Clinical Factors Associated with Maternal Death in Pregnant Women Infected by COVID-19 in Indonesia: A Multicenter National Study

Background and Objective: The aim of this study is to evaluate the clinical risk factors associated with maternal death in pregnant women infected by COVID-19.Methods: This is a multicenter prospective study in Indonesia, included all pregnant women with confirmed COVID-19. Participants were divided into two groups based on the final outcomes: maternal death group and survived group. The main outcomes evaluated were: maternal background, clinical risk factors, comorbidities, clinical characteristics, and laboratory results.Results: There were 89 participants in the maternal death group and, 1673 in the survived group. The maternal death group have an older maternal age (32 vs 31 years old, p=0.03) and earlier gestational ages during admission (33 vs 37 weeks, p=0.000). The maternal death group have a significantly higher rate of cardiac disease (6.5% vs 1.2%, p=0.004), acute kidney injury (5.2% vs 0.3%, p=0.000), coinfections (29.9% vs 10.8%, p=0.000), and anemia (14.3% vs 6.7%, p=0.012). The maternal death group have a higher level of maternal blood leukocyte (13970 vs 10345), netrofil 75.7 vs 70), ALT (47 vs 23), AST (26 vs 19), CRP (37.4 vs 0.7), and procalcitonin (0.27 vs 0.06) (p<0.05). The risk factors that independently related to maternal death are fever (Exp(B): 12.847, 95% CI: 5.638-29.277; p=0.000), pneumonia from chest x-ray (Exp(B): 2.524, 95% CI: 1.163-5.479; p=0.019), and ICU admission (Exp(B): 49.430, 95% CI: 21.024-116.215; p=0.000).Conclusion: Our research indicates that the presence of fever, pneumonia, and ICU hospitalization are independently associated with maternal death in COVID-19-infected pregnant women.