Maternal Mortality Increased Significantly at Beginning of COVID-19 Pandemic

New statistics make a compelling argument as to why pregnant women need to be up-to-date on their COVID-19 vaccines. A new study documents a startling increase in maternal deaths at the beginning of the pandemic, both because of the virus itself and exacerbations of other conditions. Here are more details.

COLLEGE PARK, MD – Coinciding with the beginning of the COVID-19 pandemic, deaths of expectant mothers shot up 18.4% between 2019 and 2020, according to the National Center for Health Statistics (NCHS).

The relative increase was 44.4% among Hispanic, 25.7% among non-Hispanic Black, and 6.1% among non-Hispanic white women who were pregnant. “Given a 16.8% increase in overall US mortality in 2020, largely attributed to the COVID-19 pandemic, we examined the pandemic’s role in 2020 maternal death rates,” write researchers from the University of Maryland and Boston University.

The study, which was published online by JAMA Network Open, used deidentified NCHS mortality and natality files from 2018 to 2020. The study team reports that 1,588 maternal deaths (18.8 per 100 000 live births) occurred before the pandemic vs. 684 deaths (25.1 per 100 000 live births) during the pandemic, a relative increase of 33.3%. The increase in late maternal mortality was especially concerning, at 41%.

Researchers found that absolute and relative changes were highest for Hispanic (8.9 per 100 000 live births and 74.2%, respectively) and non-Hispanic Black (16.8 per 100 000 live births and 40.2%) vs. non-Hispanic white (2.9 per 100 000 live births and 17.2%) women.

“A secondary code for COVID-19 was listed in 14.9% (102 of 684) of maternal deaths in quarters 2 to 4, with 0% in quarter 1 of 2020,” the authors explain. “This percentage was highest among Hispanic women (32.1%), followed by non-Hispanic Black (12.9%) and non-Hispanic white (7.3%) women.”

The study found that the largest relative increase was among indirect causes (56.9%), especially other viral diseases (2374.7%), diseases of the respiratory system (117.7%), and diseases of the circulatory system (72.1%).

“Relative increases in direct causes (27.7%) were mostly associated with diabetes in pregnancy (95.9%), hypertensive disorders (39.0%), and other specified pregnancy-related conditions (48.0%),” the study points out. “COVID-19 was commonly listed as a secondary condition with other viral diseases (16 of 16 deaths [100%]) and diseases of the respiratory system (11 of 19 deaths [57.9%]) (Table). Almost half of those with a secondary code for COVID-19 (49 of 102) had a nonspecific code (ICD-10 O26.8 or O99.8) as the underlying cause.”

Researchers suggest the change in maternal deaths during the pandemic appears to involve both conditions directly related to COVID-19 (respiratory or viral infection) or conditions exacerbated by COVID-19 or other healthcare disruptions, such as diabetes or cardiovascular disease.

“Future studies of maternal death should examine the contribution of the pandemic to racial and ethnic disparities and should identify specific causes of maternal deaths overall and associated with COVID-19,” the authors write.

Data at the end of June indicates that 56.4% of fully vaccinated pregnant women have received booster doses, but rates are much lower among Hispanic and non-Hispanic Black mothers-to-be, 46.6% and 38.6%, respectively.

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