US Trends in Drug Overdose Mortality Among Pregnant and Postpartum Persons, 2017-2020

Bruzelius, Emilie; Martins, Sílvia S.

doi:10.1001/jama.2022.17045

Cited by 63 publications

(33 citation statements)

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“…Research has reported increases in pregnancy-associated drug overdose mortality . To inform substance use policy and practice, it is important to understand trends in unintentional or undetermined-intent pregnancy-associated overdose mortality caused by common psychotropic drugs of misuse.…”

Section: Introductionmentioning

confidence: 99%

“…esearch has reported increases in pregnancy-associated drug overdose mortality. [1][2][3][4] To inform substance use policy and practice, it is important to understand trends in unintentional or undetermined-intent pregnancy-associated overdose mortality caused by common psychotropic drugs of misuse. Considering that overall drug overdose mortality has increased significantly from 2018 through the COVID-19 pandemic, 5 an examination of trends in pregnancy-associated mortality from drug overdoses by pregnancy timing, age, race and ethnicity, educational attainment, and marital status during this time frame is warranted.…”

mentioning

confidence: 99%

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Pregnancy and Postpartum Drug Overdose Deaths in the US Before and During the COVID-19 Pandemic

Han,

Compton,

Einstein

et al. 2024

JAMA Psychiatry

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ImportanceKnowledge about characteristics of US pregnancy-associated decedents is needed to guide responses.ObjectiveTo examine individual sociodemographic characteristics and residing county’s health care resources and socioeconomic factors among pregnancy-associated overdose decedents in comparison with obstetric decedents and overdose decedents who were not pregnant in the past year.Design, Setting, and ParticipantsThis cross-sectional, exploratory study included 1457 pregnant and postpartum overdose decedents, 4796 obstetric decedents, and 11 205 nonpregnant overdose decedents aged 10 to 44 years from 2018 to 2021. Data were analyzed August 2023.ExposuresDecedents from the 2018-2021 Multiple Cause of Death Files linked to the 2021 Area Health Resources Files and the 2018-2021 County Health Rankings data at the county level.Main Outcomes and MeasuresPregnancy-associated deaths were defined as deaths during pregnancy or within 1 year of pregnancy termination. This study focused on unintentional drug overdoses or drug overdoses with undetermined intent involving the most common psychotropic drugs of misuse.ResultsFrom 2018 to 2021, across the pregnancy-postpartum continuum, pregnancy-associated overdose mortality ratios consistently increased among women aged 10 to 44 years. Mortality ratio more than tripled among pregnant and postpartum women aged 35 to 44 years from 4.9 (95% CI, 3.0-8.0) per 100 000 mothers aged 35 to 44 years with a live birth in January to June 2018 to 15.8 (95% CI, 12.3-20.4) in July to December 2021 (average semiannual percentage changes, 15.9; 95% CI, 8.7-23.6; P &lt; .001). Compared with pregnant obstetric decedents, pregnant overdose decedents had increased odds of being aged 10 to 34 years (75.4% vs 59.5%; range of odds ratios [ORs], 1.8 [95% CI, 1.3-2.5] for ages 10 to 24 years to 2.2 [95% CI, 1.7-2.8] for ages 25 to 34 years), being non–college graduates (72.1% vs 59.4%; range of ORs, 2.7 [95% CI, 1.7-4.3] for those with some college education to 3.9 [95% CI, 2.4-6.1] for those with less than high school education), being unmarried (88.0% vs 62.1%; OR, 4.5; 95% CI, 3.7-6.0), and dying in nonhome, non–health care settings (25.9% vs 4.5%; OR, 2.5; 95% CI, 1.8-3.6) and were associated with decreased odds of dying in health care settings (34.7% vs 77.6%; range of ORs, 0.1 [95% CI, 0.1-0.1] for those who died in hospital inpatient settings to 0.4 [95% CI, 0.3-0.6] for those who died in hospital outpatient/emergency room settings).Conclusions and RelevanceFrom 2018 to 2021, the mortality ratio more than tripled among pregnant and postpartum women aged 35 to 44 years, consistent with increases in overdose mortality across US populations. Most pregnancy-associated overdose deaths occurred outside health care settings, indicating the need for strengthening community outreach and maternal medical support. To reduce pregnancy-associated overdose mortality, evidence-based interventions are urgently needed at individual, health care, local, and national levels, along with nonpunitive approaches incentivizing pregnant and postpartum women to seek substance use disorder treatments.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Pregnancy and Postpartum Drug Overdose Deaths in the US Before and During the COVID-19 Pandemic

