The U.S. maternal mortality rate — already the worst in the industrialized world — rose in 2020 to its highest level in half a century, with Black women three times more likely to die than white women, data showed Wednesday.
A National Center for Health Statistics report showed the rate was 23.8 deaths per 100,000 live births, far higher than comparable countries, such as Canada where it was 7.5 per 100,000, according to OECD statistics for the same year.
Overall, 861 women were identified as having died of maternal causes, which the World Health Organization defines as a death while pregnant or within 42 days of the end of pregnancy, from any cause related to or aggravated by pregnancy or its management.
In 2019, the number of deaths per 100,000 live US births was 20.1, while in 2018 it was 17.4.
“We observed increases across a broad number of categories, and Covid-19 likely contributed,” Donna Hoyert, who authored the report, told AFP.
But, she added, the disease was not mentioned in 88 percent of cases, and was thus only a part of the overall picture.
Despite spending more than twice per person on health than the average of high-income nations, the United States has historically remained an outlier on maternal mortality compared to its peers.
Across the world, maternal mortality dropped throughout the 20th century thanks to advances in medical care such as antibiotics and basic hygiene. But the United States has seen backsliding since the year 2000, unlike most other countries.
In fact, the last time the US rate was officially this high was 1968, though a new reporting methodology was introduced in 2018.
“Most of the peer countries have some form of universal health care,” Boston University professor Eugene Declercq, who studies the field, told AFP.
“What we do in the United States is we focus on care so intently on the time of birth — and that’s nice — but the fact of the matter is, women enter their pregnancies in a less healthy state because they’re not covered.”
Certain conservative-led states, such as Texas and Alabama, have increased hurdles to eligibility to Medicaid, the publicly funded health insurance program, said Declercq.
Upper income limits to enroll in Medicaid are lower for women who are pregnant, but there is a greater chance that by the time they become pregnant, they have untreated chronic conditions.
Limiting access to abortion — as conservative-led states have increasingly done in recent years — is also linked to worse maternal health outcomes a 2021 study in the American Journal of Public Health found.
Racial disparities
The racial breakdown of the 2020 figures reveal widening disparities.
The number of maternal deaths per 100,000 live births was 55.3 among Black women, compared to 19.1 among white women, which would by itself still be higher than peer countries.
Here too, there are thought to be many factors, and experts say it’s not as simple as race being a surrogate for socioeconomic conditions such as access to care and environmental stressors, though these undoubtedly play a role.
In fact, a 2016 study by the Centers for Disease Control and Prevention (CDC) showed for a Black woman with a college education, the likelihood of maternal death is still 60 percent greater than for a white woman with less than a high school education.
“Black women are time and time again shown to not receive the same level of treatment or medications,” Ebony Hilton, an anesthesiologist at the University of Virginia – Charlottesville, and an expert in disparities in health care, told AFP.
The newborn baby, safe from the coronavirus… even more so with the mother’s vaccines
“It is also important to underline that the few infections from the mother to the baby, whether during pregnancy or childbirth, 15 cases of the 2,874 tested, have been diagnosed as a mild covid infection and have always evolved positively and without complications. », rounds up the also head of the Neonatology Service of the Gregorio Marañón University General Hospital in Madrid.
“And for greater health satisfaction, the vaccines against this virus and its different mutations, now with omicron on the crest of the wave, have meant a before and after when pregnant women with coronavirus develop respiratory failure: we have gone from clinical symptoms severe to mild clinical pictures”, highlights the doctor from Madrid.
“As if that were not enough, it should be added that of the 162 cases of postnatal infection, after childbirth, both in the hospital setting and in the family home, only 8% of the babies had symptoms for which their admission to care was advisable. intensive due to suffering, most of them, previous risk factors, such as heart disease and prematurity”.
seNeo recommends vaccination and extreme prevention measures against coronavirus in all cases. Pregnant women should not live in a bubble, but should systematically avoid pandemic infection vectors
Data and keys of the seNeo covid registry on the newborn
The registry of covid cases of the Spanish Society of Neonatology is created to know the impact of SARS-Cov-2 infection in newborns; a set of “own data” compiled both from infected mothers and their newborns -perinatal situation- and from those other babies who were infected in the postnatal period.
135 Spanish public and private hospitals collaborate meticulously in the project.
The main objective of this seNeo registry is to compute all the clinical statistics on pregnancies and births during the pandemic in order to prepare a series of recommendations based on scientific evidence.
