‘Alarming’ rise in maternal deaths, pregnancy complications in COVID-19 pandemic

Maternal mortality during hospitalization and pregnancy complications rose during the COVID-19 pandemic, a new study has found.

The study, published in Jama Network Open, found “small but significant increases” in pregnancy-related complications and maternal death.

“The increase in maternal death during delivery hospitalization and pregnancy-related complications during the pandemic is alarming,” the researchers wrote.

Researchers examined more than 1.6 million pregnant patients across 463 hospitals in the United States (​​849 544 before COVID-19 and 805 324 during the pandemic). They compared outcomes during the pandemic and the 14 months before the arrival of COVID-19.

“During the COVID-19 pandemic, there were increased odds of maternal death during delivery hospitalization, cardiovascular disorders, and obstetric hemorrhage,” the authors wrote. “Further efforts are needed to ensure risks potentially associated with the COVID-19 pandemic do not persist beyond the current state of the pandemic.”

Before the pandemic, the maternal mortality rate during delivery hospitalization was 5.17 per 100 000 pregnant patients. During the pandemic, the maternal mortality rate rose to 8.69 per 100,000 pregnant patients.

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During the pandemic 16.6% of patients had a pregnancy-related hypertensive disorder, up from 15.3% before the pandemic. Also, 5.5% of patients experienced a hemorrhage during the pandemic, compared to 5.1% of patients before the coronavirus arrived.

The study found a 5% drop in births during the pandemic. The average gestational age at births remained consistent before and during the pandemic: 38.3 weeks. The rates of fetal deaths and stillbirths remained fairly stable (0.9% of all births), the study found.

The rates of preterm birth remained essentially the same before and during the pandemic, as did the mode of delivery.

“Taken together, our study raises concerns that the COVID-19 pandemic may have negatively affected obstetric care and pregnancy-related outcomes,” the authors wrote.

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The authors note COVID-19 during pregnancy is associated with a higher risk of death, but only a small number of pregnant patients in the study (318) were diagnosed with COVID-19.

However, the researchers said their analysis supports previous studies that have found the COVID-19 pandemic affected the care of those who are pregnant.

“While hospital-based obstetric care remained an essential service during the COVID-19 pandemic, outpatient prenatal care experienced substantial disruptions, and much routine care was done virtually,” the researchers wrote. “It is possible that these disruptions and limitations in monitoring with telehealth may have contributed to the slight worsening of pregnancy-related complications.”

The study found higher rates of hypertensive disorder among Black patients before the pandemic and during the pandemic. While the researchers noted the higher rates of hypertension among Black patients is “concerning,” they noted that preexisting inequities in outcomes among Black patients did not worsen. Generally, there was not a significant difference in outcomes among other racial or ethnic groups.

Researchers found that people of color “were more likely to experience disrespectful care and perceived discrimination.” Those experiences are tied to postpartum stress, the study noted.

The Centers for Medicare & Medicaid Services plans to identify “birthing friendly” hospitals as part of the federal government’s efforts to reduce maternal mortality. In the fall of 2023, the CMS plans to post the results of those hospitals earning the “birthing friendly” designation for the first time.

The authors of the study include Rose Molina of Beth Israel Deaconess Medical Center, Boston; Thomas Tsai, Brigham and Women’s Hospital, Boston; and Dannie Dai, Harvard T.H. Chan School of Public Health, along with other researchers.