The rate of maternal mortality in the U.S. increased by nearly 20% from 2019 to 2020 in a potential indication of the COVID-19 pandemic’s impact on maternal health outcomes.

Data in a new report published Wednesday by the Centers for Disease Control and Prevention shows the overall maternal death rate in the U.S. rose from 20.1 deaths per 100,000 live births in 2019 to 23.8 deaths per 100,000 in 2020, marking an 18% increase. The rate has increased by nearly 37% since 2018, when there were 17.4 deaths for every 100,000 live births.

In total, 861 women in 2020 reportedly died either during or within 42 days of the end of their pregnancy, compared with 754 women in 2019 and 658 in 2018.

The report’s findings are based on data collected from the CDC’s National Vital Statistics System, and encompass maternal deaths linked to a pregnancy or its management. Deaths from accidental or incidental causes are not included.

Maternal mortality rates in 2020 went up across multiple age and racial groups in the report; notably, however, an “observed increase from 2019 to 2020 for non-Hispanic White women was not significant,” researchers said. The overall surge was fueled heavily by a spike in the rates for both Hispanic and Black women. Black women had the highest maternal mortality rate of the three racial or ethnic groups included, at 55.3 deaths for every 100,000 live births. That rate was nearly three times higher than the 19.1 deaths per 100,000 births among white women – a larger disparity than in 2019 – and more than three times higher than the rate of 18.2 deaths per 100,000 among Hispanic women.

Yet the maternal death rate among Hispanic women saw the largest increase from 2019 to 2020, rising by 44% over that year compared with an increase of 26% among Black women.

By age, women 40 and older had both the highest mortality rate and the largest increase from 2019. The maternal mortality rate for women 40 and older was 107.9 deaths for every 100,000 live births in 2020, a 43% increase from 2019 and 7.8 times higher than the rate of 13.8 per 100,000 live births for women under the age of 25. A rate increase among women under 25 was not statistically significant.

For years, the U.S. has had what can only be described as a poor record in maternal health outcomes when compared with other wealthy nations. A 2020 analysis by The Commonwealth Fund found that the 2018 U.S. maternal mortality rate of 17.4 deaths for every 100,000 live births was more than double the recent rates of a majority of other developed countries studied.

Tracking data from the CDC shows 82 deaths among pregnant women with the disease reportedly occurred in 2020. And though the latest figures do not delineate whether deaths occurred in connection with COVID-19, they come amid concern about both the direct and indirect health risks the COVID-19 pandemic has posed for pregnant women.

The CDC warns that pregnant or recently pregnant people are more likely to become severely ill from COVID-19. A CDC study published in November and focused on Mississippi also found a higher mortality rate among women with a coronavirus infection during pregnancy – none of whom had been fully vaccinated – compared with females of reproductive age who had a coronavirus infection.

The pandemic additionally disrupted maternal health care, leading to the alteration or cancellation of prenatal visits, hospitals enacting restrictions on who could be with a mother during delivery and even the shuttering of some birth-related services, at least temporarily. The number of home births rose by nearly 20% in 2020, from more than 38,000 in 2019 to more than 45,000.

Data also points to elevated levels of issues like depression and anxiety among many pregnant women during the pandemic.

“When we think about all of the stressors that a person felt even prior to the pandemic, adding all of these other things on top, it’s no surprise that we see an additive effect of the pandemic causing feelings of unsafety,” says Kristina Wint, senior program manager for reproductive and maternal health and wellness at the Association of Maternal and Child Health Programs. “Many people think that televisits is something that has been filling in the gaps, and it absolutely has, but they are just a Band-Aid on a broader and bigger issue on how (we can) ensure that people are able to access the care that they need.”