«This exhaustive database, fed by hundreds of professionals, who work very hard, coordinated by the seNeo infectious diseases group, with the Dr. Belen Fernandez Colomer of the Central Hospital of Asturias at the helm, improves our strategy against a disease unknown at the beginning of 2020 and unheard of to date»
Dr. Manuel Sánchez Luna, president of the Spanish Society of Neonatology
4,737 perinatal cases of covid mothers
Since the cases began to be assessed during the first wave of COVID-19, the profile of pregnant women indicates that they have a mean age of 32 years and 73% of them were previously healthy, despite showing a high prevalence of obesity.
In 80% of the 4,737 cases analyzed, the pregnant women did not suffer from gestational pathologies; being the preeclampsia the most frequent complication in this group of women.
“Mothers who were admitted to the ICU for covid developed the disease in the third trimester, probably due to greater respiratory compromise. More cases of obesity and preeclampsia were described in this group of patients”, Dr. Sánchez Luna reiterates.
“We must bear in mind – he explains – that severe forms of covid are more common among pregnant women than in non-pregnant women. Still, 50% of recorded infections were asymptomatic.”
Throughout the period studied, the cesarean section rate has stood at 23% nationwide, a lower percentage than the pre-pandemic rate, which was 25% in 2019.
“It is likely that virus mutations have something to do with these data, but also, very likely, vaccination, since this preventive measure has modified the severity profile, with the need for admission to the ICU now being very infrequent. of vaccinated pregnant women”, testifies.
Late fetal death -from the 28th week of gestation, according to the WHO- has been very low: 2.8 per thousand pregnancies, also lower than the pre-pandemic rate.
The overall rate of prematurityfortunately, has been declining throughout the pandemic.
“At the beginning it was very high, 26.5%, but currently it is less than 5% and it is late prematurity (34 to 37 weeks), usually due to the need to improve the respiratory situation of the mother in the most severe cases” , highlights.
“We are pleased to say that the 94.5% of newborns have done rooming-in with his mother, without complications, avoiding the separation of both. When this mother-baby union has not been possible, it has been due to covid symptoms that forced us to separate them; that yes, the minimum possible time».
Dr. Manuel Sanchez Luna
“It is interesting to see -he points out- how the children of covid mothers behave at birth in the same way as the children of non-covid mothers,” he mentions.
Skin-to-skin contact was carried out in 78% of the deliveries and the delayed clamping of the umbilical cord in 68% of cases.
When the presence of antibodies in the mother has been determined, these have been detected in 85% of her babies. In 2.2% of those born without symptoms, the PCR was positive. In boys and girls with symptoms, the positivity in PCR was similar to the asymptomatic ones.
Of the 2,874 tested, only in 15 cases the PCR was persistently positive. The final rate of infection was 1% in newborns..
‘It is very interesting to see how the infection rate in the babies who were not separated from their mothers turned out to be lower than that in the group of babies who had to be separated from their mothers; and in addition, in those who continued breastfeeding the rate was lower than those who received donated milk from other mothers»
Dr. Manuel Sanchez Luna
On the whole, the breastfeeding rate was 88%one more success of the recommendations of the Spanish Society of Neonatology.
162 postnatal cases, covid infections after childbirth
From 54 hospitals, 162 cases of babies with postnatal infection have been reported, either in the health field or in the family home. There is a decrease in the number of cases in recent months. Symptoms have generally been mild; some did not require admission.
8% were admitted to the neonatal ICU, most with previous risk factors such as prematurity or heart disease. The most frequent symptom was fever, irritability and rhinorrhea -runny nose-.
In addition, they showed little analytical alteration and the radiological tests showed only some cases of non-specific infiltration -viral pneumonia-«.
“Most postnatal infections have occurred in the family home and very few have been infected in the hospital by their parents or by health personnel, most of them, moreover, in the first wave.
These cases of neonatal infection, in general, have been mild and with a good prognosis, without added problems in the medium and long term.
“In summary, in both cases, perinatal and postnatal infection, we can say that these newborn babies have formed a low-risk group because their mothers have most likely protected them either through the placenta or through breastfeeding.”
“In this same sense, many of these babies have received antibodies against the coronavirus generated by the maternal vaccine. One of the reasons why the Spanish Society of Neonatology strictly recommends the vaccination of pregnant women. Vaccination protects mothers from SARS-CoV-2 in its most serious forms»
Dr. Manuel Sanchez Luna
Likewise, seNeo advises that the management of newborns of covid mothers, always taking extreme hygiene and safety measures, must be practically the same as the cases of babies of mothers without infection.
“It is essential to maintain the joint hospital stay, skin-to-skin contact and encourage breastfeeding. They are safe strategies for mothers and their babies«, Dr. Manuel Sánchez Luna concludes the interview.
