Pregnancy-Associated Death in Utah

Abstract

has been reviewed by the Editorial Board and by special expert referees. Although it is judged not acceptable for publication in Obstetrics & Gynecology in its present form, we would be willing to give further consideration to a revised version. If you wish to consider revising your manuscript, you will first need to study carefully the enclosed reports submitted by the referees and editors. Each point raised requires a response, by either revising your manuscript or making a clear and convincing argument as to why no revision is needed. To facilitate our review, we prefer that the cover letter include the comments made by the reviewers and the editor followed by your response. The revised manuscript should indicate the position of all changes made. We suggest that you use the "track changes" feature in your word processing software to do so (rather than strikethrough or underline formatting).

Pregnancy-Associated Deaths from Homicide, Suicide, and Drug Overdose: Review of Research and the Intersection with Intimate Partner Violence

“…For example, from 2005 to 2014 in Utah, 26% of pregnancy-associated deaths were drug related. 48 In Maryland, the 2019 Annual Report of the Maternal Mortality Review Committee showed that 38% of pregnancy-associated deaths resulted from substance use and unintentional overdose, and for five consecutive years (2012–2017), unintentional drug overdose was the leading cause of pregnancy-associated death. 49 In a recent review from 2007 to 2016 in the 22 states that had adopted the pregnancy checkbox on death certificates, it was found that pregnancy-associated mortality involving opioids more than doubled in terms of both the rate (1.3–4.2/100,000 live births) and the percentage of all pregnancy-associated deaths (4%–10%).…”

“…Having an unrecognized SUD or not receiving medication for an opioid use disorder (OUD) contributes to pregnancy drug-induced overdose deaths. 48 , 51 Despite the evidence that comprehensive pharmacotherapy ( e.g. , methadone, buprenorphine treatment) is the current standard of care for treating OUD during pregnancy and an effective way to prevent opioid overdose in the general population, nearly half of pregnant women with OUD who are receiving treatment in publicly funded centers in the United States are not receiving these medications.…”

“… 59 , 60 One study found that 77% of pregnant women who died of a drug-induced overdose had a psychiatric condition. 48 …”

“…Fatal and nonfatal overdose events decrease during the third trimester of pregnancy, with increased risk occurring at 7 to 12 months postpartum. 48 , 51 One suggested contributing factor for the increasing risk of maternal overdose is having a newborn with a diagnosis of neonatal abstinence syndrome (NAS), a dysregulation syndrome that can predispose infants to irritability, difficulty with reading cues, and neurobehavioral problems. 65 Another relevant factor is the impact of insurance loss or the conclusion of pregnancy-related SUD treatment after delivery on treatment access and engagement, which can lead to increased overdose risk during the postpartum period.…”

Maternal and infant characteristics associated with maternal opioid overdose in the year following delivery

“…In the United States, opioid‐related overdose events are increasingly implicated in pregnancy‐associated deaths, defined as deaths occurring during or within a year of the end of pregnancy, contributing to 11–25% of deaths in several states . The majority of the reported deaths occur later in the postpartum period; in Massachusetts, more than 90% of substance use‐related pregnancy‐associated deaths occurred after 6 weeks postpartum, compared with 60% of all other pregnancy‐associated deaths .…”