Drug Overdose Deaths Reach Record High among Pregnant, Postpartum Women in US

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Drug overdose deaths increased approximately 81% among pregnant and postpartum women in the US from 2017 to 2020, according to a new study conducted at Columbia University Mailman School of Public Health. Findings also showed that increases in drug overdose mortality were most pronounced in 2020, likely due to social, economic, and health care disruptions associated with the COVID-19 pandemic.

The increase among pregnant and postpartum persons mirrored trends observed among women of reproductive age overall, noted authors in the research letter published in JAMA.

“We’ve seen significant increases in fatal and nonfatal overdose in the general population during the pandemic,” said first author Emilie Bruzelius, MPH, a doctoral student in the Department of Epidemiology at Columbia Mailman School, in a press release. “It now appears that pregnant and postpartum women are being affected as well.”

“Pregnant and postpartum people are known to face barriers to accessing drug treatment and harm reduction services, that when compounded by pandemic-associated stressors, healthcare shutdowns, and an increasingly volatile unregulated drug supply, may have increased fatal overdose risk,” added Bruzelius.

Bruzelius and Columbia Mailman School colleague Silvia Martins, MD, PhD, evaluated changes in overall and drug-specific overdose morality among pregnant or postpartum women between 2017 and 2020 using data from the National Vital Statistics System mortality files.

Bruzelius and Martins calculated annual overdose mortality rates and examined changes over time in absolute and relative terms and by drug type and pregnancy timing. There were 3 categories for timing of pregnancy: pregnant at the time of death (pregnant), pregnant within 42 days of death (early postpartum), and pregnant within 43 to 365 days of death (late postpartum). For comparison, they calculated overdose mortality rates among persons of reproductive age (ie, aged 15 to 44 years) who were not pregnant.

Results

Among the 7642 pregnancy-associated deaths identified between 2017 and 2020 among pregnant and postpartum women, 1249 were overdose-related, corresponding to a cumulative overdose mortality rate of 8.35 per 100 000 (95% CI, 7.89-8.83 per 100 000).

From 2017 to 2020, pregnancy-associated overdose mortality increased from 6.56 to 11.85 per 100 000 (absolute change rate, 5.30 [95% CI, 3.90-6.72] per 100 000; relative increase of 81%), according to investigators. Overdose mortality among women of reproductive age increased from 14.37 to 19.76 per 100 000 (absolute change rate, 5.39 [95% CI, 4.94- 5.85] per 100 000; relative increase of 38%). For both groups, increases in overdose mortality in 2020 were more pronounced than increases in any other prior year.

While pregnancy-associated overdose deaths involving benzodiazepines, heroin, and prescription opioids were mostly stable during the 4-year study period, researchers reported large increases in deaths involving fentanyl and other synthetics and psychostimulants (eg, methamphetamine, cocaine). Increases in fentanyl-involved deaths were especially marked in 2020, rising from 5.73 per 100 000 (95% CI, 5.00-6.56 per 100 000) to 9.47 per 100 000 (95% CI, 8.50-10.54 per 100 000).

The team observed higher cumulative overdose mortality rates among women identified as late postpartum (3.95 per 100 000 [95% CI, 3.64-4.28 per 100 000]) compared with those who were pregnant at the time of death (2.99 per 100 000 [95% CI, 2.73- 3.29 per 100 000]) or identified as early postpartum (1.39 per 100 000 [95% CI, 1.21-1.60 per 100 000]).

The study had limitations, including small numbers in some subgroups, limited pregnancy information, potential undercounting of early postpartum and overcounting of late postpartum deaths, and potential misclassification for pregnancy status and drug involvement.

“The findings indicate that enhanced strategies supporting substance use prevention, treatment, and harm reduction efforts among pregnant and postpartum persons are needed,” concluded Bruzelius and Martins.

Reference: Bruzelius E, Martins SS. US trends in drug overdose mortality among pregnant and postpartum persons, 2017-2020. JAMA. 2022;328:2159-2161. doi:10.1001/jama.2022.17045.