An epidemiological analysis of mortality causes in pregnant women with COVID-19 from 2019 to 2021

The coronavirus disease 2019 (COVID-19) had great health burden on the societies, including pregnant women. However, there is discrepancy in terms of the effects of COVID-19 on maternal mortality. In Iran, where maternal mortality rates were declining pre-pandemic, COVID-19 posed unique challenges due to strained healthcare resources. The aim of the current study was to assess the epidemiological causes of maternal mortality due to COVID-19. This retrospective descriptive-analytical cross-sectional study was conducted on all cases of maternal mortality, who were referred to the Forensic Medicine Department of The Khorasan Razavi Province, Iran between March 2019 and March 2021. Data collection was based on the Forensic Medicine records or interview with the deceased family and included demographic information, midwifery information, method of pregnancy care, pregnancy care agent, delivery agent, type of insurance, and the confirmed cause of death by the Forensic Medical Department. Of 77 maternal deaths, 34 (44.2%) were due to COVID-19. Mean maternal age was 31.7 years; gestational age at delivery was 30 weeks; time between delivery and death was 8 days. No significant relationships were found between COVID-19 and midwifery characteristics or outcomes. COVID-19 was a major cause, but complications were comparable to non-infected mothers. Education and SES trends suggest barriers requiring attention. COVID-19 significantly increased maternal mortality, linked to pandemic factors rather than prenatal care quality.