US preterm births remain high

In the 2025 March of Dimes Report Card, the United States earned a D+ grade for preterm births for the fourth consecutive year. In 2024, the national preterm birth rate was 10.4%, a number held three years in a row.

Half of all U.S. states received either a D or an F grade for preterm births, with 21 states seeing their rates of preterm births worsening over the last year. New Hampshire was the only state in the "A" category, earning a grade of A- with a 7.9% preterm birth rate.

Some health conditions that could increase the risk of preterm births or other poor birth outcomes include smoking, hypertension, unhealthy weight, diabetes, and hypertension in pregnancy.

According to the report, preterm birth rates varied by race/ethnicity and type of insurance, which may reflect broader social and economic factors. Black Americans had the highest rates of preterm births at 14.7%. People on Medicaid also had higher preterm birth rates compared to those on private or other insurance. 

The report also looked at rates of infant mortality in the United States. In 2023, the U.S. infant mortality rate was 5.6 deaths per 1,000 births. The highest rates of infant mortality were found in the South and Midwest regions. 

Between 2021 and 2023, the leading causes of infant mortality were birth defects (19.8%), preterm birth/low birth rate (17.9%), sudden unexpected infant death (16.1%), and accidents (5.7%). There were also racial/ethnic disparities in infant mortality, with Pacific Islander, American Indian/Alaska Native, and Black infants having higher mortality rates.

In 2023, maternal mortality rates dropped back to pre-pandemic levels at 18.6 deaths per 100,000 live births. However, racial/ethnic disparities persist, with American Indian/Alaska Natives, Black, and Pacific Islander mothers seeing the highest maternal mortality rates.

Commentary

According to Cindy Rahman, president and CEO of March of Dimes, the report's findings "[show] that while we remain stalled in our progress on preterm birth, we are also losing ground in other critical areas of maternal and infant health."

"Our country is stuck in a maternal and infant health crisis where too many families are being forgotten," Rahman added. "We must confront the systemic inequities that leave families of color and those covered by Medicaid at higher risk, improve access to early prenatal care, and tackle the growing burden of chronic disease—because every mom and baby deserves the chance for a healthy start."

L. Joy Baker, an obstetrician-gynecologist in Georgia, said the report's findings were not surprising to her and highlighted several barriers to care that her own patients experience.

"A lot of times, when I see patients who are second and third trimester, I always ask, 'What kept you from getting in? What was your barrier?' They often tell me, 'I had trouble getting my Medicaid,' or 'I was moving around a lot,' or 'I had housing insecurity or food insecurity,'" Baker said.

"As a doctor practicing in a small town, I definitely understand that there are often barriers to care for women who have become pregnant," Baker added. "There are also barriers to care for women before they become pregnant, which I think may be even more of an issue."

To address the overall maternal health crisis in the United States, Warren said there needs to be a national effort to provide women with insurance coverage across their lives and "maintain a really robust public health infrastructure."

"Every year in this country, we lose over 20,000 babies in [the] first year of life. We lose over 600 moms, either during pregnancy or delivery, or during that first year postpartum," Warren said. "That is not acceptable in the United States in 2025, and unless we change our course, those numbers are not going to get better. They're going to get worse."