During a recent five-year period, a substantial portion of maternal deaths in America — almost one-third — took place more than six weeks after childbirth, at a time when most new mothers think they are in the clear, researchers reported on Wednesday.
Pregnancy-related death rates in the United States rose almost 28 percent from 2018 to 2022, the researchers found, surging at the height of the Covid-19 pandemic in 2021 before subsiding somewhat.
Women need “access to high-quality care from the moment of conception to a full year after birth,” said Dr. Rose L. Molina, an associate professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and one of the study’s authors. While there has been a growing emphasis on care in the year after childbirth, “we’re not there yet.”
The study was based on data from the Centers for Disease Control and Prevention’s division of reproductive health, which monitors maternal mortality and identified the risk of so-called later maternal deaths — those that occur from six weeks to one year after the birth.
Cardiovascular disease was the leading cause of pregnancy-related deaths overall, as well as the leading cause of late maternal deaths. Other major causes were cancer, mental and behavioral disorders, and drug- and alcohol-induced deaths.
The risks facing women in the first year after a delivery were not well understood until recently. They take their toll after what traditionally is the new mother’s last recommended checkup, six weeks after childbirth — a period when attention is focused primarily on the health of the new baby.
The American College of Obstetricians and Gynecologists now recommends that all women see a doctor within the first three weeks after having a baby, with follow-up and ongoing care as needed, and a comprehensive postpartum visit no later than 12 weeks after birth.
The study also documented stark racial, ethnic and regional disparities. Native American and Alaska Native women died during pregnancy and the year after childbirth at rates 3.8 times as high as those among white women, while Black women died at rates 2.8 times as high. Hispanic women and Asian women died at the lowest rates.
Death rates also varied more than threefold between states. Southeastern states generally had higher pregnancy-related mortality rates: Alabama had the highest, followed by Mississippi. Nationwide, California had the lowest rate, followed by Minnesota.
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