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Antithrombin (AT) deficiency is a severe thrombophilia associated with increased rates of maternal morbidity, mortality, and greater healthcare resource utilization during pregnancy and postpartum. Two large U.S. healthcare databases were queried for women aged 15–44 with delivery-related encounters: Cerner Real-World Data (CRWD, 01/01/2000–12/31/2021) and Premier Healthcare Database (PHD, 01/01/2016–01/01/2019). Individuals receiving cardiopulmonary bypass were excluded. Three cohorts were created: 1) Individuals who had AT levels tested any time between 9-months pre- through 3-months post-delivery (CRWD Test Cohort); 2) individuals prescribed AT concentrate (ATc) within 1-year pre- or 1-year post-delivery in CRWD (CRWD Medication Cohort); and 3) the same criteria as 2) applied to PHD (PHD Medication Cohort). There were 5411 individuals in the CRWD Test Cohort, 13 in the CRWD Medication Cohort and 38 in the PHD Medication Cohort. Demographic and baseline clinical characteristics were similar across cohorts. AT level testing occurred pre-delivery in 47.9 % of the CRWD Test Cohort and 23.1 % of the CRWD Medication Cohort. ATc was administered during the delivery hospitalization to 0.1 %, 23.1 % and 50.0 % of the CRWD Test, CRWD Medication, and PHD Medication Cohorts, respectively. Across cohorts, 5.4–7.9 % of individuals experienced thrombosis during the delivery-related encounter. Mean (SD) total costs for delivery through 1-year post-delivery were $190,894 ($276,893) with $123,763 ($177,122) of total costs related to abnormal coagulation. Opportunities exist to enhance the care of pregnant individuals with low AT levels throughout pregnancy, aiming for optimal maternal outcomes. [Display omitted] • We analyzed a large cohort of real-world pregnancies with suspected AT deficiency. • Rates of VTE and maternal mortality were high in the observed cohorts. • Negative clinical outcomes increased as antithrombin levels decreased. • Healthcare resource utilization/costs were higher for delivery than U.S. averages. • Deficiencies in antithrombin testing and treatment indicate need for improved care. [ABSTRACT FROM AUTHOR]