Fentanyl and psychostimulants were responsible for much of an 81% increase in fatal overdoses among pregnant and postpartum Americans in 2017–20, a study shows. “Although steady increases in pregnancy-associated overdose deaths have been observed previously from 2007 to 2019, the increase observed in 2020 was more pronounced than in previous years,” the authors write. “Pregnant and postpartum persons are known to face barriers to accessing drug treatment and harm reduction services, which when compounded by pandemic-associated stressors, health care shutdowns, and an increasingly volatile unregulated drug supply may have increased fatal overdose risk.”
Data on pregnancy-associated deaths were obtained from the restricted National Vital Statistics System mortality files for 2017 to 2020. Pregnancy checkbox options on death certificates were pregnant at the time of death, within 42 days of death (early postpartum), and within 43-365 days of death (late postpartum). Annual overdose mortality rates showed these patterns in absolute and relative terms by drug type and pregnancy timing: “Of the 7,642 pregnancy-associated deaths between 2017 and 2020, 1,249 were overdose-related, corresponding to a cumulative overdose mortality rate of 8.35 per 100,000 (95% CI, 7.89-8.83 per 100,000). Over the study period, pregnancy-associated overdose mortality increased from 6.56 to 11.85 per 100,000 (absolute change rate, 5.30 [95% CI, 3.90-6.72] per 100,000; relative increase of 81%). Overdose mortality among reproductive age persons identified on death certificates as female similarly increased from 14.37 to 19.76 per 100,000 (absolute change rate, 5.39 [95% CI, 4.94-5.85] per 100,000; relative increase of 38%). For both groups, increases in overdose mortality in 2020 were more pronounced than increases during any prior year.
“Pregnancy-associated overdose deaths involving benzodiazepines, heroin, and prescription opioids were mostly stable from 2017 to 2020, whereas large increases in deaths involving fentanyl and other synthetics and psychostimulants (eg, methamphetamine, cocaine) were observed. Increases in deaths due to fentanyl and other synthetics were especially marked in 2020, increasing from 5.73 per 100,000 (95% CI, 5.00-6.56 per 100,000) to 9.47 per 100 000 (95% CI, 8.50-10.54 per 100,000).…”