Pregnancy-associated death increased during COVID-19 pandemic

During 2020, the rate of pregnancy-associated death increased by 35% from 2019, with changes observed in the proportions of drug-related deaths, homicides and suicides, researchers reported.

“The COVID-19 pandemic had unique effects on pregnant and postpartum people: Maternal deaths from obstetric causes increased 33% between April and December 2020 compared with previous years,” Claire E. Margerison, PhD, an associate professor of epidemiology and biostatistics at Michigan State University in East Lansing, and colleagues wrote in JAMA Network Open. “That study, however, did not include deaths from nonobstetric causes among pregnant or postpartum people. Deaths from drug overdose, suicide and homicide represent large and growing proportions of all deaths during pregnancy and the first year postpartum (ie, pregnancy-associated deaths), and rates of drug overdose deaths and homicide increased substantially in the general U.S. population in 2020.”

Margerison and colleagues analyzed data from U.S. death certificates from 2018 to 2020 to identify deaths among girls and women aged 15 to 44 years from April to December of each year. Death certificates included information on whether each person was pregnant at the time of death or had been pregnant within the past year.

The researchers also identified live births among these girls and women that were listed in the CDC WONDER database.

There were 4,528 pregnancy-associated deaths across the study period. Overall, pregnancy-associated death increased by 35% from 49.6 (95% CI, 47-52.2) per 100,000 live births in April to December 2019 to 66.9 (95% CI, 63.9-70.1) deaths per 100,000 live births in April to December 2020.

Analyses of cause of death revealed that increases in drug-related deaths (55.3%), homicide deaths (41.2%), obstetric deaths (28.4%) and other deaths such as motor vehicle crashes (56.7%) between 2019 and 2020. Pregnancy-associated suicide deaths decreased by 7.1% from 2019 to 2020.

Notably, all causes of pregnancy-associated death except those categorized as “other” increased from 2018 to 2019, but increases from 2019 to 2020 were larger, according to the researchers.

“These findings are consistent with pandemic-related trends in the overall population and with data on obstetric deaths and pregnancy-associated homicide,” the researchers wrote. “These trends may reflect multiple population stressors during 2020, including COVID-19 pandemic-related economic strain, the murder of George Floyd and the fentanyl epidemic; our analyses did not address causality.”

Future efforts should focus on prevention and intervention methods specific to pregnant and postpartum women, they wrote.