The researcher new study at the University of Utah Health found that drug-induced death is the most common cause of pregnancy-death in Utah. Postpartum women who have previously or currently struggle with substance abuse are at greater risk of overdosing. The research team explored the need for continued substance abuse counseling; access to naloxone prescriptions and mental health care in the year following childbirth.
“80 % of deaths were in the late postpartum period after mom has finished her last check-up with the obstetrician,” Smid said. “The researcher need to really look at fourth-trimester care and how to enhance this care; especially women with substance use.” According to Smid; the vast majority of women will stop using or decrease using substances during pregnancy and are particularly vulnerable to relapse postpartum.

Stress and sleep deprivation

Drug-induced mortality in the year following birth is often due to a combination of decreased tolerance; following drug abstinence during pregnancy; hormonal changes, postpartum depression, stress and sleep deprivation from infant care, the strain of intimate relationships and loss of insurance. The American College of Obstetricians and Gynecologists recently recommended that postpartum care for women extended to a ‘fourth trimester,’ typically longer than the six-week postpartum check.

In the study, the team identified 136 pregnancy-deaths using the Utah Perinatal Mortality Review Committee database. Of these cases, 35 (26 %) linked to drug use. Nearly three-quarters of the drug-induced deaths were associated with opioids (27/35, 77 %). Surprisingly, 42 percent of pregnant women insured through Medicaid in Utah are prescribed opioids for back pain, abdominal pain, headache or migraine, joint pain or another pain diagnosis.

Drug-induced deaths (35/136, 26 %) equal to the next two most common causes combined, blood clots (18/136, 13 %) and motor vehicle accidents (17/136, 12 %). The remaining deaths (66/136, 49 %) with hypertension, infection, homicide/suicide, hemorrhage, malignancy, and other causes. According to Smid, this is not a Utah problem.

Drug-induced deaths

Other states and cities that conduct maternal mortality review are finding similar increased drug-induced deaths in postpartum mothers. Women in the study who died from drug use primarily died at home (20/35, 57 %); compared to other pregnancy-associated deaths; who most commonly died at the hospital (64/101, 63 %). In addition, drug-induced deaths more common during the late-postpartum period (28/35, 80 %); defined as 43 days to one year after giving birth.
Smid notes the study is based in a state with a small population and does not include insurance status; at the time of death or insurance lapses. It also lacks complete data on abuse or intimate partner violence and complete information about substance use treatment or social circumstances. “They cannot do anything for the moms who died, but as a health care institution, we can identify the holes in care and plug them,” Smid said. “They need to develop an addiction-knowledgeable obstetrics workforce.”