In a new study published in JAMA Psychiatry, researchers have reported a sharp rise in overdose deaths among pregnant and postpartum women in America for the period 2018 to 2021.
National Institutes of Health (NIH) researchers at the National Institute on Drug Abuse (NIDA) found that the incidence of overdose mortality among pregnant and postpartum women aged 35 to 44 more than tripled during the period of their study.
Postpartum women are new moms whose babies are usually still younger than six weeks. It is well known that this group often has to battle with “baby blues” – more formally known as postpartum depression (PPD). This makes some of those women resort to certain substances that are addictive and can cause overdose death.
Findings in this research showed that women with substance use issues had difficulty accessing treatment, even when it was available.
“The stigma and punitive policies that burden pregnant women with substance use disorder increase overdose risk by making it harder to access life-saving treatment and resources,” said Nora Volkow, M.D., senior study author and NIDA Director.
Working to reduce the barriers that make access to treatment for addiction difficult can help to protect the health of both mother and child, stated Dr. Volkow.
Greater overdose mortality
There is convincing evidence of a significant increase in overdose deaths as a result of the COVID-19 pandemic. However, not much was known about mortality among pregnant women. Nothing was also known about what deaths among pregnant and postpartum women could be linked to overdose or obstetric causes.
The NIDA team, therefore, wanted to fill the gaps in knowledge with the current study. It analyzed national data before and during the pandemic, focusing on girls and women aged 10 to 44 years.
These subjects were divided into three groups. The first group included 1,457 pregnant and postpartum women who died due to an overdose of common drugs, excluding alcohol and depression medications; the second group had 4,796 whose deaths resulted from obstetric causes; and the third group included 11,205 subjects who were not pregnant during the past year and died from an overdose.
While overdose death ratios were substantially higher among pregnant and postpartum women, the highest surge was observed among those aged 35 to 44. Overdose mortality rose in this group from 4.9 per 100,000 mothers with a live birth in 2018 to 15.8 in 2021.
Medical care issues
The NIDA researchers found that overdose deaths among pregnant women were more likely to occur in “non-home, non-healthcare settings.” An estimated 60-73% of the deaths observed occurred at home or another non-healthcare setting.
What’s more worrisome was that overdose mortality commonly happened in places where medical services were available. This suggests that the women did not or could not access these services.
Findings showed pregnant and postpartum women who died from an overdose were more likely to live in counties with doctors practicing obstetrics and gynecology ranking within the 48 to 75th percentile, compared to those who died due to obstetric causes. Their counties often had at least two general hospitals ranked at the 95th percentile for obstetric care and with numbers of practicing psychiatrists per 100,000 county residents ranking over the 75th percentile among all counties in the U.S as well.
This suggests significant barriers to medical care, researchers said. The barriers include stigma, penalization, discrimination, and socioeconomic issues. Policies that impose these hurdles, therefore, urgently need to be checked across the country.
B Han, et al (2023). Pregnancy and postpartum drug overdose deaths in the US before and during the COVID-19 Pandemic. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2023.4523