US maternal deaths more than doubled between 1999-2019: JAMA

Maternal deaths in the US more than doubled over the course of two decades, and the tragedy played out unevenly.

African-American mothers died at the highest rates in the nation, while the largest increases in deaths were found in American Indian and Alaska Native mothers. And some states, and the racial or ethnic groups within them, fared worse than others.

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The findings were laid out in a new study published Monday in the Journal of the American Medical Association. The researchers looked at maternal deaths between 1999 and 2019, but not the peak of the pandemic, for each state and five racial and ethnic groups.

“It’s a call to action for all of us to understand the root causes, to understand that part of this is about health care and access to health care, but a lot of it is about structural racism and the policies and procedures and things that we have in place that can keep people from being healthy,” said Dr. Allison Bryant, one of the study authors and senior medical director for health equity at General Brigham Mass.

Among wealthy nations, the US has the highest maternal mortality rate, defined as a death during pregnancy or up to one year after. Common causes include excessive bleeding, infection, heart disease, suicide, and drug overdose.

Bryant and colleagues at Mass General Brigham and the Institute for Health Metrics and Evaluation at the washington university started with national vital statistics data on deaths and live births. They then used a modeling process to estimate maternal mortality per 100,000 live births.

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In general, they found growing and rampant disparities. The study showed that high maternal mortality rates are not limited to the South, but also extend to regions like the Midwest and states like Wyoming and Montana, which had high rates for multiple racial and ethnic groups in 2019.

The researchers also found dramatic jumps when they compared maternal mortality in the first decade of the study with the second, and identified the five states with the largest increases between those decades. Those increases exceeded:

• 162% for American Indian and Alaska Native mothers in Florida, Illinois, Kansas, Rhode Island, and Wisconsin;
• 135% for white mothers in Georgia, Indiana, Louisiana, Missouri, and Tennessee;
• 105% for Hispanic mothers in Georgia, Illinois, Indiana, Minnesota, and Tennessee;
• 93% for black mothers in Arkansas, Georgia, Louisiana, New Jersey, and Texas;
• 83% for Asian and Pacific Islander mothers in Georgia, Illinois, Kansas, Michigan, and Missouri.

“I hate to say it, but I was not surprised by the findings. Certainly we have seen enough anecdotal evidence in a single state or a group of states to suggest that maternal mortality is increasing,” said Dr. Karen Joynt Maddox, a health policy and services researcher at the University School of Medicine. of Washington in St. Louis, who was not involved in the study. “It’s certainly alarming, and we just have more evidence to figure out what’s going on and try to find ways to do something about it.”

Maddox pointed out how, compared to other wealthy nations, the US underinvests in things like social services, primary care and mental health. He also said that Missouri has not adequately funded public health and, during the study years, had not expanded Medicaid. Since then, they’ve expanded Medicaid, and lawmakers passed a bill giving new mothers a full year of Medicaid health coverage. Last week, Missouri Governor Mike Parson signed budget bills that included $4.4 million for a maternal mortality prevention plan.

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In neighboring Arkansas, black women are twice as likely to experience pregnancy-associated deaths as white women, according to a 2021 state report.

Dr. William Greenfield, medical director of family health for the Arkansas Department of Health, said the disparity is significant and “persisted over time,” and it’s hard to pinpoint exactly why there was an increase in the maternal mortality rate from state for black mothers.

Rates among black women have long been the worst in the nation, and the problem affects people of all socioeconomic levels. For example, US Olympic champion sprinter Tori Bowie, 32, died of childbirth complications in May.

The pandemic likely exacerbated all of the demographic and geographic trends, Bryant said, and “that’s absolutely an area of ​​future study.” According to preliminary federal data, maternal mortality fell in 2022 after reaching a six-decade high in 2021, a peak experts attribute mainly to COVID-19. Officials said the final 2022 rate is on track to approach the pre-pandemic level, which was still the highest in decades.

Bryant said understanding more about these disparities is crucial to help focus on community-based solutions and understand what resources are needed to address the problem.

Arkansas is already using telemedicine and working on several other ways to increase access to care, said Greenfield, who is also a professor of obstetrics and gynecology at the University of Arkansas Medical Center in Little Rock and was not involved in the study.

The state also has a “Perinatal Quality Collaborative,” a network to help health care providers understand best practices for things like reducing C-sections, managing complications with hypertensive disorders, and reducing injuries or complications. severe related to childbirth.

“Most of the deaths that we reviewed and other places have reviewed … were preventable,” Greenfield said.