Overdose Deaths Among Pregnant, Postpartum Women Sharply Increase

Drug overdose deaths among women and girls between the ages of 10 and 44 who were pregnant or pregnant within the past 12 months sharply increased from 2018 to 2021, with overdose deaths among those who were aged 35 to 44 during the study period more than tripling, according to data released on Wednesday by the National Institute on Drug Abuse (NIDA).

Findings were published in JAMA Psychiatry.

The study also found that more than 60% of pregnancy-associated overdose deaths occurred outside healthcare settings, but often in counties where healthcare resources were available.

“The stigma and punitive policies that burden pregnant women with substance use disorder (SUD) increase overdose risk by making it harder to access life-saving treatment and resources,” NIDA Director Nora Volkow, MD, the study’s senior author, said in a news release. “Reducing barriers and the stigma that surrounds addiction can open the door for pregnant individuals to seek and receive evidence-based treatment and social support to sustain their health as well as their child’s health.” 

NIDA researchers analyzed US data on multiple causes of death, county-level area health resources, county health rankings, and US births before and during the COVID-19 pandemic. The study included:

• 1457 individuals at the pregnant and postpartum stage who died from drug overdose involving the most common drugs of misuse, excluding alcohol and antidepressants;
• 4796 who died of obstetric causes; and
• 11,205 who died from a drug overdose and were not pregnant within the past 12 months.

The researchers found that overdose mortality ratios increased for pregnant and postpartum women across almost all age, racial/ethnic, educational, and marital status groups during the study period. Among pregnant and postpartum women between the ages of 35 and 44, the rate of overdose mortality increased from 4.9 per 100,000 in 2018 to 15.8 in 2021. Among those between 10 and 44 who died between 43 days and 1 year after pregnancy, overdose mortality ratios nearly doubled, from 3.1 per 100,000 in 2018 to 6.1.

The study also found that, compared to girls and women who died from obstetric causes, those who died from a drug overdose during pregnancy were more likely to:

• Be aged 10 to 34 years old (75.4% vs 59.5%);
• Be non-college graduates (72.1% vs 59.4%);
• Be unmarried (88% vs 62.1%); and
• Die in “non-home, non-healthcare settings” (25.9% vs 4.5%).

The study results are indicative that pregnancy is an urgent time for interventions that can reduce overdoses, study co-author Emily Einstein, PhD, NIDA science policy branch chief, said in the release.

“Stigmatizing and penalizing women with substance use disorders makes it very hard for them to seek help for drug use and receive routine prenatal care,” Dr Einstein said. “Effective treatments and medical services exist—unfettered access is needed to help mothers and children survive.”

Reference

Overdose deaths increased in pregnant and postpartum women from early 2018 to late 2021. News release. National Institute on Drug Abuse. November 22, 2023. Accessed November 22, 2023.