Pregnancy-Related Mortality Disparities During the COVID-19 Pandemic

<b>Objectives.</b> To compare pregnancy-related mortality ratios (PRMRs) associated with COVID-19 by race/ethnicity, by region of residence, and in states with and without Medicaid expansion. <b>Methods.</b> We used 2020-2021 data from the US Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research in our analysis. We stratified PRMRs by race/ethnicity, census regions, and Medicaid expansion and nonexpansion states. <b>Results.</b> The 2020-2021 PRMR was 40.3 per 100 000 live births. American Indian/ Alaska Native pregnant people had the greatest PRMR, followed by non-Hispanic Blacks and non-Hispanic Native Hawaiians/other Pacific Islanders. PRMRs associated with COVID-19 in the southern region were at least 2 times higher than in other regions and were highest for all pregnant people in the various racial/ethnic groups. PRMRs associated with COVID-19 were lower in Medicaid expansion states than in nonexpansion states. <b>Conclusions.</b> The US COVID-19 epidemic exacerbated racial and ethnic disparities in pregnancy-related mortality. <b>Public Health Implications.</b> The alarming increase in disparities among racial and ethnic pregnant people during the COVID-19 pandemic underscores the need to address social determinants of health at the structural level. (<i>Am J Public Health</i>. 2024;114(S9): S723-S730. https://doi.org/10.2105/AJPH.2024.307814).