News: Sepsis in pregnancy involved in one third of maternal deaths in Mississippi, study finds

In a maternal mortality hotspot, researchers found that nearly a third of delivery-associated hospital deaths involved sepsis. While rare, sepsis in pregnancy was involved in 32.4% of the delivery-associated hospital deaths in Mississippi, a state with one of the highest maternal mortality rates.

Maternal infection or sepsis was the nation's third-leading cause of pregnancy-related deaths in 2024, accounting for 14.4% of such deaths, according to the CDC.

As described in JAMA Network Open, mothers with sepsis were more likely than those without sepsis to have chronic comorbidities such as hypertension, obesity, or diabetes; to experience preterm births or c-section deliveries; and to be of Black race or on Medicaid:

• Preterm birth: 54% versus 14%
• C-section deliveries: 53% versus 33%
• Chronic comorbidities: 54% versus 33%
• Black race: 59% versus 42%
• Medicaid: 64% versus 52%

The overall rate of maternal sepsis was 6.2 cases per 10,000 births, but several maternal characteristics were associated with higher rates:

• Ages 35-49: 9.5 cases per 10,000 births (versus 6.5 cases for women ages 10-24 years)
• Preterm birth: 23.1 cases (versus 3.3 with term birth)
• C-section delivers: 10 cases (versus 3.8 with vaginal birth)
• Black race: 8.6 cases (versus 4.2 for white race)
• Medicaid recipient: 7.5 cases (versus 4.3 with private insurance)

One in three mothers with sepsis developed respiratory distress syndrome, 23.4% acute kidney failure, and 23.4% septic shock. Sepsis was involved in 18.3% of maternal respiratory ventilations performed. On average, total sepsis-associated hospital charges cost $134,844, as compared with $22,876 for the non-sepsis deliveries.

In the study, women with sepsis had significantly higher rates of hypertension (36.6% versus 21.1%) and obesity (25.9% versus 14.9%) compared to those without sepsis, and numerically higher rates of diabetes as well (11.2% versus 7.8%). Moreover, while azithromycin is known to reduce maternal infection when given intravenously during c-sections, researchers suggested lowering c-section birth rates could reduce surgical wounds, a substantial contributor to postpartum infections and sepsis.

While Mississippi's “exceptionally high” maternal sepsis mortality rate was surprising, so was its “staggeringly high” chronic comorbidity burden, particularly hypertension, among these mothers, researchers said. “This finding highlights the heavy toll of obesity-related chronic comorbidity on maternal health in Mississippi.”

Dysregulated immune responses to infection during pregnancy, childbirth, or after an abortion can cause life-threatening maternal sepsis. The researchers said their study “supports the notion that sepsis is a complex, multifactorial condition that often emerges at the intersection of infectious triggers and preexisting chronic illnesses.”

Editor’s note: To read the full study, click here. To read additional coverage from MedPage Today, click here.