The first year of the pandemic in America saw a startling and disproportionate rise in maternal mortality, according to new research released Tuesday. In 2020, the study found, deaths during or soon after pregnancy rose even higher than the spike in mortality seen nationwide. This jump in mortality was felt hardest among Black and Hispanic mothers.
The study, performed by researchers at the University of Maryland and Boston University, found a 33% increase in maternal deaths relative to the pre-pandemic era.
The research follows on a study by the CDC’s National Center for Health Statistics (NCHS), reported this February, which found that maternal deaths rose by about 18% in 2020 compared to the previous year, which was slightly more than the overall 17% increase in U.S. deaths reported in 2020. But the Maryland and Boston researchers wanted to take a closer look at how much the pandemic contributed to this rise. So using this same data, they compared maternal deaths in the U.S. over a three year period from 2018 to 2020.
They found that the rise in maternal mortality was even more pronounced after March 2020, when the pandemic began to spread widely throughout the country. There were 684 deaths (25.1 per 100 000 live births) reported during the months of April to December 2020, making for a 33% increase in deaths relative to the pre-pandemic era. And as the CDC had found, this increase was even higher than the rise in mortality seen overall in the U.S. during the first year of the pandemic.
“In the US, maternal deaths increased substantially (33%) after March 2020, corresponding to COVID-19 onset, a figure higher than the 22% overall excess death estimate associated with the pandemic,” the authors wrote in their research letter, published in JAMA Network Open.
As many other studies have shown, the harms of the pandemic on mothers were not equally distributed either. The increases were largest for Hispanic and Black mothers, with the death rate rising by 40% in non-Hispanic Black mothers and by 74% in Hispanic mothers.
“For the first time in more than a decade, the maternal mortality rate for Hispanic women during the pandemic was higher than that for non-Hispanic white women, a shift that may be related to Covid and deserves greater attention moving forward,’ said study author Eugene Declercq, a researcher at Boston University’s School of Public Health, in a statement.
Many studies have found that covid-19 during pregnancy can raise the risk of life-threatening illness and serious complications for both mother and child. And excess mortality data can provide a more accurate picture of the toll caused by large scale disasters like a pandemic, especially early on when deaths are more likely to be miscounted. But this data alone can’t tell us how many of these deaths were directly caused by infection from the coronavirus.
Some of these added deaths may have been indirectly linked to the pandemic, for instance, such as those caused by disruptions to the healthcare system. That said, the authors did find that the largest increases in maternal mortality were attributable to conditions often caused by covid, such as respiratory failure, or to conditions known to be worsened by infection, such as diabetes and cardiovascular disease. Doctors also recorded covid-19 as a secondary cause of death in 14.9% of maternal deaths in the last nine months of 2020, and listed it as a contributing factor in 32% of deaths among Hispanic people, 12.9% of deaths among Black people and 7% of deaths among non-Hispanic white women.
The development of vaccines by late 2020 has undoubtedly saved many lives (over 20 million worldwide in 2021, according to one recent estimate). So there is reason to hope that these trends in maternal mortality have improved since 2020. But vaccination rates in the U.S. have been lower for pregnant people compared to the general population, and the country has continued to experience large waves of death even after vaccines were made widely available. The authors say it will take more research to figure out whether mothers have remained at higher risk for death than before the pandemic.
“We need more detailed data on the specific causes of maternal deaths overall and those associated with COVID-19,” said study author Marie Thoma, an assistant professor of family science at the University of Maryland’s School of Public Health, in a statement. “Potentially we could see improvements in 2021 due to the rollout of vaccines, as well as the extension of postpartum care provided for Medicaid recipients as part of the American Rescue Act of 2021 in some states. We’re going to continue to examine this.”