2021, and to estimate the effect of the COVID-19 pandemic on maternal, fetal and infant deaths. Methods: Ecological study with extended time series analysis (Autoregressive Integrated Moving Average Models - ARIMA). The dependent variables were the MMR corrected for underreporting, the FMR and the IMR, observed monthly in the period from January 2017 to March 2021 in the macro-regions and in Brazil. The breakpoint of the series (exposure) was a COVID-19 pandemic in Brazil, considered since the notification of the first case of the disease in the country, measured through increasing dummy variables, coded as “zero” in the period before the pandemic, and from 1 to 14 in the months with the pandemic. We considered a Box & Jenkins (1970) modeling for the temporal analysis and the model measurements (estimating an adjusted regression coefficient – RC). The analysis were done in RStudio, version 4.1.2. Results: There was an upward trend in the observed MMR and FMR for all macro-regions and Brazil, while an decrease in the IMR was observed in all units of analysis. The COVID-19 pandemic was associated with an increase in maternal mortality (RC= 9,13; p-value=0.052) and fetal mortality (RC= 0.037; p-value: 0.002) in Brazil, and Brazilian macroregions, especially in the South, North and Northeast regions; and a slight reduction in IMC (RC= -0.04; p-value: 0.06), suggesting anticipation of deaths. Conclusion: The COVID 19 pandemic had an effect on the increase in maternal and fetal deaths, promoting an “anticipation of infant death”, in other words, the children who were born alive started to die while was still intrauterus, often also with the pregnant woman.