A new study found that the rates of pregnancy-related death in the U.S. increased by nearly 28% between 2018 and 2022, with large disparities based on state, race, and ethnicity.
The study, published in JAMA Network Open on April 9, analyzed four years of nationwide data from the U.S. Centers for Disease Control and Prevention. Researchers found that there were 6,283 pregnancy-related deaths during that time. The study determined that the rate increased from 25.3 pregnancy-related deaths per 100,000 live births in 2018 to a peak of 44.1 in 2021, before dropping slightly to 32.6 in 2022. The increase occurred across all the age groups that researchers analyzed, but people between the ages of 25 and 39 experienced the highest increase, according to the study.
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The study didn’t investigate why the rates of pregnancy-related death increased over the four-year period. But researchers noted in the study that the COVID-19 pandemic could have had an impact on maternal health and the health care system at large, particularly in 2021.
Dr. Rose Molina, one of the study’s authors and an ob-gyn at Beth Israel Deaconess Medical Center, says she and her colleagues observed “a large variation by state” in the rates of pregnancy-related death. Alabama had the highest at 59.7 deaths per 100,000 live births, followed by Mississippi at 58.2. Meanwhile, California had the lowest rate at 18.5 deaths per 100,000 live births, followed by Minnesota at 19.1. Molina says some explanations for the disparities could be variation in access to prenatal, labor and delivery, and postpartum care, as well as in state Medicaid coverage.
“There really shouldn’t be this level of variation across the states, and we need to do better across all the states,” Molina says. “One of the points we made in that article was that if all states could have performed as well as the highest performing state, like California, we could have avoided 2,679 pregnancy-related deaths” in that four-year period.
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The study also found that the pregnancy-related death rate was 3.8 times higher among American Indian and Alaska Native women compared with the rate among white women. Similarly, the rate was 2.8 times higher among non-Hispanic Black women compared with the rate among white women. Molina says many other studies have found that variations in access based on income or geography, as well as biases in the health care system, can all contribute to racial and ethnic inequities in maternal health outcomes.
The number of pregnancy-related deaths between 2018 and 2022 includes 1,891 late maternal deaths, which are deaths “from any cause related to or aggravated by pregnancy” that take place a little more than a month up until one year after the end of pregnancy, according to the study. “Late maternal death occurs in what could be a health care delivery gap between obstetric care and transition to primary care,” researchers wrote.
American Indian and Alaska Native women also had the highest rate in the late maternal death period, followed by non-Hispanic Black women, according to Molina. The study said this suggests “that these groups may face disparities in access to postnatal care, as well as other socioeconomic and systemic challenges impacting maternal health outcomes.”
The study found that, overall, cardiovascular disease was the leading cause of pregnancy-related deaths. Cancer, mental and behavior disorders, and drug or alcohol-induced death were contributing factors to late maternal death.
The U.S. has the highest maternal mortality rate among high-income nations, and Molina says the study “illustrates why we cannot take our eyes off of maternal health.”
“It’s important that we not lose sight of how maternal health needs to be a focus of investment in the years to come—that we still have work to do,” Molina says. “We need to continue investing in the infrastructure [and] the policies that ensure access to high-quality pregnancy care for everyone.”