In recent years, the United States has witnessed a troubling rise in pregnancy-associated drug overdose deaths, a trend that was further exacerbated by the COVID-19 pandemic. A recent study by Han et al. evaluating drug overdose mortality rates among pregnant and postpartum women highlighted that this increase is particularly concerning in the late postpartum period, where overdose mortality ratios nearly doubled.

Data from 2018-2021, revealed that late postpartum overdose mortality ratios rose from 3.1 to 6.1 per 100,000 mothers, indicating a profound need for targeted interventions to support women during and after pregnancy. Another concerning finding was the large number of deaths that occurred outside of a healthcare setting. This suggests that, although healthcare services may be available, they are either not accessed in time or are completely out of reach due to various barriers. Living in socioeconomically deprived neighborhoods further exacerbates these challenges, as many pregnant and postpartum overdose decedents reside in counties with limited access to healthcare, including hospitals lacking substance use treatment services. These disparities underscore the critical need for equitable, accessible, and comprehensive care.

This trend in drug overdose mortality is not uniform across all demographics. The increase in pregnancy-associated overdose deaths observed varied across age groups, races, and educational backgrounds, with women aged 35 to 44 experiencing the steepest rise, where the rate tripled between 2018 and 2021. Similarly, racial disparities were evident with black women, Hispanic women, and non-Hispanic Indian or Alaska Native women experiencing higher mortality ratios, emphasizing the need for culturally sensitive interventions that address the unique challenges faced by these populations.

To address these trends, it is essential to focus on prevention by tackling the many causes of substance use disorders and overdose. This may include education, improving access to care, and implementing early intervention programs to help women avoid substance use. Equally important is integrating substance use prevention and treatment services into prenatal and postpartum care while extending the continuum of care well into the post-partum period, including access to mental health services, is essential. Encouraging supportive, judgement-free healthcare environments is crucial, as it helps women seek help earlier without fear of stigma or punitive consequences.

The challenges presented by the data are significant, but so are the opportunities to make a difference. With collective effort we can work towards reversing these trends and ensure a healthier future for mothers and their children.

References:

Han B, Compton WM, Einstein EB, Elder E, Volkow ND. Pregnancy and Postpartum Drug Overdose Deaths in the US Before and During the COVID-19 Pandemic. (2024). JAMA Psychiatry, 81(3):270–283. doi:10.1001/jamapsychiatry.2023.4523

Knight, M., Bunch, K., Kenyon, S., Tuffnell, D., & Kurinczuk, J. (2020). A national population‐based cohort study to investigate inequalities in maternal mortality in the United Kingdom, 2009‐17. Paediatric and Perinatal Epidemiology, 34(4), 392-398. https://doi.org/10.1111/ppe.12640