CDC MMWR Sept 2020
#19,119
While we've known that pregnant women and their unborn offspring are often among the hardest hit during influenza pandemics (see 2009's Pregnancy & Flu: A Bad Combination), COVID's impact on pregnancy remains less well understood.
Early in the pandemic we looked at a number of studies that found increased risks for pregnant women, including:
And a 2023 Meta-Analysis (Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection) published by the BMJ reported:
- ~3–4× higher risk of ICU admission
- ~5× higher need for critical care
- ~7–8× higher risk of maternal death (relative risk)
- Much higher risk of mechanical ventilation and pneumonia
But today we've a analysis, published in Obstetrics & Gynecology, that quantifies the impact of pregnancy-related deaths during the COVID pandemic (up 60% in 2021), and the fact that those deaths - while lower now - still remain elevated for some sociodemographic subgroups
The full report is very much worth reading. I'll have more after the break.
Original ResearchDisparities by Age, Race and Ethnicity, and GeographyMacCallum-Bridges, Colleen L. PhD; Daw, Jamie R. PhD; Admon, Lindsay K. MD, MSc
Obstetrics & Gynecology ():10.1097/AOG.0000000000006255, April 2, 2026. | DOI: 10.1097/AOG.0000000000006255
AbstractOBJECTIVE:To describe trends in pregnancy-related death ratios from 2018 to 2024, assess the contribution of coronavirus disease 2019 (COVID-19) to these trends, and evaluate whether pregnancy-related death ratios have recovered to prepandemic levels.METHODS:We conducted an observational study that used vital statistics data to calculate the annual pregnancy-related death ratio (the number of pregnancy-related deaths per 100,000 live births) for female individuals aged 15–49 years between 2018 and 2024. We compared the pregnancy-related death ratios across prepandemic (2018–2019) pandemic (2020–2022), and postpandemic (2023–2024) periods; to assess the contribution of COVID-19, we calculated the pregnancy-related death ratio including and excluding COVID-associated deaths (ie, those with ICD-10 U07.1 listed as a cause). Pregnancy-related deaths were identified using International Statistical Classification of Diseases, Tenth Revision codes (A34, O00–O99), and the total pregnancy-related death ratio was decomposed into the early pregnancy-related death ratio (deaths during pregnancy or within 42 days after pregnancy) and the late pregnancy-related death ratio (deaths 43–365 days postpartum). We conducted subgroup analyses by maternal age, race and ethnicity, or geographic region.RESULTS:From 2018 to 2024, there were 8,298 pregnancy-related deaths (32.3/100,000 live births). From the prepandemic period to the pandemic period, the early pregnancy-related death ratio increased by 7.5 deaths per 100,000 live births (95% CI, 6.1–8.8) and the late pregnancy-related death ratio increased by 3.7 deaths per 100,000 live births (95% CI, 2.7–4.6). Most of this increase (76% for the early pregnancy-related death ratio, 50% for the late pregnancy-related death ratio) was COVID-associated deaths.
By 2023–2024, the early pregnancy-related death ratio had returned to prepandemic levels, but the late pregnancy-related death ratio remained elevated (1.4 additional deaths/100,000 live births; 95% CI, 0.4–2.4). Most subgroups experienced an increase in early and late pregnancy-related death ratios during the pandemic, but recovery varied.
Notably, both early and late pregnancy-related death ratios remained substantially elevated among non-Hispanic Black mothers in 2023–2024 compared with the prepandemic period (early pregnancy-related deaths increased by 7.0/100,000 live births [95% CI, 1.3–12.8]; late pregnancy-related deaths increased by 5.4 /100,000 live births [95% CI, 1.3–9.5]).CONCLUSION:Pregnancy-related death ratios increased dramatically during the COVID-19 pandemic, and by 2023–2024, recovery differed by the timing of death relative to pregnancy and across sociodemographic subgroups. Additional efforts are needed to identify drivers of differential recovery from the COVID-19 pandemic and inform clinical and policy initiatives to reduce pregnancy-related deaths, improve maternal health, and promote health equity.
(SNIP)
Pregnancy-related deaths increased dramatically during the COVID-19 pandemic, peaking in 2021 with 32.7 early pregnancy-related deaths per 100,000 live births and 13.1 late pregnancy-related deaths per 100,000 live births. Pandemic era increases in pregnancy-related deaths were largely explained by COVID-associated deaths, but by 2023–2024, recovery from the COVID-19 pandemic differed across sociodemographic subgroups.
Although some groups had returned to prepandemic levels, pregnancy-related death ratios remained elevated for other groups, including non-Hispanic Black mothers, a demographic that already faced substantially higher rates of pregnancy-related deaths before the COVID-19 pandemic. Additional research is needed to identify drivers of differential recovery from the COVID-19 pandemic and inform clinical, public health, and public policy initiatives to reduce pregnancy-related deaths and promote maternal health and health equity.
As the following CDC chart illustrates, pregnancy related mortality rose sharply in 2020, peaked in 2021, and began dropping significantly in 2022.
Data from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) in 2021 indicate that approximately 97% of pregnant people hospitalized (either for illness or for labor and delivery) with confirmed SARS-CoV-2 infection were unvaccinated.
In late September 2021 the CDC Issued a HAN For Pregnant Women Urging COVID Vaccination, which helped to increase its uptake.
It seems likely that the COVID vaccine, along with acquired immunity, better medical care options, and the arrival of less virulent Omicron variant in 2022, all contributed to this sharp decline.
Today, according to the latest (March 2026) ACOG COVID-19 Vaccination Considerations for Obstetric–Gynecologic Care Practice Advisory update, only about 11% of pregnant women in 2026 have received a COVID-19 vaccine.
However, vaccine uptake has waned, with a 25.7% year-to-date decrease in the 2025–2026 season compared with 2024–2025 (CDC 2025d). As of February 21, 2026, 11.1% of pregnant women overall have received a COVID-19 vaccine (CDC 2026). Clear, strong clinician recommendation remains one of the most influential factors in maternal vaccination acceptance and is essential to reducing preventable morbidity.While many choose to view COVID as a non-threat today, it continues to cause significant morbidity and mortality (see WHO Statement: COVID-19 Still Causes Severe Disease & Renewed Vaccination Recommendations).
A few recent studies include:
Nature Comms: The Risk of Kidney Disease Increases Following SARS-CoV-2 Infection Compared to influenza
Unfortunately, our growing societal laissez-faire attitude towards this virus means that some people are only going to learn this the hard way.
