The US pregnancy-related death rate shot up faster in 2021 than in 2020, nearly doubling from prepandemic rates in 2019 and disproportionately affecting women of minority races, concludes a study published yesterday in Obstetrics & Gynecology.
Researchers from the University of Maryland and Boston University analyzed data from the Centers for Disease Control and Prevention to estimate death rates during pregnancy and 1 year postpartum from pregnancy-related causes from January 2019 to March 2020 and April to December 2020 and 2021. The highly transmissible Delta and Omicron SARS-CoV-2 variants emerged in 2021.
'Rates not seen since 1964'
Maternal death rates were significantly higher in 2021 (45.5 per 100,000 live births, spiking to 56.9/100,000 in the third quarter) than in 2020 (36.7/100,000) and before the pandemic (29.0/100,000).
While pregnancy-related mortality rates rose among all races and rural-urban residence categories in 2021, the biggest hike occurred among American Indian/Alaska Native (AIAN) women (160.8 vs 79.0/100,000 live births; relative increase, 104%) in 2021 relative to April to December 2020. Black women saw the largest absolute increase in 2021 (16.5/100,000), and Hispanic women had the greatest relative increase (34%).
Medium to small metropolitan (52.4 vs 37.7/100,000 live births; relative change, 39.0%) and rural (56.2 vs 46.5/100,000; relative change, 21.0%) areas saw a larger increase in 2021 than in April to December 2020 compared with large urban areas (39.1 vs 33.7/100,000; relative change, 15.9%).
The pandemic exacerbated what were already poor maternal outcomes in the US.
"Pregnancy-related mortality ratios increased more rapidly in 2021 than in 2020, consistent with rising rates of COVID-19–associated mortality among women of reproductive age," amid COVID-19 and the pandemic-related shuttering of many obstetric facilities and services, the authors wrote.
In a Boston University press release, senior author Eugene Declercq, PhD, said the dramatic rise in AIAN maternal deaths deserves more attention. "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 death rates not seen since 1964," he said.