Sepsis in Pregnancy Is a Deadly Combo: Here’s Who’s at Risk

While rare, sepsis in pregnancy was nevertheless involved in nearly a third of maternal deaths in Mississippi, a state with one of the highest maternal mortality rates, and women with certain characteristics were particularly vulnerable.

In a retrospective study spanning 2016 to 2025, maternal sepsis was associated with 0.06% of hospital births but involved in 32.4% of the delivery-associated hospital deaths, reported researchers led by Manuela Staneva, MD, MPH, of the University of Mississippi Medical Center in Jackson.

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% vs 14% (adjusted odds ratio [aOR] 5.90, 95% CI 4.42-7.90)
• C-section deliveries: 53% vs 33% (aOR 2.32, 95% CI 1.73-3.12)
• Chronic comorbidities: 54% vs 33% (aOR 2.17, 95% CI 1.63-2.88)
• Black race: 59% vs 42% (aOR 1.74, 95% CI 1.28-2.39)
• Medicaid: 64% vs 52% (aOR 1.52, 95% CI 1.09-2.13)

While Mississippi’s “exceptionally high” maternal sepsis mortality rate was surprising, so was its “staggeringly high” chronic comorbidity burden, particularly hypertension, among these mothers, Staneva told MedPage Today. “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, and 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.”

Beyond mortality, sepsis was also associated with severe outcomes and steep hospital charges.

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

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. Mississippi is notable for having the nation’s third-highest maternal mortality rate.

The study results highlight the need “for creating a statewide prevention plan focused on identifying high-risk patients and treating infections promptly,” Staneva and colleagues wrote. “To address the entire spectrum of risk factors for sepsis and maternal deaths, Mississippi must intensify the fight against its entrenched and ongoing chronic disease epidemic.”

Mothers’ health status prior to pregnancy is a crucial factor in adverse maternal outcomes such as sepsis, said co-author Thomas Dobbs, MD, MPH, also of the University of Mississippi. Reducing obesity, hypertension, and diabetes among reproductive-age women would be the most impactful long-term step to reducing the maternal sepsis rate, he told MedPage Today.

In the study, women with sepsis had significantly higher rates of hypertension (36.6% vs 21.1%) and obesity (25.9% vs 14.9%) compared to those without sepsis, and numerically higher rates of diabetes as well (11.2% vs 7.8%).

Moreover, while azithromycin is known to reduce maternal infection when given intravenously during c-sections, Dobbs also suggested lowering c-section birth rates could reduce surgical wounds, a substantial contributor to postpartum infections and sepsis.

Prior work suggests that most infection-related maternal deaths are preventable, but antibiotics never enter the picture for many affected mothers. In that study, some of the top contributing factors to maternal mortality included issues with clinical skill or quality of care, treatment delays, a lack of continuity in care, knowledge gaps, and financial constraints.

For the current study, Staneva and colleagues analyzed statewide hospital discharge data from Mississippi residents ages 10 to 49 years, focusing on the outcome of sepsis-associated in-hospital births. Of the 320,179 live births during the study, sepsis was involved in 197. Eleven of the women with sepsis died, for a case fatality rate of 5.6%.

Among those with maternal sepsis, mean age was 27 years, 64% of mothers had Medicaid coverage, 59% were Black, 34% were white, and 56% were from nonmetropolitan areas.

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 (vs 6.5 cases for women ages 10-24 years)
• Preterm birth: 23.1 cases (vs 3.3 with term birth)
• C-section delivers: 10 cases (vs 3.8 with vaginal birth)
• Black race: 8.6 cases (vs 4.2 for white race)
• Medicaid recipient: 7.5 cases (vs 4.3 with private insurance)

Study limitations included the small sample size and a cross-sectional design unable to account for potential reverse causality between c-section births and infections.