With the rising epidemic of opioid, the general public has overlooked one vulnerable group, new moms. In a new study at the University of Utah, it discovered that the most common cause of pregnancy-associated death in Utah is drug-induced death. Postpartum women who have previously or currently struggled with substance abuse are at a higher risk of overdosing.
The team of researchers examined the need for continued substance abuse counseling, access to naloxone prescriptions and mental health care in the year following childbirth. The researchers published the results of their findings in the journal Obstetrics & Gynecology.
The first author of the paper and an assistant professor of material and fetal medicine at U of U Health, Mercela Smid, M.D., M.S., M.A., said that death is the tip of the iceberg for moms who deal with addiction. The point of the study is to determine when moms are most vulnerable, and it's the postpartum period.
From 2005 to 2014, in a retrospective study, Smid compared the characteristics of women who experienced pregnancy-associated deaths (deaths of a woman during pregnancy or within one year from the end of a pregnancy). She discovered that drug-induced deaths were the leading cause of pregnancy-associated death for women in Utah with more than three-quarters of the deaths associated with opioids.
Smid explained that 80 percent of deaths were in the late postpartum period after mom has finished her last check-up with the obstetricians. There is a need to look at fourth-trimester care and how to enhance this care, particularly women with substance use.
The research investigated 136 pregnancy-associated deaths using the Utah Perinatal Mortality Review Committee database. Twenty percent of these cases were connected to drug use. Almost three-quarters of the drug-induced deaths were linked to opioids. It was also surprising that 42 percent of pregnant women insured through Medicaid in Utah are prescribed opioids for back pain, abdominal pain, headache or migraine, joint pain or another pain diagnosis.
None of the women in the study were screened for drug use during prenatal, delivery or postpartum care even when the majority of them had drug misuse or substance use disorder in their medical files. Fewer than half received a social work consultation (14/35, 40 percent) or mental health counseling (9/35, 26 percent). None of the women were taking buprenorphine or methadone to treat opioid use disorder.
In his note, Smid explained that the study is based in a state with a small population and does not include insurance status at the time of death or insurance lapses. Also, it lacks complete data on abuse or intimate partner violence and complete information about substance use treatment or social circumstances.
Smid concluded by saying that they cannot do anything for the moms who died, but as a health care institution, they can identify the holes in care and plug them. What they need is to develop an addiction-knowledgeable obstetrics workforce.
