The leading causes of maternal death in the United States are no longer primarily related to obstetric complications or disease, according to an analysis of deaths from 2018 to 2023. Overdose, homicide, and suicide are now the dominant factors contributing to maternal mortality.
This shift, revealed in research published by the New England Journal of Medicine, challenges long-held assumptions about the drivers of the maternal mortality crisis. Although direct obstetric causes of death have declined over the last 20 years, deaths related to external factors have risen sharply. This finding contrasts with previous reports indicating a dramatic increase in overall maternal mortality rates, with the National Vital Statistics System (NVSS) at the Centers for Disease Control and Prevention (CDC) previously reporting rates nearly doubling from 17.4 in 2018 to 32.9 per 100,000 live births in 2021.
A study published in March 2024 in the American Journal of Obstetrics & Gynecology further complicates the picture, suggesting that reported maternal death rates may not be as dramatically upward trending as previously believed. Researchers re-examined underlying data, considering changes in obstetric factors, maternal chronic conditions, and data collection methods, and found rates were stable between 1999-2002 and 2018-2021. The study, published by Elsevier, questioned the accuracy of the previously reported increases by the NVSS.
The changing landscape of maternal mortality necessitates a reevaluation of public health strategies. The focus is shifting from solely addressing complications of pregnancy and childbirth to encompassing broader social and mental health factors. The rise in deaths due to overdose, homicide, and suicide highlights the need for integrated care that addresses the complex needs of pregnant and postpartum individuals.
Researchers continue to investigate the factors driving these trends, including changes in maternal medical conditions and surveillance issues related to data collection. The definition of maternal death includes deaths occurring during pregnancy, childbirth, or the postpartum period from conditions directly related to pregnancy or those exacerbated by pregnancy and birth, but excludes accidental and incidental deaths.
The CDC has not yet released a statement responding to the recent findings regarding the leading causes of maternal death. Further analysis and data are expected to be released in the coming months.
