Fetal deaths twice as high in blacks

Disparity persists compared with whites

A wide disparity in fetal mortality continued during the first two years of the pandemic: Black mothers are more than twice as likely to experience a fetal death at 20 weeks or more than white mothers.

A report by the Centers for Disease Control and Prevention out Thursday found that while fetal deaths dipped by 5% for Black mothers between 2020 and 2021, their rates remained significantly 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 first 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. The CDC defines a miscarriage as a pregnancy loss before 20 weeks of gestational age.

The disparity 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.

Did COVID- 19 affect fetal death rates?

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 first and second years of the pandemic, fluctuating 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,

How does COVID- 19 affect pregnant people?

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 also is possible.

An analysis last year by the Government Accountability Office, a nonpartisan oversight agency, found COVID- 19 was behind a quarter of maternal deaths.

Officials and experts continue to implore those who are pregnant to be vaccinated and say that the vaccine is safe for those who are expecting.

“In spite of the 5% reduction, the actual fetal death rate is so much higher in non- Hispanic Black women. It’s persistent.” Dr. Shari Lawson Johns Hopkins Medicine

What could have contributed to the slight decrease?

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 evidencebased 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.

“We still have this very severe and unyielding problem around racial disparities and fetal mortality in the United States,” Jackson said.