Trends in Maternal, Fetal, and Infant Mortality in the US, 2000-2023

Area of Science:

• Reproductive Health
• Epidemiology
• Public Health

Background:

• Accurate measurement of maternal mortality trends is hindered by data collection changes.
• The introduction of a pregnancy checkbox on death certificates complicates trend analysis.
• Understanding trends in maternal, fetal, and infant mortality is crucial for public health.

Purpose of the Study:

• To analyze maternal, fetal, and infant mortality trends from 2000 to 2023.
• To determine the impact of the pregnancy checkbox on reported maternal mortality.
• To assess the influence of the COVID-19 pandemic on these mortality trends.

Main Methods:

• National, population-level, epidemiological, cross-sectional analysis (2000-2023).
• Staggered difference-in-differences analysis to evaluate the pregnancy checkbox effect.
• Utilized US CDC WONDER database for underlying causes of death data.

Main Results:

• The pregnancy checkbox accounted for a significant portion of the maternal mortality increase pre-pandemic.
• Adjusted maternal death rates remained relatively stable until 2021, peaking during the pandemic.
• Native American/Alaska Native and non-Hispanic Black women experienced disproportionately higher mortality rates.
• Infant and fetal death rates showed a general decline but with slight recent increases.

Conclusions:

• The pregnancy checkbox significantly influenced reported maternal mortality, masking underlying trends.
• The COVID-19 pandemic exacerbated maternal health outcomes, particularly for certain demographic groups.
• Findings underscore the vulnerability of maternal health during public health emergencies.