WEDNESDAY, Nov. 22, 2023 (HealthDay News) — Drug overdose deaths skyrocketed among pregnant girls and women between 2018 and 2021, a new federal government study shows.
Between early 2018 and late 2021, fatal overdoses more than tripled among 35- to 44-year-old women, from 4.9 deaths per 100,000 mothers with a live birth to 15.8, according to the study by researchers at the National Institute on Drug Abuse (NIDA).
More than 6 in 10 of these deaths happened outside health care settings. Often, they occurred in counties where health care resources such as emergency and obstetric care were available, the study found.
"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," senior author Dr. Nora Volkow, director of NIDA, said in an institute news release. "Reducing barriers and the stigma that surrounds addiction can open the door for pregnant individuals to seek and receive evidence-based treatment and social support to sustain their health as well as their child's health."
Significant barriers to care for pregnant women with substance abuse disorders include penalization, stigma, discrimination and limited financial resources, researchers said.
Despite a sharp rise in overdose deaths associated with the COVID-19 pandemic that has been well documented, researchers said little has been known about overdose death rates associated with pregnancy during this period. They added that differences in characteristics of women who died from an overdose and those who died of birth-related causes are unknown.
To understand more, researchers analyzed nationwide cause-of-death data, county-level health resources and health rankings and U.S. births. They looked at that data for January to June 2018 and July to December 2021.
They focused on women in three groups: One included almost 1,500 women who were pregnant or had recently delivered and who died from an overdose involving the most commonly abused drugs (other than alcohol and antidepressants).
A second group included about 4,800 women who died of childbirth-related causes, and the third group, about 11,200 women, was composed of women who had not been pregnant in the past year and died of a drug overdose.
The study assessed trends in the number of deaths for every 100,000 moms with a live birth during or within one year of a pregnancy's end.
Besides the surge in overdose death rates among 35- to 44-year-old moms, the study also found:
Fatal overdose rates almost doubled among 10- to 44-year-olds who died between 43 and 365 days after pregnancy — from 3.1 in 2018 to 6.1 in the 2021 period.
Compared to those who died from obstetric causes, girls and women who died from an overdose were more likely to be between 10 and 34 years of age (74.4% versus 59.5%); not college graduates (72.1% versus 59.4%); and unmarried (88% versus 62.1%). They were also more likely to die in what researchers described as "non-home, non-healthcare settings" (25.9% versus 4.5%).
Between 60% and 73% of pregnant and postpartum women who died from an overdose were not in a health-care setting. Overdose deaths often happened in places where medical services were available, but may not have been used.
Slightly more than half of pregnant and postpartum women who died from overdoses lived in counties with at least two hospitals ranked in the top 95% nationwide for obstetric care; and between 58% and 67% lived in counties in the top 75% for numbers of practicing psychiatrists.
"These results reflect the persistent national overdose crisis and demonstrate that pregnancy is an urgent time for interventions that can reduce the risk of overdose," study co-author Emily Einstein, NIDA science policy branch chief, said in the news release. "Stigmatizing and penalizing women with substance use disorders makes it very hard for them to seek help for drug use and receive routine prenatal care. Effective treatments and medical services exist —unfettered access is needed to help mothers and children survive."
Other studies have found that pregnant women are less apt to receive an appointment at an addiction treatment center and have trouble getting childcare at such facilities.
In many states, they face consequences such as loss of child custody, incarceration and involuntary commitment. In states with punitive policies, pregnant women who use drugs are less likely to get timely quality care, which can harm their families as well. Researchers noted that children in these states are less likely to be reunited with their parents than in other states and that Black children and American Indian/Alaska Native youngsters are most affected.
Researchers said more study is needed to understand and address these problems and on the risk and protective factors of pregnancy-associated death rates among women with and without drug use.
The findings were published Nov. 22 in JAMA Psychiatry.
More information
The National Library of Medicine has more about pregnancy and substance use.
SOURCE: National Institute on Drug Abuse, news release, Nov. 22, 2023
