The rate of mothers dying during pregnancy increased by nearly a third in the last nine months of 2020, the first year of the coronavirus pandemic, with more pronounced changes among minority groups, according to a new study published Tuesday.
The study, published in the JAMA Network online journal, compared maternal mortality data from the National Center for Health Statistics in two time periods. Researchers stratified the year and month of death for individuals before the pandemic – between 2018, 2019, and January-March 2020 – and those during April - December 2020, after COVID-19 lockdowns went into effect across the country.
The data showed a total of 1588 maternal deaths (or 18.8 per 100 000 live births) across the designated pre-pandemic time period compared to 684 maternal deaths (18.8 per 100 000 live births) in the last three quarters of 2020, representing a relative increase of nearly 33%.
Researchers also noted a 41% increase in late maternal deaths after March 2020 when compared with before the pandemic. According to the World Health Organization, a late maternal death is one where an individual dies of “direct or indirect obstetric causes, more than 42 days but less than one year after termination of pregnancy.”
Maternal mortality rates increased more for Black and Hispanic Americans than for their white counterparts, according to the study. The maternal mortality rate for Hispanic individuals increased 74% and 40% for Black individuals compared to 17% for white individuals.
“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, lead study researcher and an assistant professor of family science at the University of Maryland, wrote in a statement.
The largest increase in the causes of maternal death were found to be conditions exacerbated or worsened by COVID-19 infection, researchers wrote in part, as well as conditions “directly related to COVID-19.” Those complications include diabetes, cardiovascular disease and respiratory system issues.
While no records posited COVID as the sole cause of death, some identified it as a secondary cause of maternal mortality.
Researchers noted several limitations with the study, including that a large portion of those with COVID-19 had a “nonspecific underlying cause” that represented a maternal health coding issue.
“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.”
The study published Tuesday aims to offer more specific insight into maternal mortality after the onset of the COVID-19 pandemic in March 2020. A previous report from the National Center for Health Statistics, published in February of this year, found there were almost 24 deaths per 100,000 births – or 861 deaths total – throughout 2020, and did not separate the findings based on the coronavirus pandemic.
The NCHS report did not include reasons for the trend and researchers had, at the time, not fully examined how COVID-19, which increases risks for severe illness in pregnancy, might have contributed.
The coronavirus could have had an indirect effect. Many people put off medical care early in the pandemic for fear of catching the virus, and virus surges strained the health care system, which could have an impact on pregnancy-related deaths, said Eugene Declercq, a professor and maternal death researcher at Boston University School of Public Health.
He called the high rates “terrible news’’ and noted that the U.S. has continually fared worse in maternal mortality than many other developed countries.
The Associated Press contributed to this report.