After the emergence of highly contagious COVID-19 variants Delta and Omicron, pregnancy-related death rates in the United States rose faster in 2021 than the year before, according to a new study (UMD). The Boston University School of Public Health (BUSPH) and University of Maryland School of Public Health study. The results of pregnancy-related mortality, published in the journal Obstetrics and Gynecology, are consistent with rising COVID-19-related mortality rates in women of childbearing age, and the results follow the team’s previously published research, which also showed alarming spikes in maternal mortality rates in the first year of the pandemic in 2020.
The startling data captures the worsening burden of pregnancy-related mortality in the United States during the pandemic, which includes deaths during pregnancy up to one year after birth. Death rates rose the most among racial and ethnic minorities, and the study adds COVID-19 context to a new report from the National Center for Health Statistics showing maternal death rates in the United States rose 38 percent in 2021 have increased compared to 2020 rates.
The new study found that the number of pregnancy-related deaths rose to 45.5 deaths per 100,000 live births overall in 2021 – and up to 56.9 deaths per 100,000 live births in the third quarter of 2021 – compared to 36.7 deaths per 100,000 live births in 2020 and 30.3 deaths per 100,000 live births before COVID. The Delta variant began sweeping the country in June 2021, before the even more contagious Omicron variant took hold in late fall.
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Notably, the study found that the largest relative increases in pregnancy-related deaths between 2020 and 2021 were among Hispanics (at 34 percent) and specifically among Native American/Alaska Indians (AIAN) (at 104 percent). The pregnancy-related mortality rates in 2021 were highest for AIAN (161 deaths per 100,000 live births) and black (98 deaths per 100,000 live births) pregnant people. The proportion of pregnancy-related deaths with a COVID diagnosis was highest among Hispanics (at 43 percent) and AIAN people (at 36 percent).
“The pandemic exacerbated already poor maternal outcomes in the US by deepening disparities by race/ethnicity and place of residence, resulting in maternal mortality rates not seen since 1964,” says the study’s senior author, Dr. Eugene Declercq, Professor of Community Health Sciences at BUSPH. “In particular, the extraordinary increases in Native American and Alaskan populations in 2021 deserve greater attention.”
For the analysis, Dr. Declercq and the study’s lead author, Dr. Marie Thoma, Associate Professor of Family Studies at UMD, National birth and mortality data from January 2019 to March 2020 (before the pandemic) compared to April 2020 to December 2021 (during the pandemic). ). They estimated the quarterly increase in pregnancy-related mortality for deaths that occurred during pregnancy or within one year of terminating a pregnancy and compared these rates to the mortality rates for people aged 15 to 44 listed for COVID-19 was a contributing cause of death.
In addition to the spikes in mortality among ethnically pregnant women, the study also captured increases in pregnancy-related mortality in rural areas and smaller towns between 2020 and 2021, with rates increasing by 21 percent and 39 percent, respectively. These increases accurately reflected overall shifts in COVID-related death patterns among all women aged 15 to 44. “This is worrying as we have also seen the closure of many maternity facilities and services during the pandemic, particularly in rural areas,” says Dr. Thomas.
The researchers hoped that if vaccines were made widely available to the public, vaccination rates among pregnant women would increase and offer this population greater protection from COVID-related deaths in 2021. However, the latest federal data suggests that up to 45 percent of pregnant women in the United States are still not fully vaccinated against COVID-19.
“Our maternal mortality statistics are the ‘tip of the iceberg’ when we think about the underlying maternal health impact in this country and how it is devastating families,” says Dr. Thomas. “We must turn our attention to improving systems and policies that can address our country’s maternal health.”
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