Last week, the CDC released a 2021 summary report on maternal mortality rates in the United States. The report used data from the National Vital Statistics System to summarize rates of death among pregnant women and those who were within 42 days of termination of pregnancy, according to the WHO definition. Accidental and incidental causes were not included.
The data for 2021 revealed some alarming trends.
US maternal death rate (per 100,000) continued to increase in 2021, as it has in previous years.
| Year | Total Deaths | Deaths per 100,000 Live Births |
|---|---|---|
| 2021 | 1205 | 32.9 |
| 2020 | 861 | 23.8 |
| 2019 | 754 | 20.1 |
| 2018 | 658 | 17.4 |
Maternal mortality rates increased for all racial groups, but the increase was disproportionate. Black women experienced the largest increase.
Maternal mortality rates also increased significantly with age.
The highest mortality rates were observed in women with multiple risk factors, such as Black women who were 40 years or older, with a mortality rate of 300.8 per 100,000 live births.
| Group | 2021, Deaths per 100,000 Live Births |
|---|---|
| Black, age >40 | 300.8 |
| Black, age 25-39 | 69.3 |
| Black, age <25 | 41.5 |
| Hispanic, age >40 yo | 86.4 |
| Hispanic, age 25-39 | 30.8 |
| Hispanic, age <25 | 14.1 |
| White, age >40 yo | 126.9 |
| White, age 25-39 | 24.5 |
| White, age <25 | 16.9 |
Interpretation
The recent increase in maternal mortality in the US has been attributed to COVID-19. Abundant data shows that pregnant women who contract COVID-19 are at an increased risk of complications and death. This latest data release supports the ongoing recommendations by the CDC and American College of Obstetricians and Gynecologists for COVID vaccination in pregnant women.
However, COVID-19 is not solely responsible for the ongoing increase in maternal mortality in the United States. According to the Commonwealth Fund, the US has the highest maternal mortality rate of any developed country worldwide.
According to a report published by the Commonwealth Fund, some of the reasons for the discrepancies include:
- High rate of cesarean sections
- Inadequate prenatal care
- Elevated rates of chronic illnesses like obesity, diabetes, and heart disease
- Missed or delayed opportunities for treatment.
Although it may seem that working in the emergency department or urgent care affords little opportunity to intervene in this alarming trend, that is simply not the case. We have the opportunity to take part in:
- Educating pregnant women about their risks for complications and death due to COVID-19
- Assisting pregnant women with locating pre-natal or primary care clinics
- Intervening early when pregnant women present with conditions like hypertension or diabetes
- Aggressively treating women presenting with symptoms and signs of preeclampsia or pregnancy induced hypertension
For More Reading:
References
- Hoyert DL. Maternal mortality rates in the United States, 2021. NCHS Health E-Stats. 2023.
DOI: https://dx.doi.org/10.15620/cdc:124678. - Munira Z. Gunja et al., Health and Health Care for Women of Reproductive Age: How the United States Compares with Other High-Income Countries (Commonwealth Fund, Apr. 2022). https://doi.org/10.26099/4pph-j894
Sam Ashoo, MD, FACEP, is board certified in emergency medicine and clinical informatics. He serves as EB Medicine’s editor-in-chief of interactive clinical pathways and FOAMEd blog, and host of EB Medicine’s EMplify podcast. Follow him below for more…
