A wide disparity in fetal mortality continued during the first two years of the pandemic: Black mothers are more than twice as likely to experience a fetal deathat 20 weeks or more than white mothers.
A report by the Centers for Disease Control and Prevention released Thursday found that while fetal deaths slightly decreased by 5% for Black mothers between 2020 and 2021, their rates remained significantly higher than white mothers.
For Black mothers, the rate was 9.8 per 1,000 live births and fetal deaths, compared to white mothers' rate of 4.8 from 2020 to 2021, CDC data shows.
The first year of the pandemic, the rate for Black fetal deaths was 10.34 and in 2019 the rate was 10.41 – all more than double the rate white and Hispanic mothers experienced.
Fetal mortality rates count deaths in gestation or stillbirths and do not include abortions or miscarriages. The CDC defines a miscarriage as a pregnancy loss before 20 weeks of gestational age.
The disparity also echoes disproportionate mortality rates of Black babies, who continue to die twice as often as white babies, and it signals a continued gap that needs to be addressed, experts say.
“In spite of the 5% reduction, the actual fetal death rate is so much higher in non-Hispanic Black women. It’s persistent,” said Dr. Shari Lawson, division director of general obstetrics and gynecology at Johns Hopkins Medicine.
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While previous reports found a possible association between COVID-19 during pregnancy and stillbirth, this CDC analysis shows overall U.S. fetal death rates remained the same from 2019 through the first and second years of the pandemic, fluctuating between 5.68 and 5.74.
The report authors, however, noted the COVID status of the mother "is not routinely collected on reports of fetal death unless entered as a cause of death, and, therefore, its impact cannot be directly examined here."
According to a November 2021 CDC analysis of 1.2 million delivery hospitalizations, U.S. women with COVID-19 had higher risk of stillbirth compared to those who did not have the virus,
Pregnant people who contract COVID are at higher risk for adverse outcomes, such as needing a ventilator, being admitted to the ICU or developing preeclampsia, Lawson said. Low birthweight is also possible.
An analysis last year by the Government Accountability Office, a nonpartisan oversight agency, found COVID-19 was behind a quarter maternal deaths.
Officials and experts continue to implore those who are pregnant to get vaccinated against COVID-19 and that the vaccine is safe for those who are expecting.
It’s hard to parse exactly why, but experts say it could be a variety of concurrent reasons, including increased awareness of racial health disparities and social drivers of health outcomes. Resources like the Alliance for Innovation on Maternal Health’s evidence-based patient safety “bundles,” or toolkits for health systems may also have become more widely used.
Even so, the reduction shouldn’t be cause for public health professionals and policymakers to let their guards down as the gap is still wide, said Dr. Andrea Jackson, division chief of obstetrics and gynecology at University of Southern California.
“Everything was stable,” said Jackson, noting that the rates remain concerning.
Jackson directs EMBRACE, a perinatal program for Black families that focuses on prenatal and postpartum care including mental health care.
“It's not like we're starting from a good place,” Jackson said. “We still have this very severe and unyielding problem around racial disparities and fetal mortality in the United States.”
Reach Nada Hassanein at firstname.lastname@example.org or on Twitter @nhassanein_.
Hector O. Chapa, MD, FACOGPeer