Incidence of postpartum opioid overdose death high with opioid use disorder

Key takeaways :

• Postpartum opioid overdose deaths per 100,000 deliveries were 5.4 for all women and 118 for those with opioid use disorder.
• Treating opioid use disorder after delivery was linked to fewer opioid overdose deaths.

Postpartum women with opioid use disorder experience a high incidence of postpartum opioid overdose death, other substance-related injuries, accidents and suicide, according to findings published in Obstetrics & Gynecology.

therefore, individuals with opioid use disorder are high risk for postpartum mortality, therefore efforts should be made to identify these individuals and provide them with treatment and support,” Elizabeth A. Suarez, PhD, MPH, instructor and core faculty at the Rutgers Institute for Health, Health Care Policy and Aging Research and the Rutgers School of Public Health, told Healio. “Screening for substance use disorders during pregnancy is essential, and continued follow-up during the postpartum period could be lifesaving. Initiating or continuing treatment with buprenorphine or methadone is vitally important for these patients.”

This cohort study included all pregnant women with live births or stillbirths who had continuous enrollment in the Medicaid Analytic eXtract linked to the National Death Index in the U.S. from 2006 to 2013 for 3 months prior to delivery, which led to 4,972,061 deliveries. Researchers also identified a subcohort of 48,902 women with a history of opioid use disorder 3 months prior to delivery of which 102 died during the first postpartum year.

Researchers observed a cumulative incidence of opioid overdose death of 5.8 per 100,000 deliveries among all women and 124 per 100,000 deliveries among women with opioid use disorder. Odds of opioid use death was lower among Asian/Pacific Islander women (OR = 0.3; 95% CI, 0-2.1), Hispanic women (OR = 0.2; 95% CI, 0.1-0.3) and women of other racial/ethnic backgrounds (OR = 0.3; 95% CI, 0.1-0.9) compared with white women.

Elizabeth A. Suarez, PhD, MPH

In addition, opioid overdose death was more likely among women with vs. without the following:

• pregnancy complications (OR = 4.5; 95% CI, 1.4-14);
• preterm birth (OR = 2.6; 95% CI, 1.6-4.3);
• cesarean delivery (OR = 1.7; 95% CI, 1.2-2.6);
• mental health disorders (OR = 6.2; 95% CI, 4-9.7);
• tobacco use (OR = 3.2; 95% CI, 2.1-5);
• prescription opioid analgesic indications (OR = 7.3; 95% CI, 4.7-11.4);
• opioid use disorder (OR = 26.7; 95% CI, 12.8-55.8); and
• other substance use disorders (OR = 9.2; 95% CI, 4.5-18.7)

Postpartum opioid overdose death incidence per 100,000 deliveries was 5.4 among all women and 118 among those with opioid use disorder. Women with opioid use disorder experienced a sixfold higher incidence for all-cause postpartum death compared with all women.

The common causes of death among women with opioid use disorder were other drug- and alcohol-related deaths with 47 incidents per 100,000, suicide with 26 incidents per 100,000 and other injuries including accidents and falls with 33 incidents per 100,000. Researchers observed mental health and other substance use disorders as risk factors that were strongly associated with postpartum opioid overdose death.

Among women with opioid use disorder, use of medication to treat opioid use disorder during the postpartum period was associated with 60% lower odds of opioid overdose death (OR = 0.4; 95% CI, 0.1-0.9).

“It would be great to have more recent data. When we completed this analysis, we could only access death data through 2013. Our study was also too small to study timing of initiation and potential discontinuation of medications for opioid use disorder,” Suarez said. “While we see a decrease in risk of death among pregnant individuals on treatment, the risk may vary based on the stability of treatment throughout pregnancy and the postpartum period.”

For more information:

Elizabeth A. Suarez, PhD, MPH, can be reached at ea.suarez@ifh.rutgers.edu.