Racial Disparities in Maternal Mortality Before, During, and After the COVID-19 Pandemic in the United States: A Difference-in-Difference Analysis

Background This study aimed to examine changes in racial disparities in pregnancy-related and maternal mortality before, during, and after the COVID-19 pandemic in the United States. Methodology This was a cross-sectional study using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) data from January 2018 to June 2024. We focused on pregnancy-related and maternal mortality among Black and White individuals to examine racial disparities. The study periods were defined as pre-pandemic (January 2018-March 2020), pandemic (April 2020-March 2022), and post-pandemic (April 2022-June 2024). We applied interrupted time series analysis and difference-in-difference (DID) models to assess changes in mortality trends and disparities across three periods. DID estimates with 95% confidence intervals (CI) were reported. Results From January 2018 to June 2024, there were 3,694,282 Black and 17,284,929 White individuals who gave live birth. The pregnancy-related mortality ratio (PRMR) was 68.0 deaths per 100,000 live births among Black individuals (2,513 deaths) and 26.3 among White individuals (4,547 deaths). The maternal mortality ratio (MMR) was 46.5 for Black individuals (1,718 deaths) and 17.6 for White individuals (3,044 deaths). From the pre-pandemic to pandemic period, PRMR increased by 29.4 per 100,000 (95% CI = 19.8-39.1) among Black individuals and by 11.8 (95% CI = 8.2-15.4) among White individuals, with a DID of 17.6 (95% CI = 7.3-28.0). From the pre-pandemic to post-pandemic period, PRMR increased by 9.5 (95% CI = 3.2-15.9) for Black individuals and by 1.6 (95% CI = -0.4-3.7) for White individuals, with a DID of 7.9 (95% CI = 1.2-14.6). Results for MMR were consistent with those for PRMR. Conclusions These findings indicate a significant and sustained increase in PRMR and MMR among Black individuals, while rates among White individuals returned to near pre-pandemic levels. Racial disparities in pregnancy-related and maternal mortality widened during the COVID-19 pandemic and continued in the post-pandemic period.