Most Infection-Related Maternal Mortality Is Preventable, Study Says

WASHINGTON — Infection remains a top cause of maternal mortality with most infection-related maternal deaths being preventable, a descriptive study of Maternal Mortality Review Committee (MMRC) data found.

Only half of moms who died from infection-related causes within 1 year of the end of pregnancy (51.5%) had confirmed receipt of antibiotics and only 11.8% had received antibiotics within the recommended 1 hour, reported Naima T. Joseph, MD, MPH, of Boston Medical Center and Boston University School of Medicine, in a presentation at the American College of Obstetricians and Gynecologists (ACOG) annual meeting.

MMRCs are multidisciplinary groups working at the state and local level that coordinate with the CDC to comprehensively review deaths within 1 year of the end of pregnancy. They include both clinical and non-clinical subject matter experts who review a broad swath of data from prenatal care records, birth certificates, social reports, and autopsies.

“They analyze deaths to understand whether or not these deaths are preventable and to determine the underlying cause of death,” Joseph explained. MMRCs also provide recommendations, “several of which have provided pivotal policy changes at national and federal levels.”

Joseph’s group sought to identify infection-caused maternal deaths as well as to describe the demographic and clinical characteristics of the decedents, including when deaths were preventable. They looked at data from 2017 to 2019 shared by 29 MMRCs through Maternal Mortality Review Information Application, ultimately including 91 decedents. Clinical variables were abstracted from MMRC records and contributing factors were assessed among 27 specific classes.

In total, 15.9% of decedents died during pregnancy and 5.7% died on the day of delivery. Additionally, 27.3% died within 6 days postpartum, 36.4% died within 7 to 42 days postpartum, and 14.6% died from 43 to 365 days postpartum. For many of the deaths in the latter group, the inciting injury occurred more proximal to the delivery, Joseph noted.

Two-thirds of deaths (66.8%) occurred in hospital settings, though 17.6% occurred in hospital centers that were non-obstetric, including emergency departments and outpatient settings. Also, 42.7% of deaths occurred during the delivery hospitalization.

The leading source as genital tract infections (47.9%). followed by infections of the respiratory system (17.8%) and gastrointestinal tract infections (9.8%). As for the pathogens themselves, the primary culprits were group A Streptococcus (34.0%) and Escherichia coli (15.1%).

Of the 27 contributing factors to maternal mortality, the top ones were issues with clinical skill and quality of care, delays, knowledge, lack of continuity of care, and lack of access or financial resources.

“MMRCs identified that 86.4% of deaths were preventable when a preventability determination could be made,” Joseph said.

As of 2025, infection or sepsis is still the third leading cause of pregnancy-related death following cardiovascular (CV) conditions and other non-CV medical conditions; other analyses have found that drug overdoses, homicides, and suicides also are significant cases of maternal mortality.

About 55% of study decedents were non-Hispanic white, 25% were non-Hispanic Black, and 18% were Hispanic. A majority were urban residents.

Researchers also shared MMRC recommendations “with an eye towards reducing and preventing future deaths from infection,” Joseph said.

For instance, all hospitals should have a sepsis protocol for pregnant and postpartum women. Hospitals also should disseminate educational materials on early warning signs of sepsis for moms and pregnant people.

Joseph also noted that health systems need improved care coordination and processes to connect patients with resources and follow-up care. On a federal level, Medicaid could be extended to 1 year postpartum to reduce financial burden.

ACOG attendee Sophia Drosinos, MD, of Viva Eve in New York City, told MedPage Today that the findings were “gut wrenching.”

Drosinos, who was not involved in the research, noted that “most hospitals now have some sort of sepsis protocols very early on in somebody’s presentation,” but that she hoped hopefully hospitals will include all of the strategies outlined in the study to decrease maternal mortality.

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