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    Maternal mortality in the U.S. more than doubled between 1999 and 2019   
      
      
     Date:   
         July 3, 2023   
     Source:   
         Mass General Brigham   
     Summary:   
         A new study has found that maternal mortality rates have worsened   
         from 1999 to 2019, hitting some racial and ethnic groups and   
         states harder than others. The study found rates highest for Black   
         populations and the largest increase was seen in American Indian   
         and Alaskan Native populations. By region, high rates of maternal   
         mortality were found in northern Mountain states and the Midwest   
         in addition to the South, a region traditionally known to have   
         high rates.   
      
      
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   FULL STORY   
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   A new study by investigators from the Institute for Health Metrics and   
   Evaluation (IHME) at the University of Washington and Mass General Brigham   
   found that maternal mortality rates have worsened from 1999 to 2019,   
   hitting some racial and ethnic groups and states harder than others. Their   
   results are published in the Journal of the American Medical Association   
   (JAMA).   
      
   "Maternal mortality is a crisis in the United States. These rates have   
   been increasing over the past several decades and were exacerbated by   
   the pandemic," said co-first author Allison Bryant, MD, MPH, senior   
   medical director for health equity at Mass General Brigham. "Our study   
   sheds light on the wide disparities within maternal mortality rates --   
   the specter of maternal death differentially burdens some ethnic and   
   racial populations."  Maternal mortality, or maternal death, is a death   
   during or up to one year after the end of pregnancy. According to the   
   Centers for Disease Control and Prevention, common causes of maternal   
   death include mental health conditions - - including death by suicide,   
   and overdose related to substance use disorder - - excessive bleeding   
   (hemorrhage), cardiac and coronary conditions, infection, thromboembolism   
   (blood clot), cardiomyopathy (a disease of the heart muscle) and   
   hypertensive disorders of pregnancy (relating to high blood pressure).   
      
   Previous research has found that rates of different causes of maternal   
   mortality vary by race and ethnicity.   
      
   Bryant and co-authors used the National Vital Statistics System data   
   on deaths and live births in each state and racial/ethnic group between   
   1999 and 2019.   
      
   They then used a modeling process to create estimates of maternal   
   deaths over those periods. This modeling estimated maternal mortality   
   for each state and each race and ethnicity out of every 100,000 live   
   births without potentially breaching any person's privacy.   
      
   "These disparities in maternal mortality are just the tip of the iceberg   
   and tell us a lot about the health risks facing people in the states   
   where these deaths are most likely to occur, " said Greg Roth, associate   
   professor in the Division of Cardiology and Director of the Program in   
   Cardiovascular Health Metrics at IHME. "In the U.S., maternal deaths   
   are often caused by vascular diseases like severe high blood pressure   
   or blood clots. So maternal deaths share many of the same drivers as   
   heart attacks, strokes, and heart failure.   
      
   Our state-by-state research emphasizes where we need to focus our   
   prevention efforts and which groups are suffering the most."  For all   
   ethnic and racial groups, maternal mortality more than doubled over   
   this time period. These rates have been rising most substantially   
   for American Indian and Alaskan Native people. The maternal mortality   
   rates for Black women were the highest of any group, but the average of   
   state-level rates had started to plateau around 2015 (pre-COVID) for   
   Black women. Factors like structural racism and interpersonal racism   
   play into these disparities, Bryant said.   
      
   Substantial prevention and awareness efforts around maternal mortality   
   may have had an impact for some populations, but not all.   
      
   Maternal mortality rates and disparities varied widely across states. The   
   South had high maternal mortality across all race and ethnicity groups,   
   but especially for Black individuals. Black individuals had the highest   
   maternal mortality rates in some states in the Northeast, which tripled   
   over the time of the study. Maternal mortality rates in the Midwest and   
   the Great Plains states were where highest rates were found for American   
   Indian and Alaskan Native women.   
      
   "Often, states in the South are called out as having the worst maternal   
   mortality rates in the nation, whereas California and Massachusetts have   
   the best. But that doesn't tell the whole story," Bryant said. "It's   
   essential to look at the disparities between populations that exist   
   even in the 'best' states."  The study had several limitations. The   
   researchers didn't always have access to information about the causes   
   of maternal death. And the way maternal deaths are recorded on death   
   certificates has changed in the U.S. over the time of this study.   
      
   The data used in the study stopped prior to the pandemic in 2019. National   
   data show maternal mortality increased in 2020 and 2021 when it was   
   harder to access health care. The pandemic also hindered some prevention   
   efforts to decrease the deaths of Black women. The pandemic may have   
   widened the disparities seen in this study, Bryant said.   
      
   "Our findings provide important insights on maternal mortality rates   
   leading up to the pandemic, and it's likely that we'll see a continued   
   increase in the risk of maternal mortality across all populations if we   
   analyze data from subsequent years," Bryant said. "Black individuals would   
   likely still have the highest rate, but there may be a higher uptick   
   in some of the other groups in the last few years. As we emerge from   
   the pandemic, we must renew our focus on addressing maternal mortality."   
   This study was supported in part by grants from the National Heart, Lung,   
   and Blood Institute (R01HL136868), the National Institutes of Health   
   (75N94019C00016), and Gates Ventures LLC.   
      
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   by Mass_General_Brigham. Note: Content may be edited for style and length.   
      
      
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   Journal Reference:   
      1. Laura G. Fleszar, Allison S. Bryant, Catherine O. Johnson,   
      Brigette F.   
      
         Blacker, Aleksandr Aravkin, Mathew Baumann, Laura Dwyer-Lindgren,   
         Yekaterina O. Kelly, Kelsey Maass, Peng Zheng, Gregory   
         A. Roth. Trends in State-Level Maternal Mortality by Racial and   
         Ethnic Group in the United States. JAMA, 2023; 330 (1): 52 DOI:   
         10.1001/jama.2023.9043   
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   Link to news story:   
   https://www.sciencedaily.com/releases/2023/07/230703133100.htm   
      
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