Maternal Deaths in Hospitals Are Declining, But Severe Birth Complications Are on the Rise: Study

New research suggests national in-hospital maternal mortality rates have declined significantly in recent years, even as the rate of severe birth complication rates increased, suggesting that women still face serious health risks outside of a hospital setting, during pregnancy or shortly after giving birth.

In findings published this month in the Journal of the American Medical Association (JAMA), researchers indicate the number of pregnant women dying from labor and delivery complications while hospitalized dropped by more than half over 14 years. However, the study also found that rates of serious, short and long term health problems linked to pregnancy and birth complications, known as severe maternal morbidity (SMM), increased during the same period.

Birth complications like pregnancy related high blood pressure (preeclampsia), stroke, respiratory distress, infections, sepsis, and other pregnancy related disorders are potentially fatal to expectant mothers, and pose a serious risk of long-term birth injuries for newborns.

U.S. Maternal Death Rates are High

The U.S. has one of the highest maternity death rates of any wealthy nation. Recent statistics from the U.S. Centers for Disease Control and Prevention (CDC) indicate that 53% of pregnancy related deaths occur seven to 365 days postpartum in the U.S., and approximate 80% of all pregnancy-related deaths are considered preventable. Data shows pregnancy deaths in the U.S. are especially high among minority women.

Research suggests even non-fatal birth complications pose many long-term and short-term health risks to both mother and child.

Women who experience adverse pregnancy outcomes like preeclampsia and preterm birth may face higher risk of stroke at a younger age. In additio, Preeclampsia may increase risk of neurodevelopmental disorders in newborns, and mothers who suffered preeclampsia may give birth to children with increased chances of heart disease and stroke later in life.

Pregnancy Complication Dangers Persist After Women Give Birth

In this latest study, researchers from the U.S. Department of Health and Human Services (HHS) and health care company Premier, Inc. analyzed national hospital data on 11.6 million deliveries from 2008 through 2021.

The hospital data showed the rate of delivery-related deaths declined from 10.6 deaths per 100,000 patient discharges in the first quarter of 2008, to 4.6 deaths in the fourth quarter of 2021, a drop of 57%.

Researchers found that women of all races saw a decline in maternal mortality during the study period. Maternal mortality for American Indian women decreased by 92%, while Asian women saw a decrease of  73%. Maternal mortality rates for Black women decreased by 76%, while corresponding rates for Hispanic women decreased by 60%. Pacific Islander maternal mortality rates women decreased by 79%, and White women saw a corresponding decrease of 40% .

However, researchers also found that severe maternal morbidities among patients surged by more than 20%, from 146.8 cases per 10,000 discharges in the first quarter of 2008 to 179.8 per 10,000 discharges in the fourth quarter of 2021.

Compared with 2008, there were higher instances in 2021 of sickle cell disease, high blood pressure, severe preeclampsia, substance use disorders, asthma, gestational diabetes, obesity and severe bleeding, researchers found. These types of conditions are known to escalate quickly during the postpartum period after discharge from a hospital setting, researchers noted.

The study also saw a racial disparity in maternal morbidity increase, with Pacific Islander, American Indian, and Asian patients facing the highest risk of severe birth complications.

Researchers attributed several factors to the in-hospital maternal death rate decline, including a heightened adherence to maternal care protocols, greater awareness of racial disparities in maternal mortality, and obstetric hospitalists contributing more to patient care.

They concluded that in-hospital deaths may not be the main factor for the U.S.’s persistently high maternal death rates compared to other wealthy nations, and that women still face an increased risk of maternal death from preventable birth complications once they leave a hospital setting.

To further reduce pregnancy and childbirth related dangers once new mothers are out of the hospital, researchers stressed increased focus on postpartum care, especially for high risk racial and ethnic demographics.

“As current national strategies increasingly focus on improving delivery-related maternal outcomes among high-risk groups, including racial and ethnic minority groups, it will become important to evaluate the effectiveness of these strategies in reducing occurrences of maternal mortality and SMM,” researchers wrote.