Cardiovascular diseases worsen the maternal prognosis of COVID-19

  1. Carolina Burgarelli Testa
  2. Luciana Graziela de Godoi
  3. Maria Rita de Figueiredo Lemos Bortolotto
  4. Nátaly Adriana Jiménez Monroy
  5. Bruna Rodrigues de Mattos
  6. Agatha Sacramento Rodrigues
  7. Rossana Pulcineli Vieira Francisco

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Abstract

Cardiovascular diseases (CVD) are a risk factor for severe cases of COVID-19. There are no studies evaluating whether the presence of CVD in pregnant and postpartum women with COVID-19 is associated with a worse prognosis. In an anonymized open database of the Ministry of Health, we selected cases of pregnant and postpartum women who were hospitalized due to COVID-19 infection and with data regarding their CVD status. In the SIVEP GRIPE data dictionary, CVD is defined as “presence of cardiovascular disease”, excluding those of neurological and nephrological causes that are pointed out in another field. The patients were divided into two groups according to the presence or absence of CVD (CVD and non-CVD groups). Among the 1,876,953 reported cases, 3,562 confirmed cases of pregnant and postpartum women were included, of which 602 had CVD. Patients with CVD had an older age (p<0,001), a higher incidence of diabetes (p<0,001) and obesity (p<0,001), a higher frequency of systemic (p<0,001) and respiratory symptoms (p<0,001). CVD was a risk factor for ICU admission (p<0,001), ventilatory support (p = 0.004) and orotracheal intubation in the third trimester (OR 1.30 CI95%1.04–1.62). The group CVD had a higher mortality (18.9% vs. 13.5%, p<0,001), with a 32% higher risk of death (OR 1.32 CI95%1.16–1.50). Moreover, the risk was increased in the second (OR 1.94 CI95%1.43–2.63) and third (OR 1.29 CI95%1.04–1.60) trimesters, as well as puerperium (OR 1.27 CI95%1.03–1.56). Hospitalized obstetric patients with CVD and COVID-19 are more symptomatic. Their management demand more ICU admission and ventilatory support and the mortality is higher.

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  1. Version published to 10.1371/journal.pone.0266792
  2. ScreenIT

    SciScore for 10.1101/2022.03.31.22273072: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variableAfter that, we selected pregnant and postpartum women aged 10 to 55 years old with data regarding their CVD status.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Among the limitations of the study, we should consider that the completion of the notification system included information about the presence or absence of CVD in 39.58% of the notifications, with a high percentage of loss. The difficulty in population-based use was also portrayed by other researchers. In the USA, for instance, only 5.8% (7162) of 122653 cases reported to the CDC had information about health conditions (32). In addition, we found limitation on the type of CV, since the notification form does not allow etiological distinction and interpretation of access to ICU admission in Brazil. This is because only 15% of maternity hospitals in our country have adult ICU beds (33).

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • No funding statement was detected.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2022.03.31.22273072v1 on medRxiv