Population Care

Alarming rise in U.S. maternal mortality signals need for change

Sara Berg, MS , News Editor

The U.S. faces a concerning challenge in its maternal mortality rates, standing out among high-income nations for its alarming incidence of maternal deaths despite substantial health care spending. This inequity is particularly pronounced when comparing patients from different racial and ethnic groups within the country, according to a recent study published in JAMA®.

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In the study, “Trends in State-Level Maternal Mortality by Racial and Ethnic Group in the United States,” researchers used vital registration and census data from 1999 to 2019. This included pregnant or recently pregnant people 10–54 years old. Overall, there were about 1,210 maternal deaths in 2019, up from 505 in 1999.

Researchers found that the median state maternal mortality ratio—defined as maternal deaths per 100,000 live births—rose from 14 to 49.2 among patients in the American Indian or Alaska Native population. The Black ratio rose from 26.7 to 55.4. Asian, Native Hawaiian or other Pacific Islanders also saw the maternal death ratio rise from 9.6 to 20.9, while the ratio among Hispanic patients rose from 9.6 to 19.1. Among white patients, the ratio increased from 9.4 to 26.3.

These rates also differed across geographic regions with lower maternal mortality ratios for all racial and ethnic groups in Oregon, Hawaii, Colorado, Illinois, Wisconsin, Delaware, Vermont and Rhode Island. Meanwhile, American Indian and Alaska Native women in Western states generally had higher ratios than in other regions. And Black women had high maternal mortality ratios in Southern states as well as in states in other regions, including New York, New Jersey, Arizona and Montana.

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“The big, take-home message for physicians in the United States is that this continues to be a major problem,” said corresponding author Gregory A. Roth, MD, MPH, a cardiologist and associate professor of medicine and cardiology at the University of Washington School of Medicine in Seattle. “Even though the number of deaths is low, it's telling us something about the way pregnant women miss out on important pieces of their health care.”

“We need to continue to advocate for funding and better interventions around access to that kind of coordinated universal care that we would want people to have in that fourth trimester,” Dr. Roth said.

While this analysis does not specifically map out solutions, Dr. Roth shared some steps to take to begin to reduce the maternal health crisis in the U.S.

Coordinate care postpartum

“There are a broad range of best practices and recommended interventions that have been suggested and adopted to address this,” Dr. Roth said, noting “a big part of this is awareness of the problem. Learn about the AMA’s advocacy work to improve maternal health.

In the U.S., he added, “we see a much larger proportion of deaths due to complications related to vascular disease.” This happens “not just in the immediate post-delivery or postpartum period, but in the months following delivery.”

“The coordination of care postpartum is a missed opportunity in many places in the United States,” he said. “Beyond investments in care during the pregnancy and during delivery, improved coordination of care and access to primary care, nonobstetrical care and mental health care postpartum are going to have important roles to play in reducing maternal death rates.”

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Research has also shown that only 60% of at-risk women said they were advised about heart health at their postpartum checkup, according to a separate study published in JAMA in July.

“When we see untreated or undertreated risk factors like hypertension or high blood sugar in pregnant or postpartum women, we’re learning something about the communities where they live and the quality and access to care,” Dr. Roth said. “We need to figure out how to make sure that that care is not only available, but easily accessible.”