Pregnancy-related mortality significantly impacts families and societies, reflecting healthcare access and effectiveness. Maternal mortality rates vary globally, with higher rates in developing countries. This study investigates maternal mortality in Guilan Province, Northern Iran, focusing on the incidence, causes, and implications for healthcare policy and societal development.

This study used registry-based census data to analyze all maternal mortality cases recorded in Guilan Province between 2014 and 2024. Data were collected via a checklist from the vice-chancellor of health, Guilan University of Medical Sciences. The study included deaths during pregnancy, childbirth, or postpartum.

Among 62 maternal deaths, the overall MMR was 22.83 per 100,000 live births. The highest proportion in the 31–35 age group (33.9%). Pre-existing conditions were present in 41.9% of decedents, and 53.2% had undergraduate education. MMR increased 3.2-fold during the pandemic period (40.38 vs. 12.75 pre-pandemic), peaking at 49.83 in 2022. Substantial geographic variation was observed, with Rudsar district showing the highest mortality (8.43 per 100,000). COVID-19 was the leading cause of death (19.35%), followed by hemorrhagic shock (16.13%), pulmonary embolism (9.68%), infection (8.06%), and cardiac ischemia (6.45%).

A sensitivity analysis excluding 12 COVID-19-related maternal deaths showed that non-COVID MMR remained elevated during 2020–2021 and increased again in 2023–2024.

The persistence of elevated non-COVID maternal mortality suggests that factors beyond direct COVID-19 mortality may have contributed to the observed temporal pattern, although causal relationships cannot be established from this descriptive study.