ACOG 2026: Most Pregnancy-Related Infection Deaths Are Preventable, With Naima T. Joseph, MD, MPH

Infection accounts for nearly 1 in 10 pregnancy-related deaths in the US, and new data from Maternal Mortality Review Committees (MMRCs) confirm that the overwhelming majority of those deaths could have been avoided with earlier intervention, better education, and stronger care coordination.

An analysis of MMRC data from 29 states identified 91 pregnancy-related deaths with infection as the underlying cause of death between 2017 and 2019. Among the 88 deaths for which MMRCs assessed preventability, 86.4% were determined to be preventable.

Most deaths occurred in the postpartum period: 27.3% occurred between 1 and 6 days after delivery, and 36.4% occurred between 7 and 42 days postpartum. The genital tract was the most frequently identified source of infection among decedents with a documented source (47.9%, 35/73), and Streptococcus pyogenes (group A streptococci) was the primary pathogen in 34.0% of deaths with an identified pathogen (18/53).

Despite frequent recent contact with the health care system, including hospitalizations and office visits, timely treatment was rare. Among the 17 decedents with documented intervals from symptomatic presentation to antibiotic initiation, only 2 received antibiotics within the recommended 1-hour window.

Naima Thavory Joseph, MD, a maternal-fetal medicine specialist in the Department of Obstetrics and Gynecology at Boston Medical Center and an assistant professor at Boston University School of Medicine, was among the investigators who analyzed MMRC-identified contributing factors across the 72 preventable deaths with available data. A total of 397 contributing factor classes were identified, with a median of 4 per death.

The 5 most frequent contributing factor classes were clinical skill/quality of care (18.6%), delay (10.1%), knowledge (10.1%), lack of continuity of care (9.6%), and lack of access/financial resources (7.8%). Together, these accounted for 56.2% of all contributing factor classes identified.

MMRC recommendations across these categories included implementing evidence-based obstetric sepsis protocols in every hospital, educating clinicians in emergency department and outpatient settings on modified obstetric early warning signs, and expanding postpartum follow-up regardless of pregnancy outcome.

Check out all the Patient Care ACOG 2026 coverage.

Reference:

Joseph NT, Trost SL, Hollier LM, Perkins KM, Goodman DA, Leonard M, Busacker A. Pregnancy-Related Mortality Due to Infection: Maternal Mortality Review Committees in 29 U.S. States, 2017-2019. Obstet Gynecol. doi: 10.1097/AOG.0000000000006172