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A recent study revealed a nearly 28% increase in pregnancy-related death rates in the U.S. between 2018 and 2022, highlighting significant disparities across states, races, and ethnicities.
The study, published in on April 9, analyzed four years of nationwide data from the CDC. Researchers identified 6,283 pregnancy-related deaths during this period. The rate climbed from 25.3 deaths per 100,000 live births in 2018 to a high of 44.1 in 2021, before slightly decreasing to 32.6 in 2022. The increase was observed across all analyzed age groups, with those aged 25-39 experiencing the most significant rise, according to the findings.
The research did not explore the reasons behind the increased death rates during the four-year span. However, the authors suggested that the COVID-19 pandemic may have impacted maternal health and the overall healthcare system, especially in 2021.
Dr. Rose Molina, a study author and ob-gyn at Beth Israel Deaconess Medical Center, noted “a large variation by state” in pregnancy-related death rates. Alabama had the highest rate at 59.7 deaths per 100,000 live births, followed by Mississippi at 58.2. California had the lowest rate at 18.5 deaths per 100,000 live births, followed by Minnesota at 19.1. Molina suggests that variations in access to prenatal, labor and delivery, and postpartum care, along with state Medicaid coverage differences, could explain these disparities.
“There really shouldn’t be this level of variation across the states, and we need to do better across all the states,” Molina stated. “One of the points we made in that article was that if all states could have performed as well as the highest performing state, like California, we could have avoided 2,679 pregnancy-related deaths” during the four-year period.
The study also revealed that the pregnancy-related death rate among American Indian and Alaska Native women was 3.8 times higher than that of white women. Similarly, the rate among non-Hispanic Black women was 2.8 times higher compared to white women. Molina explains that various studies have indicated that disparities in access based on income or location, as well as biases within the healthcare system, contribute to these racial and ethnic inequities in maternal health outcomes.
The count of pregnancy-related deaths between 2018 and 2022 includes 1,891 late maternal deaths, defined as deaths “from any cause related to or aggravated by pregnancy” occurring from a little over a month up to a year after the end of pregnancy, according to the research. The researchers wrote, “Late maternal death occurs in what could be a health care delivery gap between obstetric care and transition to primary care.”
American Indian and Alaska Native women also exhibited the highest rate of late maternal death, followed by non-Hispanic Black women, according to Molina. The study suggests that “these groups may face disparities in access to postnatal care, as well as other socioeconomic and systemic challenges impacting maternal health outcomes.”
The study determined that cardiovascular disease was the leading cause of pregnancy-related deaths overall. Cancer, mental and behavioral disorders, and drug or alcohol-induced deaths were contributing factors to late maternal death.
The U.S. has the among , and Molina states that the study “illustrates why we cannot take our eyes off of maternal health.”
“It’s important that we not lose sight of how maternal health needs to be a focus of investment in the years to come—that we still have work to do,” Molina emphasized. “We need to continue investing in the infrastructure [and] the policies that ensure access to high-quality pregnancy care for everyone.”
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