COVID-19 linked to surge in US maternal mortality

COVID-19 linked to surge in US maternal mortality | Image Credit: © oz - © oz - stock.adobe.com.

While maternal mortality rates were increasing in the United States prior to the COVID-19 pandemic, the pandemic itself significantly worsened these trends, according to a recent study published in JAMA Pediatrics on April 28, 2024.¹

The data highlighted a sharp rise in maternal mortality rates recorded in 2021. This impacted all racial and ethnic groups, indicating a significant impact from the COVID-19 pandemic and highlighting the need to accurately report maternal and infant health data.¹

“The numbers do not speak for themselves,” said Seth Flaxman, BA, PhD, associate professor at the University of Oxford. “At the height of the COVID-19 pandemic, pregnant women died at significantly higher rates than they did before the pandemic. But when we took a careful look at the two decades before the pandemic, we found remarkably little change.”¹

Role of the pregnancy checkbox in reporting

Data from 2000 to 2023 was included in the analysis, highlighting the impact of the pregnancy checkbox in death certificates. Researchers performed a difference-in-differences analysis to compare states where the checkbox was implemented to those that had not yet introduced it.¹

Between 2000 and 2019, 66% of the increase in maternal deaths was accounted for by the checkbox’s introduction. This indicated an additional 6.8 deaths per 100,000 live births per year, with maternal mortality rates remaining stable in the pre-pandemic period when adjusting for the checkbox’s influence.¹

Pandemic-era peaks in maternal mortality

When adjusting for maternal deaths, rates remained between 6.75 and 10.24 per 100,000 live births from 2000 to 2021.² In 2021, a peak of 18.86 deaths per 100,000 live births was reported, before dropping to 10.23 per 100,000 in 2022.

Notably, Native American women experienced the greatest increase, nearly tripling from 10.70 per 100,000 live births between 2011 and 2019 to 27.47 per 100,000 between 2020 and 2022. However, non-Hispanic Black women had the highest mortality rates over time, approximately 3-fold higher than those of non-Hispanic White women.²

Among infants, the rate of mortality decreased from 6.93 per 1000 live births in 2000 to 5.44 in 2022. A minor increase to 2018 levels was reported between 2021 and 2023, but the rate of 5.53 in 2022 was significantly lower than the rate of 6.28 in 2005.²

Persistent racial disparities in maternal mortality

This data highlighted significant racial disparities in maternal mortality.¹ This includes a rate of 20.7 per 100,000 among non-Hispanic Black women prior to the COVID-19 pandemic, compared to 5 per 100,000 among their non-Hispanic White counterparts.

Even when accounting for the influence of the pregnancy checkbox, the increase observed in the 2020 to 2022 period compared to the 2011 to 2019 period remained in most groups.² Therefore, investigators concluded that the data show the importance of public health emergencies to maternal health outcomes.

“By accounting for changes in reporting, our study clarifies the significant impact of public health emergencies on maternal outcomes,” said Robin Y. Park, PhD student at the University of Oxford and lead author.¹ “Any future initiatives on pandemic preparedness should consider provisions for childbirth and postpartum care to limit preventable maternal deaths.”

References

1. Data collection changes key to understanding maternal mortality trends in the US, new study shows. University of Oxford. April 28, 2025. Accessed April 30, 2025. https://www.eurekalert.org/news-releases/1081472
2. Park RY, Bilinski A, Parks RM, Flaxman S. Trends in maternal, fetal, and infant mortality in the US, 2000-2023. JAMA Pediatr. 2025. doi:10.1001/jamapediatrics.2025.0440