The impact of COVID-19 on maternal mortality requires rethinking public health strategies

During the peak of the SARS-CoV-2 pandemic, Chile experienced an increase in maternal mortality. This is confirmed by a natural population experiment based on data from the Department of Statistics and Health Information (DEIS) of the Chilean Ministry of Health. The study was published in PLOS Global Public Health.

In a collaborative study led by Professor Elard Koch, Senior Epidemiologist and Founder of the MELISA Institute (Chile), and conducted with a team of researchers from the Universidad Católica Sedes Sapientiae (Peru), the Pontificia Universidad Católica Argentina and the Universidad Nacional de Buenos Aires (Argentina), and the Universidad de Chile (Chile), the impact of the SARS-CoV-2 pandemic on maternal mortality by cause during the most difficult phase in Chile was assessed using time series using information from long-term annual trends, as well as ARIMA models to predict expected mortality under the hypothesis that previous mortality trends would continue in the absence of the mortality burden associated with the pandemic virus. Epidemiologist Yordanis Enriquez Canto explains that trends in maternal mortality were analyzed over time, comparing data from before and during the pandemic, through a natural experiment in which the effects of an event are observed without experimental manipulation.

This study revealed a significant impact of the COVID-19 pandemic on maternal mortality in Chile. Interestingly, the pandemic did not affect direct obstetric deaths, such as hemorrhage, sepsis and abortion, but indirect obstetric causes not related to the respiratory system increased the most. Professor Elard Koch notes that this is an important finding because it confirms that the pathophysiology of this emerging virus, despite being a respiratory coronavirus, has seriously affected other systems and organs, probably related to comorbidities such as diabetes, hypertension and other or pre-existing chronic conditions. Similarly, the epidemiologist confirms that this finding distinguishes it from the impact of other pandemics, such as the 2009 H1N1 influenza, which caused a transient increase only in maternal deaths due to sepsis and respiratory diseases, as shown in another natural experiment from Argentina published by Koch’s research team elsewhere. (Critto et al. Lancet Reg Health Am. 2021 doi: 10.1016/j.lana.2021.100116)

The results of this natural experiment underline the urgent need to strengthen the registration and surveillance system for pregnant women. Sociologist María Elena Critto emphasizes that the information obtained in this study is crucial so that, in the face of pandemic viruses, public policies can offer a rapid, comprehensive and effective response. She emphasizes that the data collected are extremely valuable to mitigate the negative effects of these viruses on maternal mortality, both in Chile and in other Latin American countries.

According to Dr. Aliro Galleguillos, obstetrician-gynecologist and public health specialist at the Universidad de Chile, well-designed epidemiological studies during natural pandemics make an important contribution to knowledge about the natural history of emerging diseases, and also allow us to assess whether limited resources meet the real health needs of pregnant women. In this sense, the importance of this scientific study lies in its fundamental role in monitoring the implementation of public policies and serves as a basis for promoting evidence-based policies in future pandemic events.