Impact of Gamma COVID-19 variant on the prognosis of hospitalized pregnant and postpartum women with cardiovascular disease

Testa, Carolina Burgarelli; Godoi, Luciana Graziela de; Monroy, Nataly Adriana Jiménez; Bortolotto, Maria Rita de Figueiredo Lemos; Rodrigues, Agatha Sacramento; Francisco, Rossana Pulcineli Vieira

doi:10.1016/j.clinsp.2024.100454

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Original articles • Clinics 79 • 2024 • https://doi.org/10.1016/j.clinsp.2024.100454 copy

Impact of Gamma COVID-19 variant on the prognosis of hospitalized pregnant and postpartum women with cardiovascular disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

The aim of the study was to assess the impact of the Gamma coronavirus disease 2019 (COVID-19) variant on pregnant and postpartum women with Cardiovascular Disease (CVD).

Methods:

The Influenza Epidemiological Surveillance System database (SIVEP-Gripe), a compulsory notification system for cases of Severe Acute Respiratory Syndrome (SARS), was investigated for notified cases of pregnant and postpartum women with reported CVD and SARS due to COVID-19 between February 16, 2020 and May 1, 2021 (when vaccination began), was investigated. In this retrospective cohort, two groups were formed based on symptom onset date, according to the predominance of the variants: original (group 2020) and Gamma (group 2021). Cases with missing information on the presence or absence of CVD were excluded. The comparative analysis was controlled for confounding variables.

Results:

Among 703 COVID-19 cases notified with CVD (406 patients in 2020 and 297 patients in 2021), compared to 2020, cases in 2021 had more respiratory symptoms (90.6 % vs. 80.1 %, p < 0.001), greater ventilatory support need (75.3 % vs. 53.9 %, p < 0.001), more ICU admission (46.6 % vs. 34.3 %, p = 0.002), longer duration (20.59 ± 14.47 vs. 16.52 ± 12.98 days, p < 0.001), higher mortality (25.6 % vs. 15.5 %, p < 0.001), with more than two-times mortality likelihood in the third trimester (adjusted OR = 2.41, 95 % CI 1.50–3.88, p < 0.001) or puerperium periods (adjusted_OR = 2.15, 95 % CI 1.34-3.44, p = 0.001).

Conclusions:

In Brazil, pregnant and postpartum women with CVDs in the Gamma variant phase have higher morbidity and mortality than those affected by the original variant of Coronavirus-19.

Keywords:
COVID-19 Gamma Variant; Pregnancy; Cardiovascular Diseases

HIGHLIGHTS

Respiratory symptoms common in the 2021 Gamma outbreak in pregnant women.

CVD caused poor outcomes in pregnant/postpartum women with COVID-19.

Gamma COVID-19 was most lethal for pregnant/postpartum women with CVD in Brazil.

This study underscores the Gamma variant’s significant impact on maternal outcomes.

