What factors increase the risk of maternal morbidity and mortality?

Certain factors increase a woman’s risk for maternal morbidity and mortality. In some cases, the woman and her healthcare provider may be able to change some of these factors to lower the risk. But not all factors can be changed. Additionally, some women experience maternal morbidity, severe maternal morbidity, near misses, or death without having any known risk factors.

Some factors that increase a woman’s risk for maternal morbidity and mortality include the following1:

  • Existing or pre-pregnancy health conditions, such as cardiovascular disease, obesity, asthma, or a compromised immune system
  • Older maternal age
  • Lifestyle factors, such as being a current or former cigarette smoker
  • Having twins, triplets, or other multiples
  • Certain pregnancy complications:
    • Preeclampsia, a spike in blood pressure after the 20th week of pregnancy, increases a woman’s risk for high blood pressure, blot clots, and stroke later in life.2
    • Women who have gestational diabetes, high blood sugar during pregnancy, are at higher lifetime risk for diabetes (usually type 2) and for fatty liver disease.3,4
  • Certain features of giving birth:
  • Racial, ethnic, and socioeconomic backgrounds. Research shows disparities in the rates of maternal deaths in the United States, with black women and American Indian/Alaska Native women at highest risk for pregnancy-related death.

Many factors that increase a woman’s risk for maternal morbidity and mortality may also mean she has a high-risk pregnancy, one in which the mother, the fetus, or both are at higher risk for problems than a typical pregnancy. Healthcare providers may consider a pregnancy to be high-risk for reasons such as having twins or an existing health problem. Healthcare providers may adjust their care for a high-risk pregnancy to closely monitor the pregnancy.

Having one or more of these risk factors does not mean that a woman is certain to have health problems or that she will die during pregnancy or childbirth. Also, most women will not experience any complications in pregnancy.


  1.   Chakhtoura, N., Chinn, J. J., Grantz, K. L., Eisenberg, E., Dickerson, S. A., Lamar, C., & Bianchi, D. W. (2019). Importance of research in reducing maternal morbidity and mortality rates. American Journal of Obstetrics and Gynecology, 221(3), 179–182. Retrieved March 3, 2020, from https://www.doi.org/10.1016/j.ajog.2019.05.050 external link.
  2.   Bellamy, L., Casas, J. P., Hingorani, A. D., & Williams, D. J. (2007). Pre-eclampsia and risk of cardiovascular disease and cancer in later life: Systematic review and meta-analysis. BMJ, 335(7627), 974. Retrieved March 3, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/17975258.
  3.   Committee on Practice Bulletins—Obstetrics. (2018). ACOG Practice Bulletin No. 190: Gestational diabetes mellitus. Obstetrics and Gynecology, 131(2), e49–e64. Retrieved March 3, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/29370047.
  4.   NICHD. (2019). Science update: Gestational diabetes may increase risk of fatty liver disease later in life, NIH study suggests. Retrieved March 3, 2020, from https://www.nichd.nih.gov/newsroom/news/062819-gestational-diabetes.
  5.   American College of Obstetricians and Gynecologists. (2017). FAQ: Vaginal birth after cesarean delivery. Retrieved March 3, 2020, from https://www.acog.org/patient-resources/faqs/labor-delivery-and-postpartum-care/vaginal-birth-after-cesarean-delivery external link.
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