Since 1987, U.S. pregnancy-related deaths have trended upward, according to the Centers for Disease Control and Prevention. Death of a woman during pregnancy or within one year of the end of pregnancy increased from 7.2 deaths per 100,00 live births in 1987 to 17.3 deaths per 100,000 live births in 2017. Some of this increase has to do with changes in federal and state reporting requirements and improved computerized data linkages, making it hard to tease out the actual deterioration in maternal outcomes. By 2020, however, the most recent data available, pregnancy-related death rates were 23.8 per 100,000 live births, according to the National Center for Health Statistics (see graph). The increase in maternal death rates was significantly higher for non-Hispanic Black women and Hispanic women than for non-Hispanic White women from 2019 to 2020.

Figure. U.S. maternal mortality rates, by race and Hispanic origin, 2018-2020. National Center for Health Statistics / Centers for Disease Control and Prevention.

Recent reports implicate the COVID-19 pandemic as possibly worsening this trend. One study in the February 22 JAMA of pregnant women in 17 hospitals who tested positive for COVID-19 found a significantly increased risk of a composite of death and serious obstetric morbidity from hypertensive disorders, postpartum hemorrhage, or infections other than SARS-CoV-2. Another study published online in JAMA Internal Medicine also found COVID-19 infection during pregnancy to be associated with severe maternal morbidity. A caveat mentioned in both studies is that they were conducted before the general population had been vaccinated.

Higher rates of COVID-19 and deaths and disruptions in access to care have disproportionately affected people of color and may have worsened maternal health outcomes, according to a 2021 report from the Urban Institute. The report also suggests that wider reimbursement of health care workers, such as midwives, doulas, and mental health providers, could improve the equitable delivery of health care. Improving staffing by expanding midwifery services and easing licensing requirements between states has been useful so far, but the authors caution that those approaches may be temporary. The report suggests that expanding Medicaid eligibility and access to services and continuing and improving telehealth services, among other approaches, could also improve equity in care delivery. Read the full report at http://www.urban.org/research/publication/maternal-health-inequities-during-covi.-Gail M. Pfeifer, MA, RN