Category: News & Press

Today, Congresswoman Moore, Senator Elizabeth Warren (D-Mass.), along with Senator Cory Booker (D-N.J) and Representatives Deborah Dingell (D-Mich.), Ayanna Pressley (D-Mass.), Lauren Underwood (D-Ill.), and Alma Adams (D-N.C.) announced the re-introduction of the Mamas First Act, vital legislation to address the maternal mortality crisis that would expand Medicaid to include doula and midwifery care. In […]

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.”

The number of women in the United States who died during pregnancy or shortly after giving birth increased sharply during the first year of the coronavirus pandemic, according to a new study, an increase that health officials attribute partly to Covid and pandemic-related disruptions.

The new report, from the National Center for Health Statistics, found that the number of maternal deaths rose 14 percent, to 861 in 2020 from 754 in 2019.

The United States already has a much higher maternal mortality rate than other developed countries, and the increase in deaths pushes the nation’s maternal mortality rate to 23.8 deaths per 100,000 live births in 2020 from 20.1 deaths in 2019. Maternal mortality rates in developed countries have in recent years ranged from fewer than two deaths per 100,000 live births in Norway and New Zealand to just below nine deaths per 100,000 live births in France and Canada.

Black women in America experienced the most deaths: One-third of the pregnant women and new mothers who died in 2020 were Black, though Black Americans make up just over 13 percent of the population. Their mortality rate was nearly three times that of white women.

The mortality rate for Hispanic women, which has historically been lower than for white women, also increased significantly in 2020 and is now almost on par with the rate for white women. Death rates increased among all pregnant women older than 24, but particularly in those 40 and over, whose mortality rate was nearly eight times that of women younger than 25.

“Our maternal morbidity and mortality is the highest in the developed world, and the trend is continuing despite our awareness of it, despite our maternal-mortality review committees, despite attention in the press,” said Kara Zivin, a professor of psychiatry, obstetrics and gynecology at the University of Michigan who studies access to care during and after pregnancy. “Whatever we’re doing is clearly not enough to address either the overall rate or the disparities.”

Did you know you can share 10 gift articles a month, even with nonsubscribers?
Share this article.
Although the new report is sparse on details — no maternal mortality figures were provided for American Indian/Alaska Native women, who have higher pregnancy-related deaths than white, Hispanic and Asian/Pacific Islander women — experts said some of the deaths were most likely related to the coronavirus pandemic. Pregnancy puts women at risk for more severe disease if they are infected with the SARS-CoV-2 virus, which causes Covid, and vaccines were not available for them in 2020.

Image
Dr. Chaniece Wallace died in 2020 from pregnancy complications after delivering her first child.
Dr. Chaniece Wallace died in 2020 from pregnancy complications after delivering her first child.
Credit…Chaniece Wallace Memorial Facebook Page
“We actually said when the lockdown started that we anticipated an increase in maternal deaths, both due to Covid and the responses to Covid,” said Dr. Denise Jamieson, an obstetrician at Emory University in Atlanta and a member of the Covid expert group at the American College of Obstetricians and Gynecologists, adding that she was not surprised by the increases.

Editors’ Picks

You Can Take It With You, if the Grave Is Deep Enough

How a Death-Row Inmate’s Embrace of Conservatism Led to His Release

Why We Dream About Past Loves
In addition to the greater risks faced by pregnant women who have Covid, she said, “we hadn’t figured out how to deliver obstetric care safely in 2020.”

“Our health systems weren’t set up yet to manage telehealth,” she said, “and there were other barriers: Kids were home from school, and parents couldn’t get away for medical appointments.”

Many doctors had stopped seeing patients in person, hospitals were often crowded and patients avoided emergency rooms filled with Covid patients.

Pregnant women who develop Covid face a higher risk of requiring intensive care or mechanical ventilation. And despite the relative youth of pregnant women, they face a higher risk of dying, studies found. Health experts have been urging them to be vaccinated, but their vaccination rates have remained low.

Black Americans overall suffered disproportionately from the pandemic, with higher hospitalization and death rates than their white counterparts, but the racial disparities in maternal mortality predate and extend beyond Covid, and stem from structural health inequities that have complex root causes.

Stress, mental health problems and substance abuse increased during the pandemic and might also have contributed to worse outcomes, said Dr. Mary D’Alton, chair of the department of obstetrics and gynecology at Columbia University Irving Medical Center.

New programs that provide enhanced services for patients, such as doulas, who can support and advocate for patients, are positive advances, she said.

“We also have to educate our providers on listening to patients,” Dr. D’Alton said. “My dad was a primary care doctor and he used to say, ‘Mary, if you want to know what’s wrong with the patient, ask them and they’ll tell you. But first of all, you’ve got to listen to them.’”

“Pregnant women’s complaints are often dismissed, and that is probably much more significant for Black and brown women,” she added.

