Drugs, Suicide Among Leading Causes of Postpartum Death in California

Drug-related deaths are second only to deaths from obstetric complications among women in California who die within a year of giving birth, a study in the American Journal of Obstetrics and Gynecology has found. Suicide ranked seventh as a cause of death in this population.

“We knew that maternal mortality rates in the United States have been increasing over the past 10 to 15 years. However, the official national statistics on maternal mortality do not include maternal deaths due to drugs or suicide,” said study co-author Sidra Goldman-Mellor, Ph.D., an assistant professor of public health at the University of California, Merced. She noted that over the past 15 years, there has been an uptick in deaths from drugs and suicide in the general population. “To inform clinical intervention and prevention efforts, we wanted to understand the extent to which drug-related and suicide deaths also affected new mothers.”

Together with Claire E. Margerison, Ph.D., an associate professor of epidemiology and biostatistics at Michigan State University, Goldman-Mellor analyzed the health records of more than 1 million women who delivered a living infant in California hospitals between 2010 and 2012. During the period studied, 300 women died within a year of giving birth, and drug-related causes and suicide together were responsible for roughly 1 in 6 of those deaths. Black women had the highest overall rate of postpartum death; non-Hispanic white women and women whose delivery costs were covered by Medicaid or paid by the patient also had an elevated risk of drug-related death or suicide.

Three-fourths of the women who died from drug-related causes or suicide had visited an emergency department (ED) or hospital at least once between giving birth and dying.

“This suggests that ED and hospital visits may serve as a point of identification of, or eventually intervention for, women at high risk for postpartum death,” Goldman-Mellor told Psychiatric News. “We think that, although guidelines recommend that all women be screened for postpartum depression and other mental and substance use problems at their six-week postpartum visit, many women may be slipping through the cracks and not getting the care they need during the postpartum period.”

Goldman-Mellor noted the potential value of teamwork in ensuring women receive the care they need.

“Integration of care between psychiatrists and OB-GYNs during and after pregnancy could be helpful, and psychiatrists treating pregnant women for substance use disorders or mental health problems should be aware that it is important to maintain the continuity of that care after delivery of the baby,” said Goldman-Mellor, who is also director of the Health Sciences Research Institute Biostatistics and Data Support Center.

“A big part of why we wanted to do this study is because the predominant focus in perinatal clinical medicine and public health is on the baby’s well-being. It goes without saying that that is vitally important. But our research, and similar research from other states, shows that mothers in the United States are also suffering and dying from largely preventable causes,” she added. “Their deaths are devastating and have profound implications for their families, loved ones, and communities, and more attention should be paid to the welfare of women during pregnancy and postpartum.” This study was supported in part by the National Institutes of Health. ■

Maternal Drug-Related Death and Suicide Are Leading Causes of Postpartum Death in California” is posted here.