For the fourth straight year, the U.S. has received a “D+” grade for its preterm birth rate of 10.4%, underscoring longstanding gaps in access to high-quality maternity care and widening disparities in outcomes, according to the March of Dimes annual report on the state of maternal and infant health.
Seven takeaways:
1. The nation’s 10.4% preterm birth rate means nearly 380,000 babies — or 1 in 10 — were born too early, putting them at increased risk for serious health complications. The report also found that while maternal mortality rates returned to pre-COVID levels, they remained high at 18.6 deaths per 100,000 live births.
2. Across both metrics, significant racial disparities remain, according to the report. The preterm birth rate for babies born to black mothers increased to nearly 15% — nearly 1.5 times higher than the overall rate. Meanwhile, maternal mortality rates among black, American Indian/Alaska Native and Pacific Islander mothers remain between two to three times the rate for white mothers.
3. Preterm birth rates improved in 19 states, though worsened in 21 states. South Dakota saw the steepest rate decline at 10%. The District of Columbia saw the steepest increase at 8%.
4. Infant mortality rates were unchanged at about 5.6 deaths per 1,000 live births.
5. The percentage of pregnant people with preexisting conditions is rising; about 6% had hypertension and 8% diabetes.
6. The report also found preterm birth rates were higher among babies born to moms covered by Medicaid at 11.7%, compared to their privately insured counterparts at 9.6%. The finding raises questions about how a $1 trillion cut to Medicaid spending passed under the One Big Beautiful Bill Act could further strain access to maternal care and affect outcomes among vulnerable populations.
“As a clinician who has seen how much is possible when we get it right, these data are deeply frustrating,” Michael Warren, MD, chief medical and health officer at March of Dimes, said in a news release. “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.”
7. The report comes on the heels of newly released guidance from the March of Dimes supporting broader use of low-dose aspirin in pregnancy to prevent preeclampsia, a leading cause of preterm birth and maternal mortality.
The organization said it may be medically reasonable for practices to offer low-dose aspirin to all pregnant patients if most are at elevated risk. The recommendation builds on evidence showing the drug can reduce the risk of preeclampsia, preterm birth and perinatal mortality. Several hospitals, including major academic centers, have already begun implementing universal or near-universal protocols to recommend low-dose aspirin starting between 12 and 16 weeks of pregnancy, according to NBC News.
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