Generally speaking, the leading causes of pregnancy-related deaths are cardiovascular conditions, other medical conditions and infections. Research has found that cardiomyopathy, a disease of the heart muscle; blood clots to the lung; and hypertensive disorders of pregnancy contribute to a higher proportion of pregnancy-related deaths among Black women than among white women.

One of the new mothers who died in 2020, whose story was widely reported, was Dr. Chaniece Wallace, a Black physician who was the chief pediatric resident at the Indiana University School of Medicine in Indianapolis.

Dr. Wallace developed a pregnancy complication called pre-eclampsia and her baby girl was delivered early by cesarean section in October 2020. But Dr. Wallace went on to develop additional complications, and she died just days after giving birth.

Severe maternal morbidity (SMM), which refers to unexpected labor and delivery outcomes that can cause life-threatening maternal health problems, is on the rise in the United States and has been estimated to impact between 50,000 to 60,000 birthing people each year, according to the latest data compiled in 2014 by the Centers for Disease Control and Prevention.

However, these estimates have been based on cases identified during hospitalization for delivery, and do not reflect maternal health complications that may occur during pregnancy or the postpartum period.

A new study led by a School of Public Health researcher has found that excluding prenatal and postpartum health complications in SMM measurements substantially underestimates the burden of maternal morbidity in the US.

Published in the journal Obstetrics & Gynecology, the study examined cases of SMM during prenatal, delivery, and postpartum hospitalizations from 2009 to 2018 in Massachusetts and identified an additional 22 percent of cases that met SMM criteria. If the 2018 rates of SMM in Massachusetts with this expanded measurement were applied nationally, the true number of cases could be closer to 90,000 per year.

Using a longitudinally linked database, the study is the first of its kind to examine SMM during pregnancy, at birth, and postpartum.

“For this project, we expanded the focus of SMM from birth to women’s health through the entire perinatal period,” says study lead author Eugene Declercq, professor of community health sciences. “The data overwhelmingly show that it is time to develop measures that more sensitively identified severe morbidities during pregnancy and postpartum.”

Declercq and colleagues analyzed data from the Pregnancy to Early Life Longitudinal (PELL) database, a Massachusetts data system that links records from birth certificates, delivery hospital discharge records, and non-birth hospital records for all birthing people. Using CDC algorithms that define SMM criteria, the researchers examined nearly 600,000 deliveries, as well as hospitalizations during pregnancy and through 42 days postpartum, from January 2009 to December 2018. SMM increased steadily over the study period, from 129.4 cases per 10,000 deliveries in 2009 to 214.3 cases per 10,000 deliveries in 2018.

Aside from blood transfusions, which cause the largest percentage of SMM cases, the leading causes for additional cases of severe morbidity during pregnancy and postpartum were sepsis, thrombotic embolism, and adult respiratory distress syndrome.

“Our findings underscore the need for a greater investment in outpatient, community-based programs and quality improvement initiatives,” Declercq says, citing examples such as standardized, outpatient risk assessment screening for venous thromboembolism, prevention of maternal peripartum infections via screening and vaccinations, and postpartum home blood pressure monitoring for birthing individuals at increased risk.

The study is the first of several publications by the research team, as part of a larger project on SMM that is funded by the National Institutes of Health. The next two studies, informed by this first publication, will examine differences in SMM by race/ethnicity and an intervention at five hospitals in Massachusetts to assess the impact of doula care on pregnancy outcomes among Black women.

nion, New Jersey — The U.S. has the highest maternal mortality rate for a developed country: About 700 women die during childbirth or soon after every year, according to the Centers for Disease Control and Prevention.  Danisha Baughan delivered her first two children in a hospital, and said both times she felt neglected. A week before she was due to […]

The climate crisis is damaging the health of foetuses, babies and infants across the world, six new studies have found. Scientists discovered increased heat was linked to fast weight gain in babies, which increases the risk of obesity in later life. Higher temperatures were also linked to premature birth, which can have lifelong health effects, […]

A study of pregnant Scottish women who contracted Covid-19 found they had higher rates of pre-term birth, stillbirth and death of newborns, with almost all such cases occurring among women who were unvaccinated when they were diagnosed with the disease, according to a paper published Thursday in Nature Medicine, underlining the urgency of convincing pregnant women to get a […]

November 19, 2021 Press Release WASHINGTON – Today, Congresswoman Lauren Underwood (IL-14) celebrated the inclusion of every eligible provision of the Black Maternal Health Momnibus Act (H.R. 959) in the Build Back Better Act, which passed the House. As a co-founder and co-chair of the bipartisan Black Maternal Health Caucus with Representative Alma Adams (NC-12), Underwood […]

On Tuesday, November 2, the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) unanimously recommended the Pfizer-BioNTech Covid-19 vaccine for children ages 5–11 under the Federal Drug Administration’s (FDA) emergency use authorization (EUA). With a committee vote of 14–0, CDC Director Rochelle P. Walensky, MD, MPH, endorsed the CDC ACIP recommendation, expanding […]