Patient Characteristics	2020	2021	2021 versus 2020
Pregnant and Puerperal Women with CVD	n = 406 (16.7 %)	n = 297 (16.9 %)	Odds Ratio	p
Ethnic category	n(%)	n(%)
Yellow	1 (0.3)	1 (0.4)		0.020
White	124 (36.6)	125 (49.0)
Indigenous	1 (0.3)	1 (0.4)
Brown	181 (53.4)	108 (42.4)
Black	32 (9.4)	20 (7.8)
Schooling	n(%)	n(%)
None	1 (0.6)	1 (0.7)		0.477
1^st–5^th grade	20 (11.0)	19 (13.9)
6^th–9^th grade	30 (16.6)	29 (21.2)
High school	95 (52.5)	70 (51.1)
Higher education	35 (19.3)	18 (13.1)
Age (years)	Mean ± SD	Mean ±SD
Age (years)	33.96 ± 8.11	34.96 ± 8.49		0.117
Age group	n (%)	n (%)
< 20 years old	10 (2.5)	2 (0.7)		0.128
20–34 years old	208 (51.2)	145 (48.8)
≥ 35 years old	188 (46.3)	150 (50.5)
Gestational period	n (%)	n (%)
1^st trimester	20 (4.9)	27 (9.1)		0.04
2^nd trimester	74 (18.2)	70 (23.6)
3^rd trimester	173 (42.6)	111 (37.4)
Unknown GA	18 (4.4)	16 (5.4)
Puerperium	121 (29.8)	73 (24.6)
Associated diseases	n (%)	n (%)
Hematologic	8 (2.7)	2 (0.9)	0.32 (0.03‒1.62)	0.199
Diabetes	101 (32.5)	81 (33.3)	1.04 (0.73‒1.49)	0.903
Obesity	64 (21.6)	70 (29.4)	1.51 (1.02‒2.24)	0.049
Asthma	26 (8.9)	18 (8.0)	0.89 (0.48‒1.67)	0.849
Liver diseases	3 (1.0)	2 (0.9)	0.85 (0.07‒7.49)	0.999
Neuropathies	5 (1.7)	7 (3.1)	1.81 (0.57‒5.79)	0.469
Lung diseases	10 (3.4)	3 (1.3)	0.38 (0.10‒1.41)	0.224
Immunodeficiencies	10 (3.5)	7 (3.1)	0.90 (0.34‒2.41)	0.999
Kidney disease	11 (3.8)	11 (4.9)	1.29 (0.55‒3.03)	0.715
At least one associated disease	172 (51.7)	147 (56.5)	1.22 (0.88‒1.69)	0.271
Number of associated diseases	n (%)	n (%)
0	161 (48.3)	113 (43.5)		0.584
1	121 (36.3)	108 (41.5)
2	41 (12.3)	30 (11.5)
>2	10 (3.0)	9 (3.5)

	2020	2021	2021 versus 2020		Weighted Propensity Score Matching
Symptoms	n(%)	n(%)	OR	p	OR	p
Fever	228 (60.8)	178 (66.9)	1.30 (0.94‒1.81)	0.134	1.25 (1.00‒1.58)	0.062
Cough	282 (74.0)	219 (78.8)	1.30 (0.90‒1.88)	0.186	1.19 (0.92‒1.53)	0.210
Sore throat	86 (25.4)	58 (25.1)	0.98 (0.67‒1.44)	0.999	0.95 (0.73‒1.25)	0.787
Smell	42 (23.1)	66 (28.2)	1.31 (0.84‒2.05)	0.284	1.26 (0.92‒1.73)	0.180
Taste	46 (25.3)	61 (25.6)	1.02 (0.65‒1.59)	0.999	1.00 (0.73‒1.37)	0.999
Diarrhea	41 (12.3)	33 (14.2)	1.18 (0.72‒1.93)	0.592	1.02 (0.72‒1.45)	0.968
Vomiting	39 (11.7)	30 (13.2)	1.14 (0.68‒1.89)	0.713	0.98 (0.69‒1.40)	0.991
Abdominal pain	21 (11.9)	21 (9.2)	0.75 (0.40‒1.43)	0.481	0.77 (0.49‒1.20)	0.302
Fatigue	53 (28.8)	77 (32.1)	1.17 (0.77‒1.77)	0.536	1.15 (0.85‒1.54)	0.408
Dyspnea	255 (67.6)	222 (80.4)	1.97 (1.36‒2.84)	<0.001	1.93 (1.49‒2.48)	<0.001
Respiratory distress	204 (55.9)	166 (65.6)	1.51 (1.08‒2.10)	0.019	1.46 (1.16‒1.84)	0.002
Saturation < 95 %	181 (50.3)	184 (69.2)	2.22 (1.59‒3.09)	<0.001	1.91 (1.52‒2.40)	<0.001
Symptoms, ≥ 1	387 (95.6)	286 (97.9)	2.22 (0.87‒5.66)	0.135	2.02 (1.07‒3.81)	0.039
Respiratory symptom, ≥ 1	314 (80.1)	259 (90.6)	2.38 (1.49‒3.80)	<0.001	2.19 (1.59‒3.01)	<0.001

