Maternal deaths in the U.S. keep climbing

An increasing number of women in the US are dying during pregnancy or soon after giving birth, according to the latest maternal mortality rate data.

In 2021, there are 32.9 deaths per 100,000 live birthscompared to 23.8 per 100,000 in 2020 and 20.1 in 2019, the National Center for Health Statistics reported on March 16. The The US rate is greatly exceeded in other high-income countries. The total number of maternal deaths in the US increased from 861 in 2020 to 1,205 in 2021.

A wide disparity remains in the maternal mortality rate for Black women, at 69.9 deaths per 100,000 live births, compared to white women, at 26.6 per 100,000. Many social determinants of health underlie this gap, including difference in quality of care that black women receive before, during and after pregnancy.

The NCHS report does not discuss the reasons behind the increase for 2021. But COVID-19 has contributed to a quarter of maternal deaths in 2020 and 2021, the US Government Accountability Office reported in October. The pandemic also contributed to the disparity in mortality between Black and white women, the GAO found, exacerbating existing structural inequalities that lead to issues such as barriers to obtaining health care (SN: 4/10/20).

Maternal deaths captured by the NCHS report are those that occur during pregnancy or within 42 days of the end of pregnancy, “from any cause related to or aggravated by pregnancy or its management.” These causes include bleeding, infections and high blood pressure disorders such as eclampsia.

The report does not include deaths after 42 days and up to the first year after birth. But 30 percent of pregnancy-related deaths occurred during this period, the US Centers for Disease Control and Prevention reported in September, from a review of the years 2017 to 2019.

“We really need to take care of our new mothers beyond those six weeks,” says maternal fetal medicine specialist Cynthia Gyamfi-Bannerman, Chair of the Obstetrics, Gynecology & Reproductive Sciences Department at the University of California, San Diego School of Medicine. of Medicine.

One effort to expand coverage in the year after birth is through Medicaid insurance, which paid for 42 percent of births in the US in 2020. States have the option to extend coverage from up to 60 days after birth. up to a full year through the provision of the American Rescue Plan Act of 2021.

The maternal mortality rate also does not include maternal deaths due to homicide. In 2018 and 2019, homicide is the leading cause of death during pregnancy or within 42 days after pregnancy, responsible for more than twice as many deaths as causes such as bleeding, researchers reported in Obstetrics and Gynecology in 2021. Studies have found that in most of these homicide cases, the intimate partner is a killer, usually using a gun. Pregnant women are at higher risk of homicide than non-pregnant women of reproductive age.

Suicide is also a leading cause of death during pregnancy and one year after birth, but is not captured in the maternal mortality rate.

There have been improvements in the management of pregnancy complications such as bleeding and blood pressure disorders, Gyamfi-Bannerman said. Implementation of care bundles, similar to medical checklists, for these and other complications can reduce maternal mortality.

But because gun violence and poor maternal mental health “also lead to maternal deaths,” says Gyamfi-Bannerman, addressing these issues is also critical.