Han,

Compton,

Einstein

et al. 2024

JAMA Psychiatry

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“…O pioid use disorder (OUD) is a national epidemic, and overdose deaths increased approxi-mately 81% among pregnant and postpartum people between 2017 and 2020. [1][2][3] Postpartum is a particularly high-risk period, with increased risk of relapse, overdose, and death compared with during pregnancy. 3,4 Patients in the late postpartum period, defined as more than 6 weeks to 1 year postpartum, have higher overdose mortality rates compared with pregnant and early postpartum people.…”

mentioning

confidence: 99%

Buprenorphine Extended-Release Treatment for Opioid Use Disorder in the Postpartum Period

Galati,

Wenzinger,

Rogers

et al. 2023

Obstetrics &Amp; Gynecology

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Buprenorphine extended-release (XR) is an extended-release monthly injection to treat opioid use disorder (OUD). This retrospective case series includes 15 postpartum patients who were treated with buprenorphine-XR at a single center and reports on their outcomes. The average total daily sublingual buprenorphine dose before initiation of buprenorphine-XR was 16.25 mg (SD±7.76, range 2–32 mg). Overall, 137 total doses of buprenorphine-XR were administered between May 17, 2021, and April 11, 2023. Urine toxicology test results were negative for opioids other than buprenorphine in the majority (80.0%) of patients once appropriate maintenance doses were achieved. Euphoria and intoxication were not reported. A minority of patients (20.0%) discontinued buprenorphine-XR. Although more extensive research is needed before widespread use, buprenorphine-XR may be a favorable treatment for OUD in this high-risk population.

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“…A major strength of this study is that Medicaid data are linked with the National Death Index, improving the identification of individuals by pregnancy status and timing of death at the national level. 2,4,5 Because most overdose deaths occur outside of the hospital setting, relying only on hospital codes likely underascertains the true burden of overdose death in this population. Although this study's design does improve ascertainment, it does not include miscarriage and abortions or individuals not insured by Medicaid before delivery.…”

mentioning

confidence: 99%

“…In this month's issue of Obstetrics & Gynecology , Suarez et al (see page 657) 1 add to the growing body of evidence showing that opioid overdose is a leading cause of death among postpartum individuals in the United States. 2–4 The authors analyzed a retrospective cohort of individuals insured by Medicaid at least 3 months before a live birth or stillbirth from 2006 to 2013. The authors found that, compared with the general population, individuals with opioid use disorder (OUD) were 24 times more likely to die in the year postpartum from opioid overdose (118 vs 5.4/100,000 deliveries) and six times more likely to die from any cause (316 vs 51.1/100,000 deliveries).…”

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confidence: 99%

Preventing Postpartum Opioid Overdoses

Smid

2023

Obstetrics &Amp; Gynecology

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US Trends in Drug Overdose Mortality Among Pregnant and Postpartum Persons, 2017-2020

Abstract: This study evaluates changes in overall and drug-specific overdose mortality among pregnant and postpartum persons before and during the COVID-19 pandemic.

Cited by 63 publications

References 5 publications

Pregnancy and Postpartum Drug Overdose Deaths in the US Before and During the COVID-19 Pandemic

Pregnancy and Postpartum Drug Overdose Deaths in the US Before and During the COVID-19 Pandemic

Buprenorphine Extended-Release Treatment for Opioid Use Disorder in the Postpartum Period

Preventing Postpartum Opioid Overdoses

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