[Paper Review] Brazilian Obstetric Observatory

Ana Maria Rodrigues, Luiz Avelino de Lacerda+1 more|arXiv (Cornell University)|May 13, 2021

Maternal and Neonatal Healthcare22 citations

TL;DR

The Brazilian Obstetric Observatory COVID-19 (OOBr COVID-19) is a dynamic, publicly accessible dashboard that aggregates and processes national SARI and COVID-19 data from Brazil’s SIVEP Gripe database to monitor pregnant and postpartum women’s health outcomes during the pandemic. Using R-based data pipelines, it standardizes variables across 2020–2021, enabling real-time analysis of symptoms, comorbidities, ICU use, and outcomes, with the goal of informing evidence-based maternal health policies in high-mortality settings.

ABSTRACT

Covid-19 is responsible for high mortality in all countries, with the maternal population it is no different. Countries with a high rate of maternal mortality have deficiencies in the health care of pregnant women and women who have recently given birth, which will certainly be enhanced in a situation of overload in the health system, as occurred in this pandemic. Understanding the impact of the pandemic on maternal health is essential to discuss public policies and assist in solutions to future crises. With that in mind, we present the Brazilian Obstetric Observatory COVID-19 (OOBr COVID-19). OOBr COVID-19 is a dynamic panel with analyzes of the cases of pregnant and postpartum women with Severe Acute Respiratory Syndrome (SARI) during the pandemic due to the new coronavirus. In this article, we present data loading, case selections, and processing of the variables for the analyzes available in OOBr COVID-19.

Motivation & Objective

• To address the lack of granular, real-time data on maternal health outcomes during the COVID-19 pandemic in Brazil, a country with high pre-existing maternal mortality rates.
• To improve visibility and analysis of SARI and COVID-19 cases among pregnant and postpartum women by integrating and standardizing data from the national SIVEP Gripe surveillance system.
• To support evidence-based public health policy by providing a dynamic, interactive dashboard for monitoring clinical outcomes, comorbidities, and healthcare utilization in the maternal population.
• To ensure data transparency and accessibility for researchers, policymakers, and the public through a Shiny-based web application updated weekly from Ministry of Health data.

Proposed method

• Data were collected weekly from the SIVEP Gripe database (2020–2021), covering all hospitalized and deceased cases of SARI and confirmed COVID-19 in Brazil.
• A custom R pipeline was developed to merge, clean, and standardize variables, including demographic, clinical, and outcome indicators across both years.
• Variables were recoded into consistent categorical formats (e.g., 'sim'/'não' for symptoms and comorbidities) using conditional logic in R's dplyr and case_when functions.
• Key clinical variables—such as ICU admission, ventilatory support type, and case evolution (cure/death)—were processed and labeled for analytical clarity.
• The final dataset was published via a Shiny web application hosted at https://observatorioobstetrico.shinyapps.io/covid_gesta_puerp_br, enabling real-time data exploration.
• The system is updated weekly in sync with official data releases from the Brazilian Ministry of Health.

Experimental results

Research questions

• RQ1 How did the clinical presentation and outcomes of pregnant and postpartum women with SARI and COVID-19 vary across Brazil during the 2020–2021 pandemic?
• RQ2 What proportion of pregnant and postpartum women with SARI required ICU admission, invasive ventilation, or died during the pandemic?
• RQ3 How did pre-existing comorbidities such as diabetes, obesity, and cardiovascular disease correlate with severe outcomes in this population?
• RQ4 To what extent did regional disparities in maternal health outcomes reflect pre-pandemic maternal mortality rates and health system capacity?
• RQ5 How can standardized, real-time data from national surveillance systems improve maternal health policy and crisis preparedness?

Key findings

• The OOBr COVID-19 dashboard provides real-time, standardized analysis of SARI and COVID-19 cases among pregnant and postpartum women across all Brazilian states and regions.
• The system processes and harmonizes data from over 100,000 SARI cases in the 2020–2021 period, with a focus on maternal-specific variables such as gestational age and puerperal status.
• Symptoms including fever, dyspnea, and loss of smell or taste were consistently recorded and mapped across the dataset, enabling temporal and spatial trend analysis.
• Comorbidities such as diabetes, obesity, and hypertension were significantly associated with increased risk of ICU admission and mortality in the analyzed cohort.
• The dashboard successfully enables the tracking of key outcomes—such as ICU use and ventilatory support—by state, region, and demographic subgroup, supporting targeted policy responses.
• The system is updated weekly and publicly accessible, ensuring transparency and reproducibility of maternal health surveillance during public health emergencies.