More than a fifth of all pregnancy-associated deaths due to drug use, suicide, homicide

Drug use, suicide and homicide account for more than a fifth of all deaths during pregnancy and the first year after birth, according to a study published in Obstetrics & Gynecology.

Claire E. Margerison, MPH, PhD, an associate professor of epidemiology and biostatistics at Michigan State University, and colleagues used death certificate records from 2010 to 2019 for 33 states and the District of Columbia to identify pregnancy-associated deaths during that time.

After identifying 11,782 pregnancy-associated deaths of women aged 15 to 44 years, the researchers attributed 59.3% of them to obstetric causes, 11.4% of them to drugs, 5.4% to suicide, 5.4% to homicide and 18.5% to other causes.

When the researchers looked at fatalities during pregnancy, they found that 54.6% died of maternal or obstetric causes, 10.5% of drug-related causes, 4.9% of suicide and 8% of homicide.

During the first 42 days postpartum, maternal and obstetric causes accounted for more than three quarters of deaths. Between 43 and 365 days postpartum, 17% of deaths were due to drugs, 8.3% were due to suicide and 5.9% were due to homicide.

By comparison, 16.5% of deaths were due to drugs, 8.1% were due to suicide and 3.4% were due to homicide among all females of reproductive age.

Also, drug-related deaths during pregnancy and in the postpartum period increased from 2.7 to 7.8 per 100,000 during the 10-year period, and homicides increased from 1.8 to 3 per 100,000. Suicides increased from 1.9 to 2.5 per 100,000, although the researchers did not consider this statistically significant.

Non-Hispanic American Indian or Alaska Native women had the highest pregnancy-associated death ratios for drug-related causes and for suicide (10.1 per 100,000 and 7.7 per 100,000, respectively). Non-Hispanic Black women had the highest pregnancy-associated deaths due to homicide (7 per 100,000). The researchers called the racial and ethnic inequities reflected in the data “unacceptable.”

Women aged 35 years and older had the highest rate of drug-related deaths (6.1 per 100,000). Women aged 15 to 19 years had the highest rates of deaths due to suicide (3.5 per 100,000) and homicide (4.9 per 100,000).

According to the researchers, the high rates of drug-related and suicide deaths during the postpartum period may be due to a lack of continuous postpartum care, specialized mental health and substance use services and structural supports such as housing.

The stress of caring for a newborn, stigma, hormonal changes and decreased tolerance to drugs after abstinence during pregnancy may be factors in these rates as well. Additionally, the researchers noted that the study period included the Great Recession, declines in fertility rates and the escalating opioid pandemic.

However, Margerison and colleagues said deaths related to mental illness are 100% preventable, and they recommended screenings for substance abuse, suicidality and psychological distress in addition to intimate partner violence.

Also, the researchers called for coordination between obstetric care and addiction medicine, behavioral health and social services. They urged attention to structural barriers to accessing care and support as well.