Study shows women in the late postpartum period were at greatest risk.


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Drug overdose deaths in pregnant and postpartum women rose by approximately 81% from 2017 to 2020 in the United States, according to a research letter in the December 6, 2022, JAMA. While pregnancy-related overdose deaths increased from 2007 to 2019, according to the authors, they rose sharply in 2020 and were highest just as the COVID-19 pandemic began to unfold. This may be a result of access to care made more difficult by the pandemic and associated shutdowns.

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The deaths were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), pregnancy-related codes and death certificate pregnancy checkbox status. The checkbox, which is included on death certificates in all states, asks whether the person was pregnant at the time of death, within 42 days of death (early postpartum), or within 43 to 365 days of death (late postpartum).


Of the 7,642 pregnancy-related deaths in the study period, 1,249 were overdose related, with a cumulative overdose death rate of 8.35 per 100,000. Pregnancy-related overdose deaths rose from 6.56 per 100,000 in 2017 to 11.85 per 100,000 in 2020-a relative increase of 81%. Of note, the numbers of late postpartum overdose deaths were higher than overdose deaths in people who were pregnant or in the early postpartum phase (3.95 deaths per 100,000 compared with 2.99 and 1.39 per 100,000, respectively).


The researchers found large increases in deaths involving fentanyl and other synthetics and psychostimulants like methamphetamine and cocaine. Overdose deaths involving benzodiazepines, heroin, and prescription opioids, on the other hand, were mostly stable during the study period.


The authors suggest the need for enhanced strategies to support substance use prevention, treatment, and harm reduction among pregnant and postpartum people. "Nurses serving these populations are in an ideal position to provide needed treatment and harm reduction interventions that can help reduce the risk of death, and to further advocate for evidence-based policies to support pregnant people who use drugs," said Emilie Bruzelius, MPH, Department of Epidemiology, Columbia University School of Public Health, the lead author of the research letter, in an email to AJN.-Amy M. Collins, managing editor