As of this month, the US Centres for Disease Control and Prevention (CDC) have reported 90.2 million Covid-19 cases and more than one million deaths, yielding a mortality rate of 1.13%. Of these, 222,372 cases and 304 deaths were among pregnant women, amounting to a mortality rate of only 0.14%. Despite this low Covid-attributable rate, there has been a drastic increase in maternal mortality since the start of the pandemic, according to a recent publication in JAMA Network Open.
Drs Thoma and Declercq conducted analyses of National Centre for Health Statistics records from 2018 to 2020 and reported cause-specific maternal deaths for every 100,000 live births in the US. The study identified a 33.3% increase in all-cause maternal deaths from pre-pandemic (2018, 2019 and January-March 2020) to pandemic (April-December 2020) timeframes. This outpaces the 22% increase in all-population deaths attributable to the Covid-19 pandemic. In addition, the increase in maternal mortality rates from pre-pandemic to pandemic was highest among Hispanics, with an increase of 74.2%, followed by non-Hispanic Black mothers, at an increase of 40.2% (as shown in Figure 1).
According to the CDC, maternal mortality in the US has been steadily increasing since 1987. All-cause maternal mortality rose from 7.2 to 17.3 deaths for every 100,000 live births from 1987 to 2018, a 2.4-fold increase. This equates to an average annual increase of 7.7%. Causes of pregnancy-related death include haemorrhage, embolism, hypertensive disorders, anaesthesia complications and cerebrovascular accidents. This indicates a complex picture of maternal health in the US.
The top three causes of maternal mortality from 2016 to 2018 were cardiovascular disease (16.2%), infection (13.9%) and cardiomyopathy (12.5%), as reported by the CDC. Maternal mortality attributed to these causes rose 72.1%, 32.6%, and 11.6%, respectively, from pre-pandemic to pandemic. Covid-19 was commonly listed as a secondary cause in ‘other viral diseases’, ‘diseases of the respiratory system’ and ‘nonspecific cause’, but not in the above causes of death. The spike in maternal mortality during the pandemic was thus due to both Covid-19 infection and other factors.
This spike in mortality may be attributable to not only Covid-19 infection during pregnancy, but also pandemic-induced stress and social factors. GlobalData epidemiologists have previously reported on the impact of Covid-19 infection and outcomes in pregnant women and babies. They have noted that Covid-positive mothers are at increased risk of pre-eclampsia, emergency cesarean deliveries, pre-term birth and stillbirth. They have, however, also reported that the stress of the pandemic itself has been demonstrated to have significant impacts on infant development, irrespective of maternal Covid-19 status.
The Covid-19 pandemic impacted the health of the US both directly and indirectly. Unemployment, housing insecurity, lockdown measures, social distancing and fear can cause increased stress on pregnant women while also removing support systems. Decreased access to healthcare, such as prenatal care, mental healthcare, and overburdened hospital systems can further harm this population. The pandemic has exacerbated the already increasing rate of maternal mortality in the US, and this may be countered with increased outreach to pregnant women and more accessible maternal healthcare.