Overdose deaths have soared among pregnant people, study reveals
Drug overdose deaths among pregnant and postpartum people soared significantly between 2018 and 2021, according to a report published Wednesday. The increase parallels a persistent rise in drug-related deaths across the nation since the onset of the opioid epidemic in the 1990s.
Researchers at the National Institute on Drug Abuse collected and analyzed data on more than 17,000 deaths, including people who were pregnant or who had been pregnant within the past year. They found that the ratio of overdose deaths more than tripled in pregnant and postpartum women aged 35 to 44, the team reports in the journal JAMA Psychiatry.
The data also show there has been a notable rise in overdose deaths among pregnant or postpartum Black women, paralleling the overall increase in maternal mortality rates among this demographic, noted study co-author Wilson Compton, deputy director of the National Institute on Drug Abuse.
Experts say the rise in overdose deaths in this group from 2018 to 2021 can be attributed to many external factors, including social isolation due to the coronavirus pandemic and lack of adequate prenatal and postpartum care in the United States.
The majority of pregnancy-associated overdose fatalities involved opioids, most notably fentanyl. Most of these deaths occurred outside of health-care facilities, the researchers found, which suggests the need for better support during and after pregnancy for people who have a substance use disorder. That includes educating people about treatment options, as well as finding ways to encourage pregnant people to seek treatment without fear of legal action.
"For a lot of pregnant and postpartum people, disclosing drug use might result in your child being taken away, so there is a lot of stigma beyond just the standard amount of stigma you get," said Chelsea Shover, an epidemiologist and assistant professor in residence at the University of California at Los Angeles School of Medicine.
Numerous laws exacerbate women's concerns about being penalized. In some states, there are mandates for the automatic reporting of child abuse and neglect in cases involving newborns exposed to certain substances, including opioids.
"We have to create environments where people who are struggling with substance use are able to disclose that and get the resources they need," Shover said. "But when people don't know that there is treatment available for opioid use disorder or can't access that, [then] that becomes the problem."
Current treatment for opioid use disorders in pregnancy and through the postpartum period includes methadone or buprenorphine combined with behavioral therapy, according to the American College of Obstetricians and Gynecologists and the Substance Abuse and Mental Health Services Administration.
A July analysis by the health policy group KFF found that drug overdose deaths predominantly linked to fentanyl surged during the pandemic. The report also noted that, despite policy efforts aimed at improving access to opioid use disorder treatments, many people do not receive the recommended medications.
For pregnant and postpartum people, the stigma surrounding drug use, coupled with being pregnant and under the influence of opioids, can further decrease the chances of getting help.
"I think our country and people in general have struggled with substance use being a medical condition; people still see it as a moral condition . . . this isn't always a choice that women are making," said Jessica L. Coker, an associate professor in the departments of psychiatry and obstetrics and gynecology at the University of Arkansas for Medical Sciences who specializes in suicide and substance use disorders in pregnant and postpartum women.
In 2022, the Department of Health and Human Services office on women's health granted more than $3.6 million to seven organizations dedicated to helping individuals grappling with substance use disorder during pregnancy and the postpartum period.
"Women who use drugs are some of the sickest patients that I have ever worked with . . . and it's not a moral failing that's caused them to use drugs," Coker said. "I have never met a pregnant person that didn't want to be a good mom and didn't want to do the right thing."
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