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Maternal mortality rates substantially increased during the COVID-19 pandemic, according to a study using data from the National Center for Health Statistics.

After March 2020, maternal deaths increased by 33.3%, which was higher than the 22% overall excess death estimate expected to result from the pandemic, reported Marie Thoma, PhD, of the University of Maryland in College Park, and Eugene Declercq, PhD, of Boston University.

The rate of maternal deaths before the pandemic was 18.8 per 100,000 live births, which increased to 25.1 per 100,000 live births during the pandemic, the authors noted in a research letter published in .

Of note, late maternal mortality increased by 41%, they added.

The largest increases were seen in Hispanic and Black women, which was in line with . Hispanic women saw a relative change of 74.2% (8.9 deaths per 100,000 live births), and Black women saw a 40.2% relative change (16.8 deaths per 100,000 live births), while white women saw a 17.2% relative change (2.9 deaths per 100,000 live births).

"Future studies of maternal death should examine the contribution of the pandemic to racial and ethnic disparities and should identify specific causes of maternal deaths overall and associated with COVID-19," the authors wrote.

The largest relative increases were seen for indirect causes of death (56.9%), including other viral diseases (2,374.7%), diseases of the respiratory system (117.7%), and diseases of the circulatory system (72.1%).

Direct causes of death increased by 27.7%, which included diabetes in pregnancy (95.9%), hypertensive disorders (39.0%), and other pregnancy-related conditions (48.0%).

COVID-19 was mostly listed as a secondary condition with other viral diseases (16 of 16 deaths) and diseases of the respiratory system (11 of 19 deaths).

For this study, Thoma and Declercq used data from the National Center for Health Statistics for the years 2018 to 2020. Data were broken down by date for the years 2018 and 2019, and in quarters for 2020. January-March 2020 acted as quarter 1, and April-December 2020 acted as quarters 2 to 4.

A secondary code for COVID-19 was listed in 14.9% of maternal deaths in quarters 2 to 4 compared with 0% in quarter 1, and was higher among Hispanic women (32.1%) and Black women (12.9%) versus white women (7.3%).

While death rates were higher than estimated, further study is needed to determine whether COVID-19 itself was the determining factor.

Study limitations included the large proportion of COVID-19 cases with a non-specific underlying cause and the partitioning of data that resulted in small numbers for some categories, Thoma and Declercq noted.

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