Severe Maternal Morbidity in United States

United States

Maternal morbidity is any outcome of pregnancy labor or delivery that leads to short- or long-term health consequences, such as cardiovascular disease, infection, bleeding, high blood pressure or blood clots. Severe maternal morbidity includes serious and potentially life-threatening events and outcomes, such as eclampsia or hysterectomy, resulting from pregnancy labor and delivery. Severe maternal morbidity is a critical indicator for identifying preventable, severe complications in maternal health care. As a population-level metric, it helps uncover underlying causes of maternal health disparities, guide improvement efforts and support the prevention of maternal mortality.

The prevalence of severe maternal morbidity in the United States has been steadily increasing since 2008.

The rate of severe maternal morbidity is higher among:

• Non-Hispanic Asian and Hispanic women compared with non-Hispanic white women. Non-Hispanic Black women have the highest rate.
• Women at the younger and older ends of the reproductive age range. Women younger than 20 and older than 40 have higher rates compared with women ages 20-39. 
• Women with a prior cesarean section, who are at greater risk for complications compared with those who have a history of vaginal delivery.
• Women with multiple births (twins, triplets, etc.), which are associated with higher rates of complications compared with singleton pregnancies.
• Women who have either never been pregnant or never had a live birth (nulliparity), as well as those who have given birth three or more times (high parity), compared with women with one or two prior live births.

Strategies to prevent maternal morbidity include: 

• Maintaining communication and collaboration among stakeholders such as national health organizations, providers and researchers. 
• Creating and using multidisciplinary and national standards and guidelines for maternal health care, such as those provided by the Alliance for Innovation in Maternal Health in their maternal patient safety bundles and screening and review guidelines from the American College of Obstetricians and Gynecologists. 
• Increasing access to early and adequate prenatal care and reducing barriers to postpartum care.
• Closing the Medicaid coverage gap to make reproductive care affordable for all women.
• Increasing the use of telehealth to promote and increase access to quality care, particularly for minority women in high-risk obstetric clinics and underserved areas.
• Improving data collection and surveillance to better understand the causes of maternal mortality and morbidity. This includes reviewing cases of severe maternal morbidity, with attention to the higher risks faced by non-Hispanic Black and American Indian/Alaska Native women. 

The Community Preventive Services Task Force recommends exercise programs for pregnant women to help reduce the risk of developing gestational hypertension and lifestyle interventions to reduce the risk of gestational diabetes, two common complications of pregnancy. The American College of Obstetricians and Gynecologists recommends pregnant women receive certain routine and additional immunizations to reduce maternal morbidity and mortality, including vaccines for influenza, pneumococcus, meningococcus and hepatitis, depending on risk.

Healthy People 2030 has an objective to reduce severe maternal complications identified during delivery hospitalizations.

Ahn, Roy, Grace P. Gonzalez, Britta Anderson, Catherine J. Vladutiu, Erin R. Fowler, and Leticia Manning. “Initiatives to Reduce Maternal Mortality and Severe Maternal Morbidity in the United States: A Narrative Review.” Annals of Internal Medicine 173, no. 11 (supplement) (December 1, 2020): S3–10. https://doi.org/10.7326/M19-3258.

Ault, Kevin A., Laura E. Riley, and ACOG Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group. “ACOG Committee Opinion No. 741: Maternal Immunization.” Obstetrics & Gynecology 131, no. 6 (June 2018): e214–17. https://doi.org/10.1097/AOG.0000000000002662.

Declercq, Eugene, and Laurie Zephyrin. Severe Maternal Morbidity in the United States: A Primer. Data Brief. Commonwealth Fund, October 2021. https://doi.org/10.26099/r43h-vh76.

Fink, Dorothy A., Deborah Kilday, Zhun Cao, Kelly Larson, Adrienne Smith, Craig Lipkin, Raymond Perigard, et al. “Trends in Maternal Mortality and Severe Maternal Morbidity During Delivery-Related Hospitalizations in the United States, 2008 to 2021.” JAMA Network Open 6, no. 6 (June 22, 2023): e2317641. https://doi.org/10.1001/jamanetworkopen.2023.17641.

Howell, Elizabeth A. “Reducing Disparities in Severe Maternal Morbidity and Mortality.” Clinical Obstetrics and Gynecology 61, no. 2 (June 2018): 387–99. https://doi.org/10.1097/GRF.0000000000000349.

Kilpatrick, Sarah J. “Next Steps to Reduce Maternal Morbidity and Mortality in the USA.” Women’s Health 11, no. 2 (March 1, 2015): 193–99. https://doi.org/10.2217/WHE.14.80.

Nik Hazlina, Nik Hussain, Mohd Noor Norhayati, Ismail Shaiful Bahari, and Halilul Rahman Mohamed Kamil. “The Prevalence and Risk Factors for Severe Maternal Morbidities: A Systematic Review and Meta-Analysis.” Frontiers in Medicine 9 (March 17, 2022): 861028. https://doi.org/10.3389/fmed.2022.861028.

Snowden, Jonathan M., Audrey Lyndon, Peiyi Kan, Alison El Ayadi, Elliott Main, and Suzan L. Carmichael. “Severe Maternal Morbidity: A Comparison of Definitions and Data Sources.” American Journal of Epidemiology 190, no. 9 (September 1, 2021): 1890–97. https://doi.org/10.1093/aje/kwab077.

Solomon, Judith. Closing the Coverage Gap Would Improve Black Maternal Health. Report. Washington, D.C.: Center on Budget and Policy Priorities, July 26, 2021.https://www.cbpp.org/research/health/closing-the-coverage-gap-would-improve-black-maternal-health.