Maternal deaths climbed 33% during COVID-19

Woman in labor
Woman in labor

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Maternal deaths in the first months of the COVID-19 pandemic increased 33%—and even higher in Black and Hispanic women—according to data from the National Center for Health Statistics (NCHS) published yesterday in a study in JAMA Network Open.

That rate compares with an overall 22% COVID-related excess death rate during the study period, according to two researchers from the University of Maryland (UMD) and Boston University (BU), who conducted the study. They defined maternal mortality as deaths during pregnancy or just after birth.

Rates rise 40% to 78% in minority women

The investigators used NCHS data from 2018 through 2020 to compare pre-pandemic with pandemic death rates.

They found that the rate of maternal deaths was 18.8 per 100,000 births before the pandemic, compared with 25.1 per 100,000 births from March through December 2020 (the pandemic period), for an overall increase of 33.3%. And they discovered that late maternal mortality (42 days to 1 year after birth) increased 41%.

Maternal mortality increased the most in Hispanic women (78.0%, or an increase of 8.9 per 100,000 births) and Black women (40.2%; 16.8), compared with 17.2% in White women (2.9).

A secondary diagnostic code for COVID-19 was listed in 14.9% of maternal deaths in quarters 2 to 4 of 2020, with 0% in quarter 1. This percentage was highest among Hispanic women (32.1%), followed by Black (12.9%) and White (7.3%) women.

For underlying cause-of-death codes, the authors determined that the largest relative increase was among indirect causes (56.9%), specifically other viral diseases (2,374.7%), diseases of the respiratory system (117.7%), and diseases of the circulatory system (72.1%). Relative increases in direct causes (27.7%) were mostly associated with diabetes in pregnancy (95.9%), high blood pressure (39.0%), and other pregnancy-related conditions (48.0%).

COVID-19 was commonly listed as a secondary condition with other viral diseases and diseases of the respiratory system.

COVID impact on childbearing women

The authors write, "Change in maternal deaths during the pandemic may involve conditions directly related to COVID-19 (respiratory or viral infection) or conditions exacerbated by COVID-19 or other health care disruptions (diabetes or cardiovascular disease) but could not be discerned from the data."

"The increase was really driven by deaths after the start of the pandemic, which are higher than what we see for overall excess mortality in 2020," said first author Marie Thoma, PhD, an assistant professor of family science at UMD, in a university press release.  

The other study author, Eugene Declercq, PhD, a professor of community health sciences at BU, said, "For the first time in more than a decade, the maternal mortality rate for Hispanic women during the pandemic was higher than that for non-Hispanic white women, a shift that may be related to COVID and deserves greater attention moving forward."

Thoma added, "We need more detailed data on the specific causes of maternal deaths overall and those associated with COVID-19. Potentially we could see improvements in 2021 due to the rollout of vaccines, as well as the extension of postpartum care provided for Medicaid recipients as part of the American Rescue Act of 2021 in some states.

"We're going to continue to examine this."

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