Maternal deaths during in-hospital deliveries decreased by 57% between 2008 and 2021, according to a nationally representative, observational study of 11 million hospital discharges. However, the study also found significant increases in severe maternal morbidities.
The U.S. Department of Health and Human Services announced the results of the study June 22. The study, "Trends in Maternal Mortality and Severe Maternal Morbidity During Delivery-Related Hospitalizations in the United States, 2008 to 2021," was conducted by HHS' Office on Women’s Health (OWH) and published in JAMA Open Network, according to the press release. The study "intends to more clearly define trends and risk factors leading to maternal mortality and morbidity in the United States and to improve overall national prevention and treatment efforts," the release reported.
"This decline in deaths during delivery hospitalization likely demonstrates the impact of national and local strategies to improve the quality of care by hospitals during delivery-related hospitalizations," HHS stated in the release.
Strategies, according to the release, include HHS quality-improvement measures including the Perinatal Quality Collaboratives with states and the Alliance for Innovation on Maternal Health. The measures also support the Biden administration's focus on addressing the country's maternal-health crisis; the U.S. has some of the highest maternal death rates among developed nations, according to the release.
The study found nationwide, in-hospital maternal death rates dropped from 10.6 per 100,000 discharges in 2008, to 4.6 per 100,000 discharges in 2021, the release reported. Mortality decreased 92% for American Indians; 79% for Pacific Islanders; 76% for Blacks; 73% for Asians; 60% for Hispanics; and 40% for Whites during the study period, according to the release.
“Further understanding these trends and risk factors is critical in public health decision-making,” Deputy Assistant Secretary for Women’s Health Dorothy Fink said in the release. “The data enable us to update programs and policies to have the most significant impact on maternal health outcomes.”
However, the study also found an increasing trend of severe maternal morbidities (SSMs), which are "serious pregnancy-related complications that have significant consequences to a woman's overall short- and long-term health," the release reported. It is estimated that for every person who dies as a result of pregnancy, 20 to 30 others have an SSM, according to the release.
The most common risk factors for developing an SSM are asthma, gestational diabetes, gestational hypertension, obesity and tobacco use, according to the release, with acute respiratory distress syndrome, acute kidney failure, sepsis and eclampsia among the most common SSM complications.
Racial- and ethnic-minority patients have seen higher increases in SSM complications, the release reported. The overall SSM trend increased for all racial and ethnic groups, from 146.8 per 10,000 discharges in 2008 to 179.8 per 10,000 discharges in 2021, with the highest rates of SSMs in Asian, American Indian and Pacific Islanders, according to the release.
The study's authors concluded an increase in preexisting conditions and a national trend toward older maternal ages could be responsible for the overall increase in SSMs, according to the release.
“We are committed to improving health outcomes before, during, and after pregnancy,” Dr. Rachel Levine, HHS assistant secretary, said in the release. “These results underscore the need to better manage women’s health, including identifying the most significant risk factors and supporting access to improved care.”
