The number of maternal mortality cases jumped in the United States in 2021 and this situation would be attributable in particular to COVID-19.
In 2021, 1,205 women died of maternal causes during pregnancy or within 42 days of childbirth in the United States. That number was 861 in 2020 and 754 in 2019, says a study by the National Center for Health Statistics (NCHS).
In 2021, the mortality rate reached 32.9 deaths per 100,000 births, compared to 23.8 per 100,000 in 2020, 20.1 per 100,000 in 2019 and 17.4 per 100,000 in 2018. This is the highest maternal mortality rate in industrialized countries.
By comparison, maternal mortality rates in Canada were 8.37 per 100,000 in 2020 and 8.60 per 100,000 in 2019. Data for 2021 will be released in July.
“We have to wait for the data, but I don’t expect any marked changes,” says Dr. Richard Brown, director of the divisions of obstetrics and maternal-fetal medicine at the MUHC. Cases of maternal mortality are very rare in the Montreal area. For those I have seen, the main causes of death were venous thromboembolism and hemorrhage. Not COVID. »
A closer analysis of the NCHS statistics demonstrates beyond any doubt that the risk of mortality increases with age and is higher among Afro-descendant women. But the COVID-19 epidemic is also responsible for many deaths.
This is the conclusion of the U.S. Government Accountability Office (GAO) – the equivalent of the Office of the Auditor General in Canada – in a publication dated October 19, 2022. The GAO then estimated at 1,178 (provisional data) the number of maternal deaths in 2021, of which 401 were attributable to COVID-19.
According to an article in the New York Times, pregnant women are more vulnerable to infectious diseases, in part because the immune system focuses on the fetus.
“In general, lung disease in pregnancy tends to be more difficult,” notes Dr. Marjorie Meyer, professor at Larner College of Medicine at the University of Vermont and contacted by La Presse in Burlington. I don’t think we know why, but affected women must have good heart reserves. »
On Thursday, the College of Obstetricians and Gynecologists of the United States (ACOG) reacted to the NCHS statistics by recalling that it had sounded the alarm in the past. “ACOG has previously expressed grave concern that the COVID-19 pandemic will worsen the maternal mortality crisis in the United States,” a statement read.
However, the World Health Organization (WHO) urges us not to draw hasty conclusions. “The stagnation in reductions in maternal mortality predates the onset of the pandemic. This may have contributed to the lack of progress, but does not represent the full explanation,” the WHO said in a document published on February 23.
For example, it is indicated that a distinction should be made between deaths attributable to the interaction between pregnancy and COVID-19 and those attributable to the interruption of health services during the pandemic.
Also according to the New York Times, the Omicron variant is less virulent than the Delta variant, which would result in lower maternal mortality. “Preliminary figures for 2022 indicate that maternal mortality is falling to near pre-pandemic levels,” the report said.
What does not seem to be changing, however, are the disparities. Among black American women, maternal mortality rates are twice as high as those of the general population. In 2021, this rate was 69.9 per 100,000 births, twice as high as that of white women (26.6 per 100,000).
“This trend must be stopped,” says the organization. ACOG strongly advocates for policies focused on improving maternal health outcomes, including the mandatory extension of postpartum Medicaid coverage from 60 days to 12 months. »
Observations shared by Bahman Kashi, assistant professor of economics at Queen’s University in Kingston. “Unlike Canada, health care is not free in the United States,” he recalls in an interview. People “shop around” for services, and when times get tough, they drop some of them. This can be the case with regular visits to the doctor during pregnancy. Less fortunate people will tend to drop them. But in doing so, the risk of complications increases over time. »