The COVID-19 pandemic and its impacts have taken a disproportionate toll on American mothers who were pregnant or just gave birth. Maternal mortality (i.e., deaths during pregnancy or in the early postpartum period) increased by 18% in 2020, according to data from the National Center for Health Statistics, exceeding the ~16% increase in overall US mortality in 2020. Yet according to a new analysis from the University of Maryland and Boston University, the maternal death rate after the start of the COVID-19 pandemic was even higher, and disproportionately impacted Black and non-white Hispanic mothers.
A research letter published in JAMA Network Open by Marie Thoma in the UMD School of Public Health and Eugene Declercq in the BU School of Public Health compared maternal mortality data from 2018-March 2020, when the pandemic began, to April-December 2020. Overall, they found large increases in maternal death (33%) and late maternal deaths (41%) after March 2020 compared with before the pandemic, and conspicuous increases among Black and Hispanic mothers.
The increase was really driven by deaths after the start of the pandemic, which are higher than what we see for overall excess mortality in 2020."
Dr. Marie Thoma, assistant professor of family science, UMD SPH
The study also showed that existing and new disparities emerged after the pandemic with a 40% jump among already high rates for non-Hispanic Black women and a 74% jump among formerly lower rates in Hispanic women.
Strikingly, said Dr. Declercq, professor of community health sciences at BUSPH, "for the first time in more than a decade, the maternal mortality rate for Hispanic women during the pandemic was higher than that for non-Hispanic white women, a shift that may be related to COVID and deserves greater attention moving forward."
COVID-19 was listed as a secondary cause of death in 14.9% of maternal deaths in the last nine months of 2020, with it being a contributing factor for 32% of Hispanic, 12.9% of Black and 7% of non-Hispanic white women giving birth.
In their analysis of causes of maternal death, they found the largest increases were due to conditions directly related to COVID-19 (respiratory or viral infection) and conditions made worse by COVID-19 infection, such as diabetes or cardiovascular disease. However, interruptions to the health care system could have led to delayed prenatal care that could have meant that risk factors for pregnancy complications went undetected.
"We need more detailed data on the specific causes of maternal deaths overall and those associated with COVID-19," Dr. Thoma said. "Potentially we could see improvements in 2021 due to the rollout of vaccines, as well as the extension of postpartum care provided for Medicaid recipients as part of the American Rescue Act of 2021 in some states. We're going to continue to examine this."
Thoma, M.E., et al. (2022) All-Cause Maternal Mortality in the US Before vs During the COVID-19 Pandemic. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2022.19133.