Emilie Bruzelius, MPH, and Silvia S. Martins, MD, Ph.D., both of Columbia University Mailman School of Public Health in New York City, reported their findings in JAMA.
Researchers found that drug overdose mortality in pregnancy or the postpartum period substantially rose in the United States in recent years, peaking around the onset of the COVID-19 pandemic in 2020. They found that overdose deaths in this population increased by 81% between 2017 and 2020, going from 6.56 to 11.85 per 100,000 women.
In contrast, the rate of overdose deaths among females of reproductive age who are not pregnant increased from 14.37 to 19.76 per 100,000, a rise of 38%.
During the study period, 1,249 of the 7,642 pregnancy-related deaths detected in the restricted National Vital Statistics System mortality files were overdose-related, with a full third of these deaths happening in 2020.
In a press release, Bruzelius noted that there are known obstacles for pregnant and postpartum women to accessing drug treatment and harm reduction services, which when combined with pandemic-related stressors, healthcare closures, and an increasingly unstable unregulated drug supply may have increased the risk of fatal overdose. According to Bruzelius and Martins, the number of deaths involving benzodiazepines, heroin, and prescription opioids in women who were pregnant or nursing babies was largely unchanged between 2017 and 2020. However, the number of fatalities involving fentanyl, other synthetic drugs, and psychostimulants like cocaine and methamphetamine increased significantly (5.73 to 9.47).
Martins emphasised the importance of and need for improved interventions to assist harm reduction, treatment, and prevention of substance use among expectant and postpartum women. We anticipate that the alarming tendencies we are observing will be addressed with the help of new and better methods.
Death certificates that specify whether a person was pregnant at the time of death, within 42 days of death (early postpartum), or within 43 to 365 days of death were used to detect pregnancy-related deaths (late postpartum). ICD-10 codes were also used to identify drug overdoses. From 2017 to 2020, the cumulative overdose death rate among women who were pregnant or recently delivered was 8.35 per 100,000. When compared to women who were pregnant at the time of death or women in the early postpartum period, those in the late postpartum period had a greater cumulative rate.
The study recommends for more awareness of the difficulties this patient population faces and stressed the necessity for more precise data collection when it comes to fatalities among pregnant and postpartum people.
Jacob S. Ballon, MD, MPH, of Stanford University in California, noted that the study authors did not provide explanations for why the overdose-related death rate rose sharper among the pregnant and postpartum group during the study period but said it will likely be the basis for further research. “[It’s] an interesting signal,” said Ballon, who was not involved with the study. “But now what do we do with that to explain it or make some sense of it?”