Racial Disparities in Severe Maternal Morbidity During the COVID-19 Pandemic: Evidence from the New Jersey Integrated...

Black birthing people face higher rates of severe maternal morbidity (SMM), a disparity that was exacerbated during the COVID-19 pandemic.

This study utilized secondary population data from the New Jersey Integrated Population Health Data Project, including birth records, hospitalization discharge data, and COVID-19 testing records from 2019 to 2021 (N = 207,790). We employed path analysis with weighted least squares mean and variance adjusted (WLSMV) estimation to examine the direct and indirect associations of Black/African American identity with (1) experiencing any SMM and (2) the cumulative burden of SMM, mediated by physiological risk factors and indicators of healthcare access and utilization.

We find that identifying as Black was directly and indirectly linked to both having any SMM type (β = 0.19) and a greater cumulative maternal morbidity burden (β = 0.10). Consistent with a potential mediation role, metabolic, cardiovascular, and respiratory conditions, obesity, and COVID-19 hospitalization were indirectly associated with maternal morbidity among Black birthing individuals. However, among those who had at least one type of SMM, only cardiovascular and metabolic conditions remained significantly associated with cumulative burden of maternal morbidity.

Our findings emphasize that Black/African American identity and Medicaid enrollment are associated maternal morbidity, while clinical conditions (particularly cardiovascular and metabolic diseases) emerge as key correlates of SMM severity. Addressing these disparities requires a dual approach: strengthening clinical care models while concurrently addressing structural inequities that perpetuate maternal health disparities.