ICU	2020	2021	2021 versus 2020		Weighted Propensity	Score Matching
ICU	n(%)	n(%)	OR	p	OR	p
	131 (34.3)	132 (46.6)	1.67 (1.22‒2.29)	0.002	1.58 (1.27‒1.97)	<0.001
ICU by pregnancy period	n (%)	n (%)
1^st trimester	8 (40.0)	8 (32.0)	0.71 (0.21‒2.41)	0.807	0.56 (0.24‒1.30)	0.256
2^nd trimester	28 (39.4)	32 (48.5)	1.45 (0.73‒2.85)	0.371	1.27 (0.79‒2.05)	0.389
3^rd trimester	43 (26.7)	52 (48.6)	2.59 (1.55‒4.34)	<0.001	2.43 (1.70‒3.49)	<0.001
Puerperium	49 (43.0)	34 (48.6)	1.25 (0.69‒2.28)	0.557	1.27 (0.84‒1.92)	0.294
Days of ICU stay	Mean ± SD	Mean ± SD
Mean ± SD	13.67 ± 16.39	14.95 ± 13.10		0.219		0.809
Ventilatory support	n (%)	n (%)
No	172 (46.1)	69 (24.7)		<0.001		<0.001
Yes, non-invasive	139 (37.3)	126 (45.2)
Yes, invasive	62 (16.6)	84 (30.1)
Orotracheal intubation	n (%)	n (%)
Orotracheal intubation	62 (16.6)	84 (30.1)	2.16 (1.49‒3.14)	<0.001	2.01 (1.54‒2.62)	<0.001
Orotracheal intubation by pregnancy period	n (%)	n (%)
1^st trimester	3 (16.7)	6 (26.1)	1.74 (0.30‒12.67)	0.706	1.85 (0.65‒5.23)	0.363
2^nd trimester	14 (20.6)	19 (29.2)	1.59 (0.72‒3.53)	0.341	1.39 (0.80‒2.43)	0.309
3^rd trimester	14 (8.9)	30 (27.8)	3.96 (1.98‒7.90)	<0.001	3.79 (2.27‒6.31)	<0.001
Puerperium	28 (24.8)	24 (35.3)	1.66 (0.86‒3.19)	0.179	1.55 (0.98‒2.44)	0.077
Outcome	n (%)	n (%)
Recovery	343 (84.5)	221 (74.4)	1.87 (1.29‒2.72)	0.001	1.93 (1.48‒2.52)	<0.001
Death	63 (15.5)	76 (25.6)
Death by pregnancy period	n (%)	n (%)
1^st trimester	3 (15.0)	5 (18.5)	1.28 (0.21‒9.42)	0.999	1.41 (0.48‒4.15)	0.729
2^nd trimester	15 (20.3)	17 (24.3)	1.26 (0.57‒2.77)	0.705	1.30 (0.74‒2.29)	0.437
3^rd trimester	18 (10.4)	24 (21.6)	2.38 (1.22‒4.62)	0.015	2.41 (1.50‒3.88)	<0.001
Puerperium	23 (19.0)	24 (32.9)	2.09 (1.07‒4.07)	0.044	2.15 (1.34‒3.44)	0.001
Days between onset of symptoms and outcome	Mean ± SD	Mean ± SD		CVD
Any outcome	16.52 ± 12.98	20.59 ± 14.47		<0.001		<0.001
Recovery	15.94 ± 12.27	19.66 ± 14.91		0.002		0.012
Death	19.56 ± 16.03	23.24 ± 12.85		0.036		0.166

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[1] *Corresponding author. E-mail address:carolina.burgarelli@hc.fm.usp.br (C.B. Testa).