Impact of emerging SARS-CoV-2 on total and cause-specific maternal mortality: A natural experiment in Chile during the peak of the outbreak

Abstract

AbstractBackgroundThis study estimated the effects of the SARS-CoV-2 pandemic on maternal death causes in Chile during the outbreak peak between 2020 and 2021.Materials and MethodsA natural experiment was conducted using official data on maternal deaths and live births (LBs) between 1997 and 2021. Trend changes in the maternal mortality ratio (MMR) were assessed using segmented regression. The effects of the SARS-CoV-2 outbreak were evaluated using interrupted time series (ITS) and an autoregressive integrated moving average (ARIMA) model to forecast the expected rates on MMR and 95% confidence intervals (95% CI).FindingsITS analysis revealed that the SARS-CoV-2 outbreak impacted the MMR due to indirect causes, with a greater increase in indirect nonrespiratory causes than respiratory causes. The ARIMA forecast was consistent with ITS, showing that the expected MMR for indirect causes was substantially lower than the observed rates (9.65 in 2020 and 7.46/100,000 LBs in 2021). The expected MMR was 3.44 in 2020 and 1.55 in 2021. For nonrespiratory causes, the observed values of the MMR for 2020 (8.77/100.000 LBs) and 2021 (7.46/100.000 LBs) doubled the prediction 4.02 (95% CI: 0.44-7.61) and 3.83 (95% CI: -0.12-7.79). No significant effect was found on direct obstetrical deaths.InterpretationDuring 2020-2021, there was a rise in the MMR in Chile attributable to SARS-CoV-2. The pandemic contributed to an escalation in the MMR due to indirect causes, particularly nonrespiratory and infectious causes, suggesting that the risk of pregnant women to SARS-CoV-2 was increased from previous comorbidities.