Original Investigation
Obstetrics and Gynecology
April 9, 2025
Pregnancy-Related Deaths in the US, 2018-2022
Yingxi Chen, Meredith S. Shiels, Tarsicio Uribe-Leitz, et al
JAMA Netw Open. 2025;8(4):e254325. doi:10.1001/jamanetworkopen.2025.4325
Question What is the pattern of pregnancy-related deaths in the US?
Findings In this cross-sectional analysis of 6283 pregnancy-related deaths in the US from 2018 to 2022, there were large disparities by state and race and ethnicity; American Indian and Alaska Native women had the highest age-standardized annual and aggregated rate (106.3 deaths per 100 000 live births), followed by non-Hispanic Black women (76.9 deaths per 100 000 live births). During 2018 to 2022, 2679 pregnancy-related deaths could have been prevented if the national rate was reduced to the lowest state rate.
Meaning These findings suggest that detailed, nationwide, age-standardized analyses of pregnancy-related deaths are essential for identifying opportunities to reduce avoidable deaths.
Abstract
Importance The US has the highest rate of preganncy-related death among high-income countries, and disparities continue to widen despite many of these deaths being largely preventable.
Objective To examine the age-standardized national rates of pregnancy-related death from 2018 to 2022 in the US, stratified by cause, and to compare the rates across state and race and ethnicity.
Design, Setting, and Participants This serial cross-sectional study used nationwide data on births and pregnancy-related deaths from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research. All pregnancy-related deaths among women aged 15 to 54 years from 2018 to 2022 were included.
Exposure State, race and ethnicity, and age.
Main Outcomes and Measures The primary outcomes were all-cause and cause-specific maternal death and late maternal death (ie, deaths occurring >42 days and up to 1 year after pregnancy). The age-standardized annual and aggregated rate of pregnancy-related mortality (ASR) was estimated by age group and race and ethnicity, and state-specific crude pregnancy-related mortality rates per 100 000 live births and 95% CIs were calculated.
Results During 2018 to 2022, there were 6283 pregnancy-related deaths, including 1891 late maternal deaths. The ASR increased by 27.7% from 25.3 deaths per 100 000 live births (95% CI, 23.7-26.9) in 2018 to 32.6 deaths per 100 000 live births (95% CI, 31.2-34.8) in 2022. The increase was observed across age group and was disproportionately driven by deaths that occurred among women aged 25 to 39 years (by 36.8%, 2018 vs 2022). There was a considerable variation in rates by state, ranging from 18.5 to 59.7 deaths per 100 000 live births. If the national rate was reduced to the lowest state rate, 2679 pregnancy-related deaths could have been prevented in 2018 to 2022. American Indian and Alaska Native women had the highest ASR (106.3 deaths per 100 000 live births), followed by non-Hispanic Black women (76.9 deaths per 100 000 live births). Although cardiovascular disease was the leading cause of the overall pregnancy-related deaths, cancer, mental and behavior disorders, and drug-induced and alcohol-induced death were important contributing causes of late maternal death.
Conclusions and Relevance In this cross-sectional analysis of pregnancy-related deaths in the US, rates increased during 2018 to 2022, with large variations by state and race and ethnicity. The concerning rates in the US should be an urgent public health priority.
