Patterns of Infectious Disease Associated With Injection Drug Use in Massachusetts

Gonsalves, Gregg; Paltiel, A. David; Thornhill, Thomas; DeMaria, Alfred; Cranston, Kevin; Klevens, R. Monina; Warren, Joshua L.

doi:10.1093/cid/ciad073

Cited by 5 publications

(1 citation statement)

References 25 publications

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“…The data also document the considerable risks associated with opioid use by birthing people because those with any hospital contact associated with opioid use in the year before pregnancy were more than six times more likely to experience pregnancy-associated but not pregnancy-related death overall or during the postpartum period. As in the rest of the country, the prevalence of substance use has been increasing in Massachusetts overall 26,27 and among birthing people. 28,29 The allocation of resources within the state to assist birthing people with opioid use disorder appears justified.…”

Section: Discussionmentioning

confidence: 99%

Prior Hospitalization, Severe Maternal Morbidity, and Pregnancy-Associated Deaths in Massachusetts From 2002 to 2019

Declercq,

Cabral,

Liu

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To examine demographic and clinical precursors to pregnancy-associated deaths overall and when pregnancy-related deaths are excluded. METHODS: We conducted a retrospective cohort study based on a Massachusetts population–based data system linking data from live birth and fetal death certificates to corresponding delivery hospital discharge records and a birthing individual's nonbirth hospital contacts and associated death records. Exposures included maternal demographics, severe maternal morbidity (without transfusion), hospitalizations in the 3 years before pregnancy, comorbidities during pregnancy, and opioid use. In cases of postpartum deaths, hospitalization between delivery and death was examined. The primary outcome measure was pregnancy-associated death, defined as death during pregnancy or up to 1 year postpartum. RESULTS: There were 1,291,626 deliveries between 2002 and 2019, of which 384 were linked to pregnancy-associated deaths. Pregnancy-associated but not pregnancy-related deaths (per 100,000 deliveries) were highest for birthing people with opioid use before pregnancy (498.3), severe maternal morbidity (387.3), a comorbidity (106.3), or a prior hospitalization (88.9). In multivariable analysis, the adjusted risk ratios associated with severe maternal morbidity (9.37, 95% CI, 6.14–14.31) and opioid use (6.49, 95%, CI, 3.71–11.35) were highest. Individuals with pregnancy-associated deaths were also more likely to have been hospitalized before or during pregnancy (2.30, 95% CI, 1.62–3.26). Among postpartum deaths, more than two-thirds (69.9%) of birthing people had a hospital contact after delivery and before their death. CONCLUSION: Severe maternal morbidity and opioid use disorder were precursors to pregnancy-associated deaths. Individuals with pregnancy-associated but not pregnancy-related deaths experienced a history of hospital contacts during and after pregnancy before death.

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