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. 2023 May 1;141(5):911-917.
doi: 10.1097/AOG.0000000000005182. Epub 2023 Mar 15.

Changes in Pregnancy-Related Mortality Associated With the Coronavirus Disease 2019 (COVID-19) Pandemic in the United States

Marie E Thoma  1 , Eugene R Declercq
Affiliations

Changes in Pregnancy-Related Mortality Associated With the Coronavirus Disease 2019 (COVID-19) Pandemic in the United States

Marie E Thoma et al. Obstet Gynecol. .

Abstract

Objective: To examine pregnancy-related mortality ratios before (January 2019-March 2020) and during (April 2020-December 2020 and 2021) the coronavirus disease 2019 (COVID-19) pandemic overall, by race and ethnicity, and by rural-urban classifications using vital records data.

Methods: Mortality and natality data (2019-2021) were obtained from the Centers for Disease Control and Prevention's WONDER database to estimate pregnancy-related mortality ratios, which correspond to any death during pregnancy or up to 1 year after the end of a pregnancy from causes related to the pregnancy per 100,000 live births. Pregnancy-related mortality ratios were determined from International Classification of Diseases, Tenth Revision codes A34, O00-O96, and O98-O99. Overall pregnancy-related mortality ratios were partitioned by whether COVID-19 was listed as a contributory cause, and quarterly estimates were compared between 2019 and 2021. Pregnancy-related mortality ratios were compared by race and ethnicity and rural-urban residence before (2019-March 2020) and during (April 2020-December 2020 and 2021) the COVID-19 pandemic.

Results: Pregnancy-related mortality was significantly higher in 2021 (45.5/100,000 live births) compared with during the pandemic in 2020 (36.7/100,000 live births) and before the pandemic (29.0/100,000 live births). Pregnancy-related mortality ratios increased across all race and ethnicity and rural-urban residence categories in 2021. The largest increase occurred among American Indian/Alaska Native people during 2021 compared with April-December of 2020 (pregnancy-related mortality ratio 160.8 vs 79.0/100,000 live births, 104% relative change, P =.017). Medium-small metropolitan (52.4 vs 37.7/100,000 live births, 39.0% relative change, P <.001) and rural (56.2 vs 46.5/100,000 live births, 21.0% relative change, P =.05) areas had a larger increase in 2021 compared with April-December 2020 compared with large urban areas (39.1 vs 33.7/100,000 live births, 15.9% relative change, P =.009).

Conclusion: Pregnancy-related mortality ratios increased more rapidly in 2021 than in 2020, consistent with rising rates of COVID-19-associated mortality among women of reproductive age. This further exacerbated racial and ethnic disparities, especially among American Indian/Alaska Native birthing people.

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Conflict of interest statement

Financial Disclosure Marie E. Thoma disclosed receiving payment from the following: the World Health Organization via contract with Dr. Carie Cox; Dept. of Veterans Affairs via grant with University of Iowa (PI: Ginny Ryan); Share-Net International; and the U.S. Department of Agriculture, Economic Research Service cooperative agreement, contract with the Prince George's County Health Department. Eugene R. Declercq did not report any potential conflicts of interest.

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