Pregnancy-related mortality in the United States from 2018 to 2020

Maternal reproductive health is facing significant challenges in the United States. Currently, the nation has the highest maternal death rate among high-income countries, and the rate continues to increase. Recent United States data indicate that 80% of maternal deaths are preventable, highlighting the urgent need for action on this critical issue. We analyzed United States national death certificate data and birth data from the CDC's wide-ranging online data for epidemiologic research databases. We estimated pregnancy-related mortality rates by state, age group and race, and ethnicity. We assessed cause-specific pregnancy-related mortality and late maternal death (i.e., deaths occurring >42 days and up to 1-year post-pregnancy). During 2018–2020, we observed 3364 pregnancy-related deaths, including 1006 late maternal deaths. The age-standardized mortality rate (ASR) increased by 37.2% from 25.4 (95% CI: 23.8–26.9) per 100,000 live births in 2018–34.7 (95% CI: 32.8–36.5) in 2020. Rates ranged from 16.8 per 100,000 to 57.5 per 100,000. If the national rate was reduced to the lowest state rate, 1448 pregnancy-related deaths could have been avoided. The rate among non-Hispanic Black people (ASR2018–2020 = 70.7 per 100,000) was two to three times higher than other groups estimated. Cardiovascular conditions are the leading cause of pregnancy-related deaths overall, yet cancer was associated with 20% of late maternal death. Mental and behavioral disorders and drug and alcohol-induced death were also important contributors to late maternal death. We observed alarming trends of increasing pregnancy-related death rates in the United States. Our study provides important insights for identifying opportunities to reduce avoidable maternal deaths.