A new study shows that maternal mortality in the US rose more rapidly in 2021 than in 2020 and nearly doubled from pre-pandemic rates in 2019. American Indians/Alaska Natives endured the largest increase in pregnancy-related deaths.
Boston University School of Public Health
Following the emergence of the highly contagious Delta and Omicron COVID-19 variants, pregnancy-related mortality rates increased faster in the United States in 2021, compared to the previous year, according to a new study from the School of Public Health from Boston University (BUSPH). and the University of Maryland (UMD) School of Public Health.
The staggering data captures the worsening burden of pregnancy-related mortality, including deaths during pregnancy up to 1 year after delivery, in the US during the pandemic. Death rates have increased particularly among racial and ethnic minorities, and the study provides COVID-related context to a new report from the National Center for Health Statistics indicating that U.S. maternal mortality rates increased by 38 percent. percent in 2021, compared to 2020 rates.
Published in the journal Obstetrics & Gynecology , the findings on pregnancy-related mortality are consistent with increasing COVID-19-related mortality rates among women of reproductive age, and the results follow previously published research by the team that also revealed alarming increases in maternal mortality rates during the first year of the pandemic in 2020.
The new study found that pregnancy-related death rates increased to 45.5 deaths per 100,000 live births overall in 2021, and up to 56.9 deaths per 100,000 live births during the third quarter of 2021, in compared to 36.7 deaths per 100,000 live births in 2020, and 30.3 deaths per 100,000 live births pre-COVID. The Delta variant began sweeping the country in June 2021, before the even more contagious Omicron variant took hold in late fall.
Quarterly pregnancy-related mortality rates due to contributing cause of coronavirus disease 2019 (COVID-19), 2019-2021, United States. Q, fourth.
Notably, the study found that the largest relative increases in pregnancy-related deaths between 2020 and 2021 occurred among Hispanic people (at 34 percent) and especially American Indian/Alaska Native (AIAN) people ( by 104 percent). Pregnancy-related mortality rates in 2021 were highest for AIAN (161 deaths per 100,000 live births) and Black pregnant people (98 deaths per 100,000 live births). The proportion of pregnancy-related deaths with a COVID diagnosis was highest among Hispanic (43 percent) and AIAN (36 percent) people.
“The pandemic exacerbated what were already poor maternal outcomes in the US by deepening disparities by race/ethnicity and place of residence, resulting in maternal mortality rates not seen since 1964,” says lead author of the study, Dr. Eugene Declercq, professor of community health sciences at BUSPH. “In particular, the extraordinary increases among American Indians and Alaska Natives in 2021 deserve greater attention.”
For the analysis, Dr. Declercq and the study’s lead author, Dr. Marie Thoma, associate professor of family sciences at UMD, used national birth and mortality data from January 2019 to March 2020 (before the pandemic) compared to April 2020 to December 2021 (during the pandemic). They estimated pregnancy-related mortality increases by trimester for deaths that occurred during pregnancy or within a year after the end of a pregnancy, and compared these rates to mortality rates among people ages 15 to 44. , for which COVID-19 was listed as a contributing cause of death.
In addition to mortality spikes among racial/ethnic pregnant people, the study also captured increases in pregnancy-related mortality in rural areas and smaller cities between 2020 and 2021, with rates increasing by 21% and 39%. , respectively.
These increases closely mirrored overall changes in COVID-related death patterns among all women ages 15 to 44.
“This is concerning as we also saw the closure of many obstetric facilities and services during the pandemic, particularly in rural areas,” says Dr. Thoma.
Researchers had hoped that vaccination rates among pregnant people would increase and provide greater protection against COVID-related deaths for this population in 2021, when vaccines would be widely available to the public. But the latest federal data suggests that up to 45 percent of pregnant women in the US are still not fully vaccinated against COVID-19.
“Our maternal mortality statistics are the ’tip of the iceberg’ when we think about the underlying impact on the health of mothers in this country and how this devastates families,” says Dr. Thoma. “We need to focus our attention on improving the systems and policies that can address our country’s maternal health.”
About Boston University School of Public Health
Founded in 1976, the Boston University School of Public Health is one of the top five private public health schools in the world. It offers master’s and doctoral level education in public health. Faculty across six departments conduct policy-changing public health research around the world, with a mission to improve the health of populations, especially the disadvantaged, underserved and vulnerable, locally and globally.
