Maternal Deaths Surged Between 2018 and 2022 — Why?

Story at a glance:

• Recent data show U.S. maternal mortality rates increased by 27.7% between 2018 and 2022, with one-third of pregnancy-related deaths occurring after the standard six-week postpartum care period.
• Significant disparities exist in maternal death rates by state, race and ethnicity. American Indian/Alaska Native women face a nearly four times higher risk than white women.
• Cardiovascular disorders are the leading cause of late maternal deaths, followed by cancer and endocrine conditions. Drug and alcohol-related issues and mental or behavioral disorders are also significant contributors.
• U.S. infant mortality also increased by 3% from 2021 to 2022, the first rise in 20 years, with deaths from maternal complications rising 8.6% and newborn bacterial sepsis up 13.7%.
• To reduce maternal mortality risk, track your symptoms after birth, push for care beyond the standard six-week visit, and make informed decisions throughout pregnancy and postpartum.

Pregnancy pushes a woman’s body far beyond its limits. The heart works harder to circulate an increased volume of blood, hormone levels shift repeatedly to support fetal development, and the immune system adjusts in ways that leave many women more vulnerable to infections and other complications.

Childbirth is commonly seen as the point when everything returns to normal and the mother begins to recover.

However, that assumption is directly challenged by a major cross-sectional study led by researchers at the National Institutes of Health (NIH), who examined maternal deaths not only during childbirth but throughout the entire year following delivery.

By expanding the timeframe, the researchers revealed that previous analyses underestimated the long-term risks mothers face, and that current monitoring practices fall short, leaving a wide and dangerous gap in care where serious complications often go undetected or untreated.

What does the latest data reveal about postpartum deaths?

The featured study, published in JAMA Network Open, analyzed pregnancy-related deaths in the U.S. from 2018 to 2022 using national birth and death certificate data from the Centers for Disease Control and Prevention.

Unlike many previous studies, it also examined “late maternal deaths,” which are deaths from pregnancy-related causes that occur more than 42 days and up to one year after delivery.

• Maternal deaths increased sharply in just five years — Between 2018 and 2022, the national rate of pregnancy-related deaths increased by 27.7%. The steepest rise was among women aged 25 to 39, with a 36.8% increase. These are the same women typically considered to be in their peak reproductive years, which makes the trend especially alarming.
• Where a woman lives made a major difference — States varied widely in maternal death rates, ranging from 18.5 to 59.7 deaths per 100,000 live births. Alabama had the highest rate, while California had the lowest. The researchers calculated that if every state had matched California’s rate, over 2,600 maternal deaths could have been prevented during the study period.
• Disparities by race and ethnicity were equally striking — American Indian and Alaska Native women had the highest age-standardized death rate at 106.3 per 100,000 live births, which is nearly four times higher than the rate for non-Hispanic white women. Non-Hispanic black women had the second highest rate at 76.9, while Latina and Asian women had significantly lower rates.
• One-third of all pregnancy-related deaths occurred after six weeks — These late maternal deaths made up 30% of the overall pregnancy-related mortality and were most often linked to cardiovascular disorders, which were the top medical contributor at 4.7 deaths per 100,000 live births.
  Cancer followed at 2.0 per 100,000, endocrine conditions at 1.6, drug and alcohol-related deaths at 1.1, and mental and behavioral disorders at 1.0 per 100,000. These categories are not mutually exclusive, meaning that a single death could involve multiple contributing conditions.
• Postpartum care often ends too early — Standard maternal health care in the U.S. rarely extends past six weeks postpartum. According to the study, this time limit overlooks a crucial window when life-threatening conditions may develop or worsen, particularly among populations already experiencing limited access to care.

The researchers emphasized that identifying and addressing the causes of late maternal death is essential to lowering pregnancy-related mortality in the U.S.

“We cannot take our eyes off of maternal health right now,” said Dr. Rose Molina, an OB-GYN at Harvard Medical School and co-author of the study. “If anything, we need to not just maintain focus, but actually increase investment in maternal health.”

Infant mortality is rising alongside maternal deaths

For the first time in 20 years, the national infant death rate increased, pointing to the same systemic failures endangering both mothers and newborns. New federal data shows where these deaths are concentrated and who is most at risk.

