Maternal Mortality Due to Cardiovascular Disease More Than Doubles in the US

Maternal mortality attributed to cardiovascular causes has more than doubled in the US between 1999 and 2022, according to research to be presented at the American College of Cardiology’s Annual Scientific Session (ACC.25). The study highlights significant disparities, with Black women and individuals living in Southern states facing higher mortality rates.

The US has the highest maternal mortality rate among developed nations, with cardiovascular disease serving as a leading cause of death during pregnancy and the postpartum period. Researchers analyzed data from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database to evaluate trends in cardiovascular-related maternal mortality over the 24-year period. They found that the rate increased from 3.6 per 1 million individuals in 1999 to a peak of 10.5 per million in 2021, before declining slightly to 9.1 per million in 2022. In absolute numbers, an estimated 600 women died from cardiovascular-related causes in 2022.

“We’re heading in the wrong direction. The United States is supposed to be a global leader in advancing health and medicine, and the fact that we still have pregnant women who are dying—often because of preventable causes—should sound alarm bells,” lead author Mohammad Ahabab Hossain, MD, a resident physician at Rutgers New Jersey Medical School in Newark, New Jersey, said in an ACC press release. “The fact that there are disparities based on race means we need to pay better attention to more vulnerable populations, specifically Black women.”

Hossain and colleagues identified a particularly high increase in maternal mortality during the COVID-19 pandemic, which they suggested may have been related to limited access to prenatal care or a hesitancy to visit medical clinics during the peak of the pandemic. Additionally, the greatest year-over-year increase was observed in 2018, which coincided with the full nationwide adoption of standardized reporting of pregnancy status on death certificates, which may have contributed to improved case identification.

"While the addition of the pregnancy checkbox on death certificates complicates the comparison of maternal mortality pre- and post-2018, what remains certain is that maternal deaths due to cardiovascular causes remain unacceptably high," Hossain said in the press release.

From 2018 to 2022, Black women experienced a maternal mortality rate of 21.9 per million, approximately three times higher than the 7.1 per million rate observed among White women. Geographically, maternal mortality was highest in the South (12.1 per million) and lowest in the West (5.4 per million). Socioeconomic factors, health care access disparities, and a higher prevalence of cardiovascular risk factors were cited as contributors to these disparities.

“Part of the reason this is happening is because heart disease and hypertension are becoming more and more prevalent, as are the conditions that are connected to heart disease, like diabetes and obesity. As a result, we wind up with more high-risk pregnancies,” Hossain said. “However, a lot of this is preventable. If a patient has a history of hypertension or other preexisting cardiovascular disease, that patient should be connected with a high-risk obstetrics clinic to receive the care they need.”

Researchers emphasized the importance of improving access to prenatal and postpartum care, particularly for high-risk patients. Increased awareness of cardiovascular risk factors and better coordination among obstetricians, cardiologists, nursing staff, and social workers could help reduce maternal deaths. Hossain underscored that early intervention, including managing hypertension and diabetes, may mitigate risks associated with pregnancy.

One limitation of the study was that maternal mortality was calculated as a ratio of cardiovascular-related maternal deaths to the total number of women of reproductive age (15-44 years) rather than the number of pregnancies per year. As a result, the reported rates may underestimate the true burden of maternal mortality.

Hossain will present the study, “Trends and Disparities in Cardiovascular-Related Maternal Mortality in the United States: 1999-2022,” on Saturday, March 29, 2025, at 9:30 am CT in Moderated Poster Theater 9.