The rising maternal mortality rate is part of a worsening maternal health crisis in the United States. In 2020, the maternal mortality rate rose significantly to 23.8 deaths per 100,000 live births, an 18% increase since 2019 (Hoyert 2020). The COVID-19 pandemic may have fueled part of this dramatic increase. While we do not yet fully understand the pregnancy complications caused by COVID-19, recent research has shown that pregnancy should undoubtedly be considered a high-risk category for COVID-19 given the increased incidence of adverse pregnancy outcomes.
According to the CDC, pregnant people are at a higher risk of getting “very sick” from COVID-19 than people who are not pregnant (“COVID-19 during Pregnancy”). Studies have also shown that one in five pregnant people who contracted COVID-19 developed moderate or severe disease (Andrikopoulou, Madden, Wen et al. 2020). Pregnant people also have a 70% increased risk of death from COVID-19 compared to non-pregnant people (“SMFM Update on COVID-19 in Pregnancy”).
The results of COVID-19’s effect on pregnancy outcomes are equally disheartening. COVID-19 infection during pregnancy is associated with a 60% increase in C-sections, a 60% increase in hypertensive disorders, and a 3.5x chance of delivering preterm ("SMFM Update").
An increased rate of maternal mortality is also associated with COVID-19. Maternal deaths increased by 33% after March 2020, corresponding to the COVID-19 onset in the U.S. This is a larger figure than the estimated 22% increase in the overall excess death rate associated with the pandemic (Thoma et al. 2022). Racial disparities in maternal mortality, already one of the most egregious aspects of the maternal health crisis, have widened as well. The increase in maternal deaths is highest for non-Black Latinx women and Black women, a 72.4% and 40.2% increase, respectively (Thoma et al. 2022).
At Delfina, we are supporting pregnancies with the goal of improved outcomes for babies as well as their parents, so the impact of COVID-19 on neonatal health is particularly concerning. Reassuring research does not associate COVID-19 with a significant increase in infant mortality. However, maternal infection with COVID-19 has been associated with an increase in stillbirths. For patients with COVID-19 during pregnancy, the risk of a stillbirth nearly doubled – and during the Delta wave, it quadrupled (DeSisto et al. 2021). One physiological explanation for this concerning increase is SARS-CoV-2 placentitis, an infection of the placenta by the COVID-19 virus (Schwartz et al. 2022).
Notably, in all reported cases of SARS-CoV-2 placentitis causing stillbirth, the mothers were unvaccinated (Schwartz et al. 2022). Contrary to rampant disinformation, studies have shown that the COVID-19 vaccine is not associated with premature birth, or low birth rate (“Pregnancy and COVID-19: What are the risks?”). By contrast, infection with COVID-19 during pregnancy significantly heightens the risk of prematurity and stillbirth.
As the COVID-19 virus continues to evolve, Delfina is committed to helping providers prevent adverse pregnancy outcomes associated with COVID-19. By collecting data on patients' symptoms, Delfina Care can support clinicians in addressing infection with COVID-19 quickly, to mitigate the impact on patients and their babies. Delfina Care also tracks other factors that cause pregnancy complications like diabetes and hypertension, which would increase a patient’s risk of contracting severe COVID-19. Finally, our closed-loop system of pregnancy care ensures that patients are getting medical guidance on-demand from their care team, preempting misinformation on key topics like COVID-19 vaccination. We will continuously incorporate learnings from the COVID-19 pandemic into Delfina Care for the benefit of our pregnant patients and their babies.