• First national rise in infant mortality since 2002 — The U.S. infant mortality rate increased by 3% from 2021 to 2022. This statistically significant change marked the first national year-to-year increase in two decades, based on provisional data covering 99.3% of U.S. births. Specifically, mortality among male infants increased by 3.9%, while female infant deaths rose by 2%.
• Infant deaths rose across both age and gestational groups — Mortality increased by 2.6% during the neonatal period (the first 28 days of life) and by 3.6% during the postneonatal period (from 28 days to one year). This shows that the rise in infant deaths is not limited to a specific stage of infancy. However, preterm infants (those born before 37 weeks) remained the most vulnerable, with a 3.3% increase in deaths overall, while early preterm infants (under 34 weeks) experienced a 4.4% increase.
• Native and White infants saw the largest increases — Infant mortality rose by 21.5% among American Indian and Alaska Native births and by 3.7% among White births. Meanwhile, no significant changes were observed among infants born to Black, Hispanic, Native Hawaiian or Other Pacific Islander, or Asian mothers.
• Maternal age between 25 and 29 was most affected — The infant mortality rate for mothers aged 25 to 29 increased by 4.3%. Although other maternal age groups also showed increases, including under 20, 20 to 24, and 30 to 34, these were not statistically significant. The rates for mothers aged 35 to 39 and 40 and older also remained stable.
• Four states saw significant increases in mortality — Between 2021 and 2022, infant mortality rose significantly in Georgia, Iowa, Missouri, and Texas. Only one state, Nevada, saw a statistically significant decrease. Other state-level changes were not significant.
• Two causes of death showed notable increases — Deaths linked to maternal complications rose by 8.6%, while deaths from bacterial sepsis of the newborn increased by 13.7%. No significant changes were reported for other leading causes, such as congenital malformations, short gestation, low birth weight, or sudden infant death syndrome, or SIDS.

To learn more about what’s behind this nationwide rise and what it means for newborn health, read “America’s Infant Mortality Rate Increases for the First Time in 20 Years.”

The U.S. leads in infant and maternal deaths despite spending the most

The U.S. spends more on healthcare per person than any other high-income country, and yet it continues to deliver some of the worst outcomes, especially for mothers and newborns.

While the system is often described as one of the most advanced in the world, the reality is that some countries spending far less consistently achieve better results, according to a report from the Commonwealth Fund.

• Infant deaths are the highest among wealthy nations — In 2020, the U.S. had the worst infant mortality outcomes compared to other high-income countries like Canada, France, Germany, Japan, South Korea, and the U.K. The infant mortality rate was 5.4 per 1,000 live births — more than three times higher than Norway’s, which had the lowest at 1.6.
• Maternal deaths are also far higher than peer nations — The report also showed that U.S. maternal mortality rate was nearly 24 deaths per 100,000 live births, which was more than three times the rate seen in most other high-income countries. Again, this has further increased in the latest federal data.
• Socioeconomic disparities and poor care access contribute to the crisis — The report attributes these poor outcomes to multiple system-wide failures, including high rates of cesarean sections, inadequate prenatal care, and socioeconomic conditions that promote chronic diseases such as obesity, heart disease, and diabetes.
• Vaccine schedule correlation noted in peer-reviewed data — While not included in the Commonwealth Fund analysis, a separate study published in Human and Experimental Toxicology found a positive correlation between the number of childhood vaccine doses and national infant mortality rates. A reanalysis in 2023, published in Cureus, also reaffirmed the link between higher vaccine dose counts and increased infant deaths across countries.

For a deeper look at the data linking vaccine dose schedules to infant death rates, check out “Study: More Infant Vaccines Lead to Higher Infant Mortality.”

5 steps to lower your risk of postpartum complications

If you’re pregnant, planning to get pregnant, or recently gave birth, here are five specific steps you can take to protect your health and lower your risk of serious complications that often go overlooked after delivery:

1. Track your symptoms and trust what your body is telling you — If something feels off after giving birth, don’t ignore it, even if you’re told it’s “normal.” Keep a written log of symptoms starting immediately after delivery.

Watch for signs like chest pain, shortness of breath, facial or leg swelling, heart palpitations, or persistent headaches. These could be warning signs of complications.

2. Push for postpartum care beyond the six-week visit — One checkup six weeks after delivery isn’t enough. You deserve multiple follow-ups in the months after childbirth, especially if you had complications during pregnancy or delivery. If you’re still recovering, managing chronic conditions, or feeling emotionally overwhelmed, ask for more visits.

If you’re a Black or Native woman, or if you live in a rural area, your risk of death is higher due to systemic care gaps. That means you need to be even more proactive. Advocate for yourself, or have a partner or friend do it with you.

3. Know your risks and manage them from day one — If you’ve had high blood pressure, gestational diabetes, preeclampsia, thyroid problems, or a prior heart condition, your risk of complications after delivery is higher.

You need to stay on top of these conditions. Keep monitoring your blood pressure at home, use a glucose meter if needed, and ask your provider to recheck your hormone or iron levels.

4. Build your own support system if the system fails you — The truth is, in many parts of the U.S., postpartum care is severely underfunded and understaffed. That means you need to build your own circle of care.

This includes friends or family checking in regularly, doulas, or midwives trained in postpartum support, and local groups that can guide you through nutrition, rest, and stress management.

5. Make informed choices before, during and after childbirth — C-sections, inductions, unnecessary scans, and routine shots have all become normalized, but that doesn’t mean they’re safe.

