Maternal Mortality and Opioid Crisis Intersect with Overdose Deaths

November 30th, 2023

By Jill Drachenberg, Editor, Relias Media

Drug overdose deaths increased more than threefold in pregnant and postpartum women during the COVID-19 pandemic in what appears to be the intersection between the opioid crisis and worsening maternal mortality rates.

Women ages 33-44 years saw the greatest increase in overdose deaths, from 4.9 per 100,000 mothers with a live birth in 2018 to 15.9 per 100,000 in 2021, according to the authors of a recent study. The overall maternal overdose death rate increased from 6.9 per 100,000 in 2018 to 12.2 per 100,000 in 2021. From July 2020 to December 2021, late postpartum overdose mortality rates were higher than pregnancy overdose mortality — 2.7 vs. 16.6, respectively.

Pregnant and postpartum women who died of overdose were more likely to be younger (75%), unmarried (88%), non-college graduates (72%), and dying outside the home in non-healthcare settings (26%). They also were more likely to live in counties with income inequality and little access to hospitals, emergency care, and psychiatric care. These deaths also occurred more frequently in states with Medicaid expansion, suggesting women cannot or do not access available services.

Treatment for opioid use disorder is critical. However, some women may be unable to access services — or may fear repercussions. “Use of medications for opioid use disorder, and timely overdose treatments are critical to prevent overdose mortality. These can be challenging because many women may conceal their drug use from clinicians during pregnancy and motherhood due to stigma and fear of prosecution and loss of custody,” the study authors noted. “Strategies to destigmatize pregnant and nonpregnant women with substance use disorders are necessary to improve their access to health care services, including substance use treatments. … Research is required to identify evidence-based strategies for policymakers, clinicians, and social service professionals to help promote harm reduction approaches and treatment access and improve the treatment quality for pregnant and postpartum women with substance use disorders.”