In a 29-state review of 2017–2019 data, 86.4% of pregnancy-related infection deaths were deemed preventable, with genital tract infections, group A streptococcus, and delays in antibiotics emerging as key targets for intervention.
Infection accounted for nearly 1 in 10 pregnancy-related deaths reviewed by state Maternal Mortality Review Committees (MMRCs) between 2017 and 2019, and most were deemed preventable, according to a new analysis of 29 states’ data.1
Naima T. Joseph, MD, MPH, an assistant professor at Boston University Chobanian & Avedisian School of Medicine and colleagues evaluated pregnancy-related deaths reported to the Centers for Disease Control and Prevention with an MMRC-determined underlying cause of infection. “Maternal mortality remains an urgent public health priority,” Joseph said, noting that “the United States maternal mortality rate continues to exceed that of all industrialized nations, with most recent estimates ranging from about 18 deaths per 100,000 live births.”
Among deaths reported during 2017–2019, 9.2% were due to underlying infection. The study identified 91 pregnancy-related infection deaths; among 88 with a preventability determination, 86.4% were considered preventable. Most deaths (69.3%) occurred within 42 days postpartum.
Joseph emphasized the role of MMRCs in identifying root causes and prevention opportunities. These committees “are really given wide berth to a variety of sources that include medical records, natality data, autopsy reports, social services, legal records, etc,” she said, allowing them to “accurately identify root causes for maternal deaths” and generate “very specific and actionable recommendations that inform local and national prevention strategies.”
Clinically, infections most frequently involved the genital tract. When a source was identified, approximately 48% were genital tract infections (47.9%, 35 of 73). When a pathogen was identified, 34.0% (18 of 53) were due to group A streptococcus. “We found that when a source was identified in approximately 48% of the cases, the source of infection was genital, and that when a pathogen was identified approximately 34% of the time, it was group A streptococcus,” Joseph said.
The majority of decedents (69.1%, 47 of 68) had a health care encounter within 7 days of death, and hospitalization was the most frequent encounter type (50.7%, 36 of 71). Contributing factor categories most often cited by MMRCs included clinical skill or quality of care (18.6%), delay (10.1%), knowledge (10.1%), lack of continuity of care (9.6%), and lack of access or financial resources (7.8%).
Delays in antibiotic administration were common. “We also looked at timeliness in intervention and measured that by timing to antibiotic receipt, which was variably coded. But in the majority of instances there was a delay in antibiotic administration,” Joseph said. These findings, she added, “suggest that we have some prevention opportunities that can be done to improve the quality of care patients are receiving, specifically and importantly around genital tract infection.”
At the bedside, this may translate to “improving clinician examination of the genitourinary tract and maybe enhancing just the underlying sense or diagnostic probability by asking all patients timing in pregnancy, they’re currently pregnant or recently pregnant,” she said. She also pointed to “a role for improving group A strep recognition,” noting that invasive group A streptococcus “has a very high case fatality, but is extremely treatable with appropriate antibiotic selection and source control.”
Ultimately, Joseph underscored opportunities at both the facility and system levels to enhance clinician detection, education, decision support, and timely treatment to reduce serious maternal infections.
REFERENCE
1. Joseph NT, Trost SL, Hollier LM, et al. Pregnancy-related mortality due to infection: maternal mortality review committees in 29 U.S. States, 2017-2019. Obstet Gynecol. 2026 Jan 9. doi:10.1097/AOG.0000000000006172
