key: cord-0847781-7k9d4959 authors: Nakamura‐Pereira, Marcos; Betina Andreucci, Carla; de Oliveira Menezes, Mariane; Knobel, Roxana; Takemoto, Maíra Libertad Soligo title: Worldwide maternal deaths due to COVID‐19: A brief review date: 2020-08-09 journal: Int J Gynaecol Obstet DOI: 10.1002/ijgo.13328 sha: acaba2cc2f99ad3c4a79b8ce04677cdf7246cf23 doc_id: 847781 cord_uid: 7k9d4959 160 maternal deaths due to COVID‐19 have been reported worldwide, most of them in middle‐income countries, representing a barrier to reducing maternal mortality. After initial studies suggested that pregnant women were not at a higher risk of complications due to COVID-19 infection, 1 recent investigations from Sweden and the US have indicated that pregnant and postpartum women are at increased risk of severe complications associated with COVID-19. 2, 3 In an analysis of 8207 cases of in the obstetric population, the Centers For Disease Control and Prevention (CDC) reported a higher risk of ICU admission and mechanical ventilation compared to non-pregnant women, although no higher risk of mortality was identified. 3 We searched PubMed/MEDLINE, EMBASE, SciELo and LILACS for documented COVID-19-related maternal deaths from December 2019 until July 1, 2020. After removal of duplicates, our results showed that six countries had reported maternal deaths due to COVID-19 by July 1, 2020: three high-income countries (France, UK, and US) 3-5 and three middle-income countries (Brazil, Iran, and Mexico). [6] [7] [8] The total number of reported maternal deaths was 160 (Table 1) . Twenty-two maternal deaths were documented in high-income countries, and 138 in middleincome countries (124 from Brazil, representing 77.5% of all maternal deaths reported in the literature). It is reasonable to assume that worldwide figures of maternal deaths due to COVID-19 are even higher. We did not identify published cases from low-income countries, which may reflect underreporting rather than absence of cases. The number of deaths, overall and in the obstetric population, is still rising in some countries such as Brazil and the USA, and the time gap between actual events and their reporting in peer-reviewed publications is bound to result in underestimations in literature reviews on COVID-19. Notably, the combined population size of the three high-income countries reporting maternal deaths is slightly larger than that of the middle-income countries. Therefore, the incidence of maternal mortality in the latter seems at least six times higher than the figures in high-income countries. As expected, the impact of COVID-19 maternal deaths on the maternal mortality ratio tends to be proportionally higher in countries where such events are less frequent outside of the pandemic context, as seen in the UK. Comparability of available data is impaired due to methodological differences in studies. For example, Iran 8 International efforts to reduce maternal mortality have been steadily applied in recent years, including a new global pact through the Sustainable Development Goals (SDG) for 2030. 9 The COVID-19 pandemic may represent a major obstacle to realizing the SDG by 2030, especially in middle-and low-income countries, where the pandemic seems to be leading to a significant increase in cases of both maternal near miss and mortality. MNP and MLST equally contributed to study conception and design, data collection, data analysis, and data interpretation. MNP wrote the first draft of the paper and incorporated substantial contributions from CBA, MOM, RK and MLST after critical revision. All authors reviewed and approved the final manuscript. Clinical characteristics of pregnant women with Covid-19 in Wuhan Pregnant and postpartum women with SARS-CoV-2 infection in intensive care in Sweden Characteristics of women of Reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status -United States A snapshot of the Covid-19 pandemic among pregnant women in France Characteristics and outcomes of pregnant women hospitalised with confirmed SARS-CoV-2 infection in the UK a national cohort study using the UK Obstetric Surveillance System (UKOSS) The tragedy of COVID-19 in Brazil: 124 maternal deaths and counting Maternal mortality from COVID-19 in Mexico Maternal death due to COVID-19 disease Transforming our World: The 2030 Agenda for Sustainable Development The authors would like to thank all members of the Brazilian Group for Studies of COVID-19 and Pregnancy for their efforts in supporting this work. The authors have no conflicts of interest.