Maternal mortality rates jumped from 2019 to 2020; racial and ethnic disparities persist

All-cause maternal mortality rates increased nearly 30% in the United States from 2019 to 2020, with racial and ethnic disparities evident across the board, according to the results of a research letter published in JAMA Network Open.

Jeffrey T. Howard, PhD, an associate professor of public health at the University of Texas at San Antonio, and colleagues wrote that recent research has indicated trends of worsening maternal health due to severe maternal morbidity, substance use and depression in the U.S. over the past decade, particularly during the pandemic. Additionally, they noted recent increases in all-cause mortality and drug and alcohol poisoning mortality rates for pregnant people.

To learn more, the researchers conducted a cross-sectional study to evaluate cause-specific and all-cause mortality rates among pregnant people from 2019 to 2020 and assess how the results varied by race and ethnicity.

Howard and colleagues used deidentified data of 4,535 deaths from 2019 to 2020, 64% of whom were women aged 34 years or younger, 50.5% of whom were white, 28.1% of whom were Black and 14.8% were Hispanic. They obtained multiple cause of death data from the National Center for Health Statistics and live birth count data from the CDC’s WONDER database, which were then aggregated by race and ethnicity, year and age group. The researchers also identified causes and manner of death through ICD-10 codes.

For recently pregnant women — defined as those who died within 1 year after pregnancy or who were pregnant at the time of death — Howard and colleagues reported that all-cause mortality rates increased 29% from 2019 to 2020 (mortality rate ratio [MRR] = 1.29). The leading causes of death were pregnancy-associated causes and drug poisoning.

Additionally, mortality rates significantly increased by 36% (MRR = 1.36) from 26.4 to 36 per 100,000 live births for nonpregnancy causes and 22% (MRR = 1.22) from 27.5 to 33.6 per 100,000 live births for pregnancy-associated causes.

The researchers observed significant increases in mortality rates due to drug poisoning (MRR = 1.42), homicide (MRR = 1.33) and motor vehicle collision (MRR = 1.31). Suicide mortality rates, however, did not increase.

Although they comprised just 2.4% of the study population, the researchers found that American Indian or Alaska Native women had significantly higher mortality rates across all causes of death compared with their white counterparts. Additionally, the researchers noted that Black women faced significantly higher mortality rates for every cause except drug poisoning and suicide, and multiracial women saw higher homicide rates.

“Compared with non-Hispanic white women, mortality rates were three- to five-fold higher among American Indian or Alaska Native women for every cause, including suicide,” Howard and colleagues wrote. “Likewise, these findings suggest that non-Hispanic Black women experienced significantly higher mortality rates across causes, with the highest rates for homicide. Enhanced surveillance and intervention for these vulnerable groups may be warranted.”