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Maternal mortality increased sharply at start of COVID-19 pandemic, study says

Maternal mortality increased sharply at start of COVID-19 pandemic, study says
A new analysis found that the maternal death rate after the start of the COVID-19 pandemic disproportionately affected Black and non-White Hispanic mothers. File Photo by Terry Schmitt/UPI | License Photo

WASHINGTON, June 28 (UPI) -- In another worrying sign of COVID-19's sad toll on U.S. society, a new study finds that maternal mortality increased sharply at the start of the pandemic, disproportionately affecting Black and Hispanic mothers.

Overall, the public health experts at the University of Maryland and Boston University who analyzed the trend found sharp increases in maternal deaths and late maternal deaths (42 days to a year following childbirth), at 33% and 41%, respectively, after March 2020 compared with pre-pandemic rates.

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The study also showed existing and new disparities emerged after the pandemic began, with a 40% increase among already high rates for non-Hispanic Black women and a 74% rise among formerly lower rates in Hispanic women.

In fact, for the first time in more than a decade, the maternal mortality rate for Hispanic women in the pandemic's first nine months in 2020 was higher than the rate for non-Hispanic White women. Researchers said the shift may be related to COVID-19 and deserves greater attention going forward.

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But they said that determining causes of the increase in U.S. maternal mortality will require further exploration of the data. Their research letter was published online Tuesday in JAMA Network Open.

"We can't really say what caused it," said Marie E. Thoma, associate professor in the Department of Family Science at the University of Maryland School of Public Health.

"We do see rises in conditions that seem directly related to COVID, like respiratory and viral infection, but also increases in diabetes and cardiovascular disease -- conditions we know can be exacerbated by COVID," she said.

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Thoma added that, "because the healthcare system was so inundated and resources were limited, especially in 2020" because of COVID-19, this may have led to delayed prenatal care, causing risk factors for pregnancy complications to go undetected.

She noted that during pregnancy there is more biological risk because the immune system is suppressed and more susceptible to COVID-19. But the rate of late maternal deaths "suggests there may be something else going on, like less interaction with the healthcare system and delayed diagnoses."

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However, broad coding used for late maternal deaths requires more analysis to find contributing factors, she said..

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COVID-19 was listed as a secondary cause of death in 14.9% of maternal deaths in the last nine months of 2020, and listed as a contributing factor for 32% of Hispanic, 12.9% of Black and 7% of non-Hispanic White women giving birth, the study found.

Maternal mortality is defined by the Centers for Disease Control and Prevention as the death of a woman during pregnancy, at delivery, or soon after delivery (within 42 days). The CDC estimates that 700 women in the United States die each year as the result of pregnancy or delivery complications.

Such deaths climbed by 18% in 2020, according to data from the National Center for Health Statistics, above the 16% increase in overall U.S. mortality in 2020, the researchers noted.

But the new analysis, digging deeper, found that the maternal death rate after the start of the COVID-19 pandemic was even higher, and disproportionately affected Black and non-White Hispanic mothers.

They compared maternal mortality data from 2018 through March 2020, when the pandemic began, to April through December 2020.

"Obviously, we had wide disparities in maternal deaths prior to the pandemic," said Eugene R. Declercq, professor of community health sciences at Boston University's School of Public Health.

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But Declercq explained that these disparities widened at the start of the pandemic, and after a decade of Hispanic mothers having lower maternal mortality rates than White mothers -- a fact he noted was not well publicized -- Hispanic maternal deaths rose by 74% to top the rate for White maternal deaths.

"That's not completely surprising," he said, because pregnant Hispanic women "had a rate of COVID as a secondary cause of death more than 32% [of the time], versus 7% for White mothers."

He described the situation as "something we need to monitor going forward."

Thoma said 2021 data from the National Center for Health Statistics is expected to be released in the next month or two.

"We think maybe there will be declines [in maternal mortality rates] because of vaccines, better treatment," and the American Rescue Act extending Medicaid coverage for new mothers to one year post-partum, contrasted to two months coverage for many women previously.

"We know the risk extends for more than two months," Thoma said.

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