Opioids account for a quarter of pregnancy-related deaths in Utah, according to a new study.
The rate of women dying shortly before or after giving birth in the US is staggering, higher than in any other developed country.
Overwhelmingly, heart disease is to blame, but each state has its own unique set of problems.
New research by Dr Marcela Smid at the University of Utah shows Utah, which has one of the highest maternal mortality rates in the country, is particularly blighted by drug use after delivery.
Most of the deaths (80 percent) were months after childbirth, when mothers have typically stopped seeing their doctor for follow ups. A quarter of deaths were caused by drugs, mainly opioids
‘Death is the tip of the iceberg for moms who deal with addiction, these are the women that we can see,’ said Marcela Smid, MD, an assistant professor of maternal and fetal medicine at U of U Health and first author on the paper.
‘The point of this study is to determine when our moms are most vulnerable, and it’s the postpartum period.’
The opioid epidemic has blighted the US, lowering the life expectancy and killing more Americans in one year than died in the entire Vietnam War.
It all started with soaring rates of prescriptions for highly-addictive painkillers, which began in the 1980s and reached a height in the early 2000s.
Opioid use soared in every demographic, including the most vulnerable.
Around 14 to 40 percent of pregnant women will receive an opioid prescription during their pregnancy to treat migraines, joint pain, and back pain, among other things, and millions of women are prescribed opioids for pain after delivery.
It’s particularly a problem in Utah, where nearly half (42 percent) of the state’s pregnant women on Medicaid had received an opioid prescription – more than any other state.
Dr Smid’s new study looked at data on women who died while pregnant or within a year of giving birth between 2005 and 2014. They identified 136 deaths that fit the criteria.
Most of the deaths (80 percent) were months after childbirth, when mothers have typically stopped seeing their doctor for follow ups.
A quarter of deaths were caused by drugs, mainly opioids – more than the rates for blood clots and car accidents combined.
None of them had been screened for drug use, only a quarter had received counseling, and none were on methadone or buprenorphine to treat addiction.
Most of them (57 percent) died at home.
During the study time period – the years that led to the climax of America’s overdose epidemic – the ratio of drug-related deaths during pregnancy soared 200 percent.
The finding adds weight to the recent recommendation from the American College of Obstetricians and Gynecologists: that we should recognize there are four trimesters to pregnancy, rather than three, including a mother’s recovery post-partum far beyond the six-week cut-off point currently in place.
‘We need to really look at fourth trimester care and how to enhance this care, especially women with substance use,’ Dr Smid said.
For women who struggled with drug use before pregnancy, the post-partum period can be particularly destabilizing.
Most women reduce their drug intake during pregnancy whether they suffered from addiction or not.
As a result, those who return to substances after nine months off, may have a much lower tolerance than they expect.
What’s more, there are hormonal changes, postpartum depression, stress and sleep deprivation from infant care, strain of intimate relationships and loss of insurance – pressure which can drive people to self-medicate with numbing pills.
‘We cannot do anything for the moms who died, but as a health care institution, we can identify the holes in care and plug them,’ Dr Smid said.
‘We need to develop an addiction-knowledgeable obstetrics workforce.’
Dr Smid warns that these results are not unique to Utah.
But researchers have struggled to map out the details of the maternal mortality crisis in each state and across the country.
The bodies that collect national data (including the CDC, WHO, ACOG and IHME) have each published wildly varied numbers and hypotheses.
This is largely to do with the inconsistency in how states record mothers’ deaths, a recent feature by Scientific American points out.
Each state differs in what qualifies as a pregnancy-related death.
While some (as Smid does in this study) comply with the CDC’s definition of pregnancy-related death as extending up to a year after birth, some only count a few months.
What’s more, many states have been inconsistent in even collecting data at all.
As is the case for many states, Utah has only been reviewing mothers’ deaths since 1995.
There is no regularity to its reports.
Until 2004, the state only analyzed deaths related to weight and age.
The latest report, in 2017, was brief, with a list of causes of death and the death rate, but no analysis or detail.