Death rates linked to maternity spiked in the United States in 2021 to a level not seen since 1964, according to a study in Obstetrics & Gynecology.
The findings follow an uptick in maternal mortality rates in 2020 during the first year of the COVID-19 pandemic, according to researchers with Boston University and the University of Maryland. The maternal mortality rates increased especially after June 2021 just as the Delta variant of COVID-19 spread, the study found.
Though the study does not examine causality, a press release accompanying the study noted: “The Delta variant began ripping through the country in June 2021, before the even-more-contagious Omicron variant took hold in late fall.” Delta is considered the deadliest iteration of SARS-CoV-2 to date, while Omicron is the most infectious.
The study’s lead author, Marie Thoma, Ph.D., an associate professor of family science at the University of Maryland, told Fierce Healthcare in an email that what happens next in Medicaid as flexibilities introduced during the pandemic end will probably have a significant impact on maternity mortality rates. Thoma said that “about 40% of births in the U.S. are covered by Medicaid (as the main source of payment), so depending on the cuts proposed, that could impact a significant portion of pregnant and postpartum individuals.”
As Fierce Healthcare reported, a recent study in Health Affairs found that Medicaid coverage makes for fewer pregnancy-related adverse events. States that expanded Medicaid under the Affordable Care Act saw a 17% decline in postpartum hospitalizations from 2010 through 2017.
A study last year by the Kaiser Family Foundation said that over 14 million beneficiaries could lose Medicaid coverage this year as states restart the redetermination process next month.
The study found that maternal death rates among racial and ethnic minorities were the highest, something which researchers noted happened in 2020 as well, but not at the pace seen in 2021.
A spokesperson for the Blue Cross Blue Shield Association told Fierce Healthcare in an email that “people of color are more likely to have higher risk of pregnancy-related complications regardless of having commercial health insurance or Medicaid."
"These disparities are likely the result of the pandemic and the broader health system and societal challenges including underlying chronic conditions, racial inequities and biases within the health care system,” the spokesperson said. They added that “reversing this trend requires a multistakeholder approach to create a pathway toward safe pregnancies, deliveries and postpartum experiences for all people giving birth.”
“Our findings show that these patterns intensified in 2021, with a particularly high pregnancy-related mortality ratio among American Indian/Alaska Native individuals [AIAN], a group that experienced higher rates of overall COVID-19 mortality in 2021,” the study said.
Thoma said that “the U.S. rate has been high, although these rates in 2021 are unprecedented and our analyses show that the non-COVID pregnancy-related mortality remained similar to pre-pandemic years, suggesting maternal health was significantly impacted by COVID.”
The findings come from an analysis of data from the Centers for Disease Control and Prevention and estimated mortality rates during pregnancy and one year postpartum. Researchers compared CDC data from 2019 to March 2020—before the pandemic—and then again from April 2020 to December 2020 and through 2021, during the pandemic.
American Indian and Alaska Native women experience 160.8 deaths per 100,000 live births in 2021, compared 79 deaths per 100,000 live births in 2020, an increase of 104%.
The study found that Hispanic women also experienced a high relative increase in pregnancy-related deaths between 2020 and 2021 at 34%. Black women saw 98 deaths per 100,000 live births, according to the study.
Eugene Declercq, Ph.D., a professor of community health sciences at Boston University School of Public Health and the study’s senior author, said in the press release that “the pandemic exacerbated what were already poor maternal outcomes in the U.S. by deepening disparities by race/ethnicity and place of residence resulting in maternal death rates not seen since 1964. In particular, the extraordinary increases among American Indian and Alaska Natives in 2021 deserves greater attention.”
Pregnancy-related deaths also increased in rural areas and smaller cities between 2020 and 2021, to 21% and 39% respectively. They mirrored shifts in COVID-related death patterns for all women ages 15 to 44.
COVID-19 vaccines became widely available in 2021 and the researchers, whose study updates similar research that looked at maternity mortality rates in 2020, had hoped that pregnant women would get inoculated. However, about 45% of pregnant women in the U.S. have not been vaccinated, according to the CDC.
Thoma said she thinks that “there are a number of considerations, including vaccinations before or during pregnancy...but more broadly, there are a number of factors that include increasing recognition of signs and symptoms of other pregnancy-related conditions as well" such as pre-eclampsia or mental health challenges.
"The latter can also include screening by pediatricians not just OB/GYNs (and covering those costs for appropriate time to do so). Increasing training for providers on perinatal mental health to address gaps in perinatal mental health services," she said.
The BCBSA spokesperson noted that the group compiled a list of the top 10 maternal health equity actions that leaders in the public and private sectors should adopt to close health equity gaps.
“We must prioritize access to cultural humility and unconscious bias training for everyone in the maternal care continuum; the management of chronic diseases at every stage of pregnancy; treatment plans and programs that are tailored for people at high risk for maternal morbidity; and ensuring providers and facilities are measured on the quality of care they deliver and are meeting national recognized standards for quality, expertise and patient experience," they said.