Severe Maternal Morbidity in United States

United States

The prevalence of severe maternal morbidity in the United States has been steadily increasing since 2008. Tracking severe maternal morbidity is important for monitoring population-level maternal health and preventing maternal mortality. Severe maternal morbidity encompasses unanticipated labor and delivery outcomes which result in short- or long-term health effects. Long-term consequences include cardiovascular disease, impaired sexual function and pulmonary disease. Additional serious and potentially life-threatening events and outcomes from severe maternal morbidity include eclampsia or hysterectomy resulting from labor and delivery.

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: 

• Training non-obstetric health care professionals for obstetric emergencies.
• Improving communication and collaboration among national health organizations, health care providers, researchers and other stakeholders. 
• Creating and using multidisciplinary national standards for maternal health care, such as the Patient Safety Bundles created by the Alliance for Innovation on Maternal Health and the 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 that pregnant women receive certain immunizations to reduce maternal morbidity and mortality, including influenza, pneumococcal, meningococcal and hepatitis vaccines, depending on risk.

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

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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.

Gothelf, Itamar, Israel Yoles, Danielle Ben-Ayoun, Majdi Imterat, Asnat Walfisch, and Tamar Wainstock. “Long-Term Maternal Health Outcomes Following Severe Maternal Morbidity: A Cohort Study.” BJOG: An International Journal of Obstetrics & Gynaecology 133, no. 3 (2026): 454–62. https://doi.org/10.1111/1471-0528.70055.

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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.

Severe Maternal Morbidity: Screening and Review. Obstetric Care Consensus, No. 5. American College of Obstetricians and Gynecologists, September 2016. https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2016/09/severe-maternal-morbidity-screening-and-review.

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.

“Strategies and Actions: Improving Maternal Health and Reducing Maternal Mortality and Morbidity.” In The Surgeon General’s Call to Action to Improve Maternal Health. Washington, D.C: U.S. Department of Health and Human Services, Office of the Surgeon General, 2020. https://www.ncbi.nlm.nih.gov/books/NBK568218/.