Characteristics and Outcomes of COVID-19 in Hospitalized Pregnant and Postpartum Women in a Region of the Brazilian Amazon from 2020 to 2023

Context: The COVID-19 pandemic severely impacted global public health. Pregnant and postpartum women constitute a highly vulnerable group due to the physiological changes of the pregnancy-puerperal cycle, which can exacerbate respiratory infections. In Brazil, the scenario was critical, with regressions in the Maternal Mortality Ratio, especially in the North Region, where deaths doubled. This study is justified by the need to understand the regional particularities of the infection in the state of Pará to support health policies and obstetric care. Methods: This was a retrospective and cross-sectional epidemiological study using secondary data from the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe). Cases of Severe Acute Respiratory Syndrome (SARS) caused by COVID-19, confirmed by RT-PCR in pregnant and postpartum women residing in Pará between 2020 and 2023, were analyzed. Statistical analysis was performed using R software, employing Chi-square, Fisher's exact tests, and binary logistic regression to identify factors associated with death, with a significance level of 0.05. Results: A total of 1,337 cases were analyzed. The predominant profile was women in the third gestational trimester (51.98%), of mixed-race ( parda ) (79.44%), and with low educational levels (70.33% with incomplete primary education). The case-fatality rate was 7.18% (96 deaths). It was observed that 52.73% of the patients were unvaccinated. The most frequent symptoms were cough (80.8%) and fever (70.26%). The multivariate model revealed that being postpartum increased the odds of death by 3.58 times (OR=3.58; p=0.0076). Oxygen saturation below 95% (OR=2.48) and respiratory distress (OR=1.30) were clinical predictors of severity. Conversely, vaccination demonstrated a protective effect, reducing the risk of death by approximately 75% (OR=0.246). Conclusion: Maternal mortality due to COVID-19 in Pará proved to be closely linked to social vulnerabilities and the absence of immunization. The postpartum period was identified as the phase of highest clinical risk, requiring increased surveillance. Addressing the disease requires differentiated protocols for the postpartum period and the strengthening of vaccination coverage to mitigate fatal outcomes in the region.