US maternal mortality rate down, morbidity up since 2008
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Key takeaways:
- Maternal mortality decreased from 10.6 deaths per 100,000 discharges in 2008 to 4.6 deaths in 2021.
- Severe maternal morbidity increased from 146.8 per 10,000 discharges in 2008 to 179.8 in 2021.
From 2008 to 2021, delivery-related mortality decreased for all races, ethnicities, age groups and modes of delivery in the U.S. while severe maternal morbidity increased, according to an HHS study.
“Obstetrical providers are essential to care, management, and education of women before, during and after pregnancy to identify conditions that may negatively impact maternal and infant outcomes. These providers are essential drivers of hospital quality improvement efforts, such as implementation of maternal safety bundles and support of the Alliance for Innovation on Maternal Health Program,” Dorothy A. Fink, MD, deputy assistant secretary for Women’s Health and director of the Office on Women’s Health at HHS, told Healio. “Inpatient mortality rates have significantly decreased, which is a positive reflection of overall efforts to address this national issue. All providers, particularly obstetrical providers who are responsible for maternal care, are critical to advancing and sustaining national quality improvement efforts focused on identification and management of conditions impacting maternal health outcomes.”
Fink and colleagues conducted a retrospective cross-sectional study, published in JAMA Network Open, utilizing a large, geographically diverse, all-payer hospital administrative database. Researchers analyzed 11,628,438 unique hospital discharges (mean age, 28 years) from 2008 to 2021 with any Medicare Severity Diagnosis Related Group, delivery diagnosis or procedure code indicating delivery. The primary outcome was maternal mortality and severe maternal morbidity during delivery-related hospitalization.
Overall, 53.3% of women were white, 15.2% were Hispanic, 14.1% were Black, 3.8% were Asian, 0.8% were American Indian and 0.7% were Pacific Islander. Researchers observed a reduction from 10.6 deaths per 100,000 discharges in 2008 to 4.6 deaths per 100,000 discharges in 2021 in regression-adjusted maternal mortality. Maternal mortality was significantly higher among women aged 35 to 44 years vs. women aged 25 to 34 years (adjusted OR = 1.49; 95% CI, 1.22-1.84).
Researchers noted that cesarean delivery (aOR = 2.28; 95% CI, 1.87-2.79), cardiac complications (aOR = 111.11; 95% CI, 86.69-142.42), cystic fibrosis (aOR = 40.17; 95% CI, 7.22-223.56), aneurysm (aOR = 25.07; 95% CI, 7.4-84.91), puerperal cerebrovascular disorder (aOR = 9.09; 95% CI, 6.11-13.51), and COVID-19 diagnosis (aOR = 13.31; 95% CI, 8.95-19.79) were also significant risk factors for maternal mortality.
Regarding severe maternal morbidity, researchers observed an increased prevalence from 146.8 per 10,000 discharges in 2008 to 179.8 per 10,000 discharges in 2021. Risk factors for severe maternal morbidity included age 24 years or younger, age 35 years or older, racial or ethnic minority group status, cesarean delivery, Medicaid and presence of one or more comorbidities.
“Future research must focus on better understanding how comorbid conditions impact severe maternal morbidity and mortality and how we can better address these conditions through public health interventions,” Fink said. “Furthermore, we need to better understand the causes of mortality that occur outside of the hospital setting since inpatient mortality is improving.”
For more information:
Dorothy A. Fink, MD, can be reached at dorothy.fink@hhs.gov.