COVID-19’s impact on maternal mortality calls for a rethink of public health strategies

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

A collaborative study led by Professor Erard Koch, founder and senior epidemiologist at the Chilean MELISA Laboratory, and carried out with a team of researchers from the Universidad Católica Sedes Sapientie in Peru, the Universidad Católica de Argentina, the National University of Buenos Aires (Argentina) and the University of Chile (Chile), assessed the impact of the SARS-CoV-2 pandemic on cause-specific maternal mortality during Chile’s toughest period. It used time series that leverage information from long-term annual trends and ARIMA models that predict expected mortality rates under the assumption that previous mortality trends would continue in the absence of pandemic virus-related mortality burden. Epidemiologist Yordanius Enríquez Canto explains that through a natural experiment that observes the impact of events without experimental manipulation, they compared data from before and during the pandemic to analyze trends in maternal mortality over time.

The study revealed that the COVID-19 pandemic had a significant impact on maternal mortality in Chile. Interestingly, the pandemic did not affect direct obstetric deaths such as hemorrhage, sepsis or miscarriage, but rather indirect non-respiratory obstetric causes increased the most. Professor Eraldo Koch points out that this finding is important because it confirms that this emerging virus, despite being a respiratory coronavirus, had a severe impact on other systems and organs, in relation to comorbidities such as diabetes, hypertension and other chronic or pre-existing chronic diseases. Similarly, epidemiologists assert that this finding distinguishes it from the effects of other pandemics, such as the 2009 H1N1 influenza, which only caused a temporary increase in maternal mortality due to sepsis and respiratory diseases, as demonstrated in another natural experiment in Argentina published elsewhere by Koch’s research team. (Kritt et al. Lancet Reg Health Am 2021 doi: 10.1016/j.lana.2021.100116)

The results of this natural experiment highlight the urgent need to strengthen registration and surveillance systems for pregnant women. Sociologist María Elena Kritt emphasizes that the information obtained in this study is key to allowing public policies to provide a rapid, comprehensive and effective response in the face of pandemic viruses. She stresses that the data collected will be extremely valuable to reduce the negative impact of these viruses on maternal mortality, both in Chile and in other countries in Latin America.

According to Dr. Aliro Galleguillos, obstetrician-gynecologist and public health specialist at the University of Chile, well-designed epidemiological studies during naturally occurring pandemic outbreaks can significantly contribute to our knowledge of the natural history of emerging diseases and also assess whether limited resources are meeting the real health needs of pregnant women. In this sense, the importance of this scientific research lies in its fundamental role of monitoring the performance of public policies and being the basis for promoting evidence-based policies during future pandemic outbreaks.