Take the time to understand your options, question what’s truly necessary, and weigh risks against benefits based on your specific situation. Informed decisions protect both your health and your child’s, especially in a system that often prioritizes protocol over individualized care.

What to do before pregnancy to protect your health and your baby

Preventing maternal and infant death starts well before conception. How you prepare your body, manage your health, and make decisions throughout this process determines how well you and your baby recover in the months that follow. Here are some strategies I recommend adopting for a healthy pregnancy:

1. Improve your body composition — Obesity before or during pregnancy increases the risk of preeclampsia, gestational diabetes, cesarean delivery, and poor recovery postpartum. It also raises the chance of stillbirth and developmental delays in your child.

To improve your body composition, start with your diet. Prioritize protein intake (about 0.8 grams per pound of lean body mass) to support muscle health and satiety. Include a variety of whole fruits and vegetables rich in antioxidants in your diet, and ensure sufficient intake of folate and iodine, which support neural and muscular development.

If tolerated, small amounts of wild-caught fatty fish like sardines or Alaskan salmon offer omega-3 fats like docosahexaenoic acid, or DHA, and eicosapentaenoic acid, or EPA, to support your baby’s development.

However, remember to keep omega-3 intake moderate, as they’re still polyunsaturated fats (PUFs) that will contribute to oxidative stress when consumed in excess.

The most concerning PUF is linoleic acid (LA), which is abundant in vegetable oils and processed foods, so you should minimize your intake of these. This ubiquitous ingredient may harm fetal growth. Nuts and seeds also contain LA, so moderate your intake of these as well.

2. Exercise regularly — Staying active during pregnancy supports overall fetal health and lowers the risk of complications like pregnancy-induced hypertension and preeclampsia.

The American College of Obstetricians and Gynecologists recommends at least 150 minutes of moderate-intensity exercise per week, such as walking or bodyweight resistance. These can be divided into shorter, manageable sessions throughout the week to maintain consistency.

3. Manage chronic conditions — Conditions like insulin resistance, hypertension, autoimmune disease, and gut dysfunction typically worsen during pregnancy and increase the risk of complications such as preterm birth, gestational diabetes, and low birth weight.

If you know you’re dealing with any of these, it’s important to get them under control before conceiving. The more stable your health is going in, the fewer variables you’re up against later.

4. Manage stress and protect your mental health — Mental health complications, especially depression and anxiety, are among the leading causes of postpartum death. The hormonal shifts of pregnancy amplify emotional sensitivity and make you more vulnerable to stress.

To improve your mental health, optimize your sleep and use relaxation techniques like Emotional Freedom Techniques, or EFT, deep breathing, or mindfulness meditation to improve your emotional resilience. Get more tips in “Unlocking Pregnancy Health — The Powerful Impact of Relaxation.”

5. Get daily sun exposure — Sunlight plays an important role in cellular energy production and fetal development. As noted in my article “Vitamin D and Prenatal-Newborn Health,” getting enough vitamin D is important because it helps lower the risk of preterm birth and low birth weight.

Aim for at least 20 minutes of sun exposure daily, ideally during the morning or midday when UV intensity is beneficial but not extreme. However, if your diet is high in LA, you need to detox from it first. This process takes several months, during which you need to avoid harsh midday sun and get your exposure earlier or later in the day to reduce sunburn risk.

Measure your vitamin D level twice a year to make sure you’re within an optimal range. I recommend aiming for between 60 and 80 nanograms per milliliter (150 to 200 nmol/L), which is where the greatest benefits of vitamin D appear.

FAQs about maternal mortality

Q: What is considered a late maternal death?

A: Late maternal death refers to pregnancy-related deaths that occur more than 42 days and up to one year after the pregnancy ends. These are often missed by conventional tracking systems that only monitor outcomes shortly after birth.

Q: Why is postpartum care limited to six weeks?

A: The six-week model stems from outdated guidelines that don’t reflect the reality of modern maternal health risks. As the featured study shows, one-third of pregnancy-related deaths occur after this period, suggesting that care needs to continue well beyond that timeline.

Q: What are the main causes of death after six weeks postpartum?

A: The leading contributors include cardiovascular disorders, cancer, endocrine conditions, drug and alcohol-related deaths, and mental and behavioral health disorders. Many of these issues are either not screened for or not properly managed after the initial checkup.

Q: Why are maternal and infant mortality rates higher in the U.S. than in other high-income countries?

A: Multiple factors are at play, including inadequate postpartum care, socioeconomic disparities, high rates of medical interventions like C-sections, and limited access to preventative services. The U.S. spends more on healthcare than any other country, yet continues to have worse outcomes for mothers and infants.

Q: What steps can I take to lower my risk during and after pregnancy?

A: Start by improving your health before conception. Maintain a nutrient-dense diet, exercise regularly, and address any chronic conditions early.

After delivery, track your symptoms daily, push for follow-up visits, and build a strong support system. Being informed and proactive can make a life-saving difference.

Originally published by Mercola.