ArticleBMC infectious diseases2016
Severe maternal morbidity due to respiratory disease and impact of 2009 H1N1 influenza A pandemic in Brazil: results from a national multicenter cross-sectional study.
Article in BMC infectious diseases, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 31 citations in OpenAlex.
- Facing the COVID-19 pandemic inside maternities in Brazil: A mixed-method study within the REBRACO initiative.PloS one · 2021Trial
- The impact of the COVID-19 pandemic on the diagnosis and management of pre-eclampsia: Identifying healthcare delays.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- Viral threats to pregnancy: Global health risks in the era of pandemics.Advances in virus research · 2026Review
- Analysis of the influence of the COVID-19 pandemic on maternal mortality trends, 2011-2021.Revista latino-americana de enfermagem · 2025Article
- A Retrospective Cross-Sectional Analysis of Viral SARI in Pregnant Women in Southern Brazil.Microorganisms · 2024Article
- Biological, social, and healthcare factors for death due to influenza A(H1N1) during the 2009 epidemic in Brazil.Revista de saude publica · 2024Article
- The COVID-19 pandemic in Brazilian pregnant and postpartum women: results from the REBRACO prospective cohort study.Scientific reports · 2022Article
- Maternal Deaths from COVID-19 in Brazil: Increase during the Second Wave of the Pandemic.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2022Article
- Impact of emerging virus pandemics on cause-specific maternal mortality time series: a population-based natural experiment using national vital statistics, Argentina 1980-2017.Lancet regional health. Americas · 2022Article
- The Association Between Severity of Anemia During Pregnancy and Severe Maternal Outcomes: A Retrospective Cohort Study.Clinical epidemiology · 2022Article
- Mortality in pregnancy and the postpartum period in women with severe acute respiratory distress syndrome related to COVID-19 in Brazil, 2020.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2021Article
- Call to action for a South American network to fight COVID-19 in pregnancy.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2020Article
- Extracorporeal membrane oxygenation in pregnant and postpartum women: a ten-year case series.American journal of obstetrics & gynecology MFM · 2020Article
- The fetal origins of mental illness.American journal of obstetrics and gynecology · 2019Review
- Skin Color and Severe Maternal Outcomes: Evidence from the Brazilian Network for Surveillance of Severe Maternal Morbidity.BioMed research international · 2019Article
- The impact of hypertension, hemorrhage, and other maternal morbidities on functioning in the postpartum period as assessed by the WHODAS 2.0 36-item tool.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2018Article
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Authors and funding
11 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe aim of this study was to assess the burden of respiratory disease, considering the influenza A pandemic season (H1N1pdm09), within the Brazilian Network for Surveillance of Severe Maternal Morbidity, and factors associated with worse maternal outcome.
methodsA multicenter cross-sectional study, involving 27 referral maternity hospitals in five Brazilian regions. Cases were identified in a prospective surveillance by using the WHO standardized criteria for potentially life-threatening conditions (PLTC) and maternal near miss (MNM). Women with severe complications from respiratory disease identified as suspected or confirmed cases of H1N1 influenza or respiratory failure were compared to those with other causes of severe morbidity. A review of suspected H1N1 influenza cases classified women as non-tested, tested positive and tested negative, comparing their outcomes. Factors associated with severe maternal outcome (SMO = MNM + MD) were assessed in both groups, in comparison to PLTC, using PR and 95 % CI adjusted for design effect of cluster sampling.
resultsAmong 9555 cases of severe maternal morbidity, 485 (5 %) had respiratory disease. Respiratory disease occurred in one-quarter of MNM cases and two-thirds of MD. H1N1 virus was suspected in 206 cases with respiratory illness. Around 60 % of these women were tested, yielding 49 confirmed cases. Confirmed H1N1 influenza cases had worse adverse outcomes (MNM:MD ratio < 1 (0.9:1), compared to 12:1 in cases due to other causes), and a mortality index > 50 %, in comparison to 7.4 % in other causes of severe maternal morbidity. Delay in medical care was associated with SMO in all cases considered, with a two-fold increased risk among respiratory disease patients. Perinatal outcome was worse in cases complicated by respiratory disease, with increased prematurity, stillbirth, low birth weight and Apgar score < 7.
conclusionsRespiratory disease, especially considering the influenza season, is a very severe cause of maternal near miss and death. Increased awareness about this condition, preventive vaccination during pregnancy, early diagnosis and treatment are required to improve maternal health.
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