Odds of maternal death, pregnancy complications increase during COVID-19 pandemic

During the pandemic, the risk for death during hospitalization for delivery, cardiovascular disorders and obstetric hemorrhage increased for pregnant patients, according to a retrospective cohort study published in JAMA Network Open.

“We found a small but statistically significant increase in maternal death during hospitalization for childbirth and pregnancy-related complications during the pandemic, which is alarming,” Rose L. Molina, MD, MPH, an OB/GYN and director of the OB/GYN diversity, inclusion and advocacy committee at Beth Israel Deaconess Medical Center in Boston, said in a press release. “Our work demonstrates how the overall disruptions of the COVID-19 pandemic impact the health of pregnant people.”

Using data from a national, hospital-based database, Molina and colleagues assessed the relative change in birth outcomes, mode of delivery, maternal mortality, pregnancy-related complications and length of hospital stay between the period before the pandemic — from Jan. 1, 2019, to Feb. 28, 2020 — and during the pandemic — from March 1, 2020, to April 30, 2021.

In total, 849,544 and 805,324 patients delivered at 463 hospitals across the United States before and during the pandemic, respectively. The researchers found that patient characteristics such as race and insurance type did not differ significantly between those time periods.

Analyses of pregnancy outcomes revealed that live births decreased by 5.2% during the pandemic. Despite this, the rate of preterm birth (10.7%) and fetal deaths and stillbirths (0.9%) remained relatively unchanged across the study period.

The rates of vaginal delivery (61.5% vs. 61.1%), primary cesarean delivery (17% vs. 17.6%), repeated cesarean delivery (15.6% vs. 15.5%), assisted birth (3.7% vs. 3.7%) and vaginal birth after cesarean (2.3% vs. 2.2%) also remained relatively stable from the pre-pandemic period to during the pandemic.

During the pandemic, the odds of maternal mortality during hospitalization for delivery increased from 5.17 to 8.69 per 100,000 pregnant patients (aOR = 1.75; 95% CI, 1.19-2.58). The odds were also higher for gestational hypertension (aOR = 1.08; 95% CI, 1.06-1.11), chronic hypertension (aOR = 1.06; 95% CI, 1.03-1.09), obstetric hemorrhage (aOR = 1.07; 95% CI, 1.04-1.10) and preeclampsia (aOR = 1.04; 95% CI, 1.02-1.06), according to the study.

Additionally, data showed that the length of stay during hospitalization for delivery decreased by 7% (rate ratio = 0.931; 95% CI, 0.928-0.933).

Notably, although racial and ethnic disparities existed before and during the pandemic, there were few changes in those disparities between the two periods.

Molina and colleagues cautioned that their findings were limited by the nature of the study and the registry they used as a data source.

As for the future, the researchers suggested that “further efforts are needed to ensure risks potentially associated with the COVID-19 pandemic do not persist beyond the current state of the pandemic.”

References:

• Nationwide study shows rise in pregnancy-related complications during COVID-19 pandemic. https://www.eurekalert.org/news-releases/961594. Published Aug. 12, 2022. Accessed Aug. 12, 2022.
• Molina RL, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.26531.