Abstract
BackgroundMaternal reproductive health is facing significant challenges in the United States. Currently, the nation has the highest maternal death rate among high-income countries, and the rate continues to increase. Recent United States data indicate that 80% of maternal deaths are preventable, highlighting the urgent need for action on this critical issue. MethodsWe analyzed United States national death certificate data and birth data from the CDC's wide-ranging online data for epidemiologic research databases. We estimated pregnancy-related mortality rates by state, age group and race, and ethnicity. We assessed cause-specific pregnancy-related mortality and late maternal death (i.e., deaths occurring >42 days and up to 1-year post-pregnancy). ResultsDuring 2018–2020, we observed 3364 pregnancy-related deaths, including 1006 late maternal deaths. The age-standardized mortality rate (ASR) increased by 37.2% from 25.4 (95% CI: 23.8–26.9) per 100,000 live births in 2018–34.7 (95% CI: 32.8–36.5) in 2020. Rates ranged from 16.8 per 100,000 to 57.5 per 100,000. If the national rate was reduced to the lowest state rate, 1448 pregnancy-related deaths could have been avoided. The rate among non-Hispanic Black people (ASR2018–2020 = 70.7 per 100,000) was two to three times higher than other groups estimated. Cardiovascular conditions are the leading cause of pregnancy-related deaths overall, yet cancer was associated with 20% of late maternal death. Mental and behavioral disorders and drug and alcohol-induced death were also important contributors to late maternal death. ConclusionsWe observed alarming trends of increasing pregnancy-related death rates in the United States. Our study provides important insights for identifying opportunities to reduce avoidable maternal deaths.
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