US fetal mortality rate reaches 'historic low,' but Black mothers still suffer

Despite a historic drop in fetal deaths in the U.S., Black mothers are still twice as likely to lose a fetus compared with white mothers, according to a new Centers for Disease Control and Prevention report.

The CDC report published Thursday found the national fetal mortality rate in 2022 had declined 4% from 2021, and noted there had been a 27% drop in fetal deaths since 1990. In 2022, there were 20,202 fetal deaths, translating to a rate of 5.48 fetal deaths for every 1,000 live births. The year prior, the rate was 5.73.

The findings show that maternal and prenatal care are getting back on track since the COVID-19 pandemic disrupted health care on a broad scale, said Dr. Deirdre Lyell, co-chair of the California Maternal Quality Care Collaborative.

“But babies and moms – pregnant people – are still dying from preventable reasons, so we have lifesaving work to do,” Lyell, also a professor at Stanford Medicine, said in emailed responses.

The report looked at fetal deaths or stillbirths at 20 weeks gestation or more. The data did not include abortions or miscarriages, which the CDC typically defines as the loss of a pregnancy before 20 weeks gestation.

White mothers experienced the most fetal deaths but they also saw the largest decline in fetal mortality – 8% – from 4.85 deaths to 4.48. The fetal mortality rate among white mothers was lower than most other racial or ethnic groups. No other groups saw statistically significant changes, the researchers noted.

Black mothers saw a slight uptick, from a fetal death rate of 9.89 in 2021 to 10.05 in 2022. The 2022 fetal mortality rates among Black and Native Hawaiian or other Pacific Islander mothers remained higher than the national rate in 1990.

The CDC report didn't delve into drivers of the high fetal death rates for Black mothers, but experts have suggested that racial health disparities, pre-existing conditions, structural discrimination and access to quality care may be factors.

This contributes to a “weathering effect” in which stress and other factors contribute to adverse health outcomes for Black mothers and other women of color, who die at higher rates than other groups, said Usha Ranji, the associate director for women’s health policy at the research nonprofit KFF.

The large disparities in fetal deaths for Black mothers, Ranji told USA TODAY, "really mirror what we see with other maternal and infant health outcomes.”

The CDC report breaks down fetal mortality rates in the early stage, from 20 to 27 weeks gestation, and those counted as late, at 28 weeks or more. More than half of all deaths occurred in the early stage and the total declined 5% from the previous year. The late-stage fetal mortality rate also declined for the first time since 2014, the report said.

Fetal mortality rates were highest among mothers 40 and older, mothers who smoked during pregnancy, and mothers carrying multiple fetuses.

The fetal death rates were highest in Mississippi, Alabama and Arkansas. Often, Ranji said, the highest rates coincided in states that tend to have worse infant and maternal health outcomes. States with lower fetal death rates included New Mexico, Texas, Connecticut, Montana, Nebraska and Massachusetts.

Only 43 states and the District of Columbia identified the cause of fetal death. In jurisdictions that did, the report said 33% of deaths were attributed to an unspecified cause and more than 24% of deaths involved placental, cord and membrane complications. Health complications for the mother accounted for nearly 12% of deaths, maternal conditions unrelated to pregnancy for another 11.2%, and congenital malformations of the fetus for nearly 10%.

Targeted efforts to address stillbirths, which have been understudied compared to infant mortality, are needed at state and national levels, said Dr. Andreea Creanga, a professor at the Johns Hopkins University Bloomberg School of Public Health, in an email. This includes higher-quality data on fetal deaths, additional research on risk factors and initiatives to address conditions found in early and late stillbirths through improved care.

Research indicates that about a quarter of fetal deaths are potentially preventable, Creanga said. "The large racial disparities documented in this CDC report (as in previous such CDC reports) further demonstrate that many stillbirths could be avoided."

This article originally appeared on USA TODAY: As US fetal mortality rate drops, losses for Black moms remain high