All-Cause Maternal Mortality Before vs During COVID-19 Pandemic

During the COVID-19 pandemic, the National Center for Health Statistics (NCHS) reported an 18.4% increase in US maternal mortality. Overall US mortalities increased by 16.8% during the pandemic, so the fact that maternal mortalities rose even more merits further investigation.

One study, published this week in the Journal of the American Medical Association, examined the pandemic’s role in 2020 maternal death rates. The investigators utilized NCHS mortality and natality files from 2018-2020. The mortalities were stratified by month, and years were stratified by before the pandemic (2018, 2019, January-March 2020) and after the pandemic (April-December 2020).

Rates of maternal mortalities and percentages of deaths with COVID-19 as a secondary cause were compared by timing, race, ethnicity, and underlying cause.

A total of 1588 maternal deaths (18.8 per 100000 live births) occurred before the pandemic, and 684 deaths (25.1 per 100000) occurred during the pandemic, for a relative increase of 33.3%. Late maternal mortalities rose by 41%.

Broken down by ethnicity, the maternal mortalities during COVID-19 increased by 44.4% among Hispanic women, 25.7% among non-Hispanic Black women, and 6.1% among non-Hispanic white women.

COVID-19 as a secondary cause of death was coded in 14.9% of maternal mortalities from the second through fourth quarters of 2020. At 32.1%, this percentage was also highest among Hispanic women, followed by 12.9% in non-Hispanic Black women and 7.3% in non-Hispanic white women.

The largest relative increase in cause of maternal deaths were indirect causes (56.9%), with a 2374.7% increase in other viral diseases, 117.7% in respiratory system diseases, and 72.1% in circulatory system diseases.

The 27.7% relative increase in direct causes were 95.9% associated with diabetes in pregnancy, 39.0% with hypertensive disorders, and 48.0% with other specified pregnancy-related conditions.

COVID-19 was listed as a secondary cause of death in 16/16 of maternal mortalities due to other viral diseases, and 11/19 respiratory disease deaths. Almost half of maternal mortalities with COVID-19 as a secondary cause of death had a nonspecific code listed as the primary cause of death.

The investigators concluded that maternal deaths in the US increased by 33.3% after March 2020, higher than the 22% overall mortality increase associated with the pandemic.

This increase in maternal mortalities during the pandemic may have been due to respiratory or viral conditions directly related to COVID-19, or conditions exacerbated by COVID-19, including healthcare shortages and disruptions.

The authors recommended future study into maternal death to examine how the pandemic worsened racial and ethnic mortality disparities. Additionally, work should be done to more specifically identify causes of maternal death during the COVID-19 pandemic.