- Racial disparities in preterm birth rates significantly impact maternal and infant health.
- Late initiation of prenatal care persists, with 1 in 4 women delaying past the first trimester.
- Chronic conditions among pregnant women are rising, increasing preterm birth risks.
For the fourth straight year, the U.S. has earned a D+ grade from the March of Dimes annual report card when it comes to preterm birth. More than 1 in 10 babies were born prematurely in 2024, which can have serious consequences to the health and future of the newborn.
That means the U.S. has one of the highest preterm birth rates among its peer developed nations.
March of Dimes concluded that “behind this year’s grade lies a sobering reality: Our maternal and infant health system remains dangerously stalled.”
Maternal mortality declined back to prepandemic levels, with 18.6 deaths per 100,000 live births, but there were big differences by race. A news release noted that “Black, American Indian/Alaska Native, and Pacific Islander moms and birthing people still die at two to three times the rate of white moms.” It added that more than 30,000 “experience severe complications each year.”
Preterm births are far from the sole challenge. Per the report:
- Racial disparities are getting worse and the rate of preterm births to Black moms climbed to 14.7%. Among Asians, the rate was 9.1%, followed by whites (9.5%), Hispanic (10.1%), Pacific Islander (12.3%) and American Indian/Alaskan Native (12.5%).
- Babies whose moms are covered by Medicaid have a preterm birth rate of 11.7%, while for privately insured moms, the rate is 9.6%.
- For the fourth straight year, rates of prenatal care have started later on average, with a quarter of pregnant women not beginning prenatal care during the first trimester.
- The share of pregnancies that include chronic preexisting conditions is rising: Hypertension increased 6% and diabetes 8% this year among those who are pregnant, posing risk for preterm birth.
- Infant mortality hasn’t changed. For every 1,000 live births, there were 5.6 deaths. That translates to more than 20,000 babies who died before their first birthday.
“As a clinician who has seen how much is possible when we get it right, these data are deeply frustrating,” Dr. Michael Warren, March of Dimes chief medical and health officer, said in a news release about the report. “We have known about risk factors for preterm birth, including prior history or preterm birth, chronic disease, and unequal access to care, for years. That the national rate remains unchanged while disparities continue to widen means we must deepen our commitment to research, expand maternity care access, and push for better policies that protect our nation’s moms and babies.”
March of Dimes is advocating change, including dealing with the factors that put those of color and Medicaid beneficiaries at higher risk, bolstering access to prenatal care and better managing chronic disease so that babies and moms aren’t at increased risk of bad birth outcomes.
What grades did states receive?
Per the report card, of the 50 states, Washington, D.C. and Puerto Rico, 19 improved and 21 got worse. Washington, D.C., saw the steepest increase in preterm births. Twelve states didn’t change.
New Hampshire was the only state to earn a high preterm birth grade. With a preterm birth rate of 7.9%, it received an A-, but the group noted that Black babies are still 1.4 times more apt to be preterm than all other babies.
The states earning a B were Massachusetts, Oregon and Vermont. California got a B-, as did Idaho, Rhode Island and Washington.
Lots of states fell in the C or average range, including Alaska, Arizona, Colorado, Connecticut, Hawaii, Iowa, Kansas, Maine, Minnesota, Montana, New Jersey, New Mexico, New York, North Dakota, Pennsylvania, Wisconsin.
Utah was in that range, with a C+, a preterm birth rate of 9.5% and the note that Pacific Islander babies are 1.4 times more likely to be preterm than all other Utah babies.
States in the D range include Delaware, Florida, Illinois, Indiana, Maryland, Michigan, Missouri, Nebraska, Nevada, North Carolina, Ohio, Oklahoma, South Dakota, Tennessee, Texas and Wyoming.
There were plenty of failing grades, as well, with Fs going to Alabama, Arkansas, Georgia, Kentucky, Louisiana, Mississippi, South Carolina and West Virginia. Puerto Rico also failed.
Risk factors
Among the factors that make a preterm birth and other poor birth outcomes more likely, per the report:
- Smoking, which happens in about 3% of pregnancies.
- Preexisting hypertension, occurring in 3.4% of pregnancies.
- Moms with an unhealthy weight, 34.8% of pregnancies.
- Diabetes, which is involved in 1.3% of pregnancies.
- Hypertension that appears during pregnancy in 10.4% of pregnancies.
The report also notes that 26.6% of low-risk deliveries for first-time moms who are carrying a single baby correctly positioned for delivery head first and at full term are done by cesarean section.
Significant short- or long-term consequences for the pregnant woman occur in 93.1 of every 10,000 hospital deliveries.
Policies and programs the March of Dimes heralds as improving and sustaining maternal and infant health include Medicaid extension for one year postpartum, Medicaid expansion, doula reimbursement, paid family leave, mental health screening and mortality review to understand what happened in a bad outcome and what could prevent such an occurrence in the future.