Trends in pregnancy-associated mortality involving opioids in the United States, 2007–2016

Gemmill, Alison; Kiang, Mathew V.; Alexander, Monica

doi:10.1016/j.ajog.2018.09.028

Cited by 94 publications

(72 citation statements)

References 5 publications

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“…Other population-based studies report increased perinatal maternal mortality in mothers using opioids [5,16,17] and longer-term risk in mothers with alcohol or drug misuse during pregnancy [20,22] (Table 1). None of these studies address long-term all-cause mortality for mothers of NAS-affected infants as we have done.…”

Section: Discussionmentioning

confidence: 99%

“…Other countries such as England have seen similar rates of increase in prescription opioid use but not concomitant increases in mortality rates, likely related in part to better access to addiction treatment and more oversight of prescription opioids [4]. Across all of these jurisdictions, there is increasing opioid use by pregnant women, and while little is known about associated maternal mortality, a recent study using data from 22 US states and the District of Columbia reports a higher than 3-fold increase from 2007 to 2017 in opioid-related deaths in women during or within the first year after pregnancy [5].…”

Section: Introductionmentioning

confidence: 99%

“…Evidence on mortality for mothers who use opioids in pregnancy is limited but consistently shows increased rates around the time of delivery (Table 1) [5,16–18]. Very high rates of longer-term maternal mortality have been reported in 2 older studies (1 Australian and 1 Finnish) [19,20], but these studies may not reflect the current opioid epidemic in North America or the UK [4].…”

Section: Introductionmentioning

confidence: 99%

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Long-term mortality in mothers of infants with neonatal abstinence syndrome: A population-based parallel-cohort study in England and Ontario, Canada

Guttmann

Blackburn²,

Amartey

et al. 2019

PLoS Med

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BackgroundOpioid addiction is a major public health threat to healthy life expectancy; however, little is known of long-term mortality for mothers with opioid use in pregnancy. Pregnancy and delivery care are opportunities to improve access to addiction and supportive services. Treating neonatal abstinence syndrome (NAS) as a marker of opioid use during pregnancy, this study reports long-term maternal mortality among mothers with a birth affected by NAS in relation to that of mothers without a NAS-affected birth in 2 high-prevalence jurisdictions, England and Ontario, Canada.Methods and findingsWe conducted a population-based study using linked administrative health data to develop parallel cohorts of mother–infant dyads in England and Ontario between 2002 and 2012. The study population comprised 13,577 and 4,966 mothers of infants with NAS and 4,205,675 and 929,985 control mothers in England and Ontario, respectively. Death records captured all-cause maternal mortality after delivery through March 31, 2016, and cause-specific maternal mortality to December 31, 2014. The primary exposure was a live birth of an infant with NAS, and the main outcome was all deaths among mothers following their date of delivery. We modelled the association between NAS and all-cause maternal mortality using Cox regression, and the cumulative incidence of cause-specific mortality within a competing risks framework. All-cause mortality rates, 10-year cumulative incidence risk of death, and crude and age-adjusted hazard ratios were calculated. Estimated crude 10-year mortality based on Kaplan–Meier curves in mothers of infants with NAS was 5.1% (95% CI 4.7%–5.6%) in England and 4.6% (95% CI 3.8%–5.5%) in Ontario versus 0.4% (95% CI 0.41%–0.42%) in England and 0.4% (95% CI 0.38%–0.41%) in Ontario for controls (p < 0.001 for all comparisons). Survival curves showed no clear inflection point or period of heightened risk. The crude hazard ratio for all-cause mortality was 12.1 (95% 11.1–13.2; p < 0.001) in England and 11.4 (9.7–13.4; p < 0.001) in Ontario; age adjustment did not reduce the hazard ratios. The cumulative incidence of death was higher among NAS mothers than controls for almost all causes of death. The majority of deaths were by avoidable causes, defined as those that are preventable, amenable to care, or both. Limitations included lack of direct measures of maternal opioid use, other substance misuse, and treatments or supports received.ConclusionsIn this study, we found that approximately 1 in 20 mothers of infants with NAS died within 10 years of delivery in both England and Canada—a mortality risk 11–12 times higher than for control mothers. Risk of death was not limited to the early postpartum period targeted by most public health programs. Policy responses to the current opioid epidemic require effective strategies for long-term support to improve the health and welfare of opioid-using mothers and their children.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term mortality in mothers of infants with neonatal abstinence syndrome: A population-based parallel-cohort study in England and Ontario, Canada

Guttmann

Blackburn²,

Amartey

et al. 2019

PLoS Med

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“…Study participants are comprised of [ 1 ] community health-care providers and [ 2 ] pregnant women with OUD. Community health-care providers include nurse practitioners, physician’s assistants, obstetricians, pediatricians, family practice physicians, behavioral health care professionals, and child protective services caseworkers practicing within the targeted counties who are willing to participate in the educational sessions delivered by the project team and provide informed consent.…”

Section: Methodsmentioning

confidence: 99%

“…Opioid use disorder (OUD) among women delivering at a hospital has increased 400% from 1999–2014 in the United States [ 1 ] From the years 2007 to 2016, opioid-related mortality during pregnancy increased over 200%, and drug-overdose deaths made up nearly 10% of all pregnancy-associated mortality in 2016 in the US [ 2 ]. Access to care and lack of provider understanding of evidence-based treatment for perinatal OUD are both contributing factors to drug-related pregnancy-associated and pregnancy-related deaths, particularly in rural areas [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Addressing opioid use disorder among rural pregnant and postpartum women: a study protocol

Bryan

Smid

Cheng

et al. 2020

Addict Sci Clin Pract

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Background Opioid use disorder (OUD) among women delivering at a hospital has increased 400% from 1999–2014 in the United States. From the years 2007 to 2016, opioid-related mortality during pregnancy increased over 200%, and drug-overdose deaths made up nearly 10% of all pregnancy-associated mortality in 2016 in the US. Disproportionately higher rates of neonatal opioid withdrawal syndrome (NOWS) have been reported in rural areas of the country, suggesting that perinatal OUD is a pressing issue among these communities. There is an urgent need for comprehensive, evidence-based treatment services for pregnant women experiencing OUD. The purpose of this article is to describe a study protocol aimed at developing and evaluating a perinatal OUD curriculum, enhancing evidence-based perinatal OUD treatment in a rural setting, and evaluating the implementation of such collaborative care for perinatal OUD. Methods This two-year study employed a one group, repeated measures, hybrid type-1 effectiveness-implementation design. This study delivered interventions at 2 levels, both targeting improvement of care for pregnant women with OUD. The first area of focus was at the community healthcare provider-level, which aimed to evaluate the acceptability and feasibility of perinatal OUD education across time and to improve provider education by increasing knowledge specific to: MOUD provision; screening, brief intervention, and referral to treatment (SBIRT) utilization; and NOWS treatment. The second area of intervention focus was at the patient-level, which assessed the preliminary effect of perinatal OUD provider education in promoting illicit opioid abstinence and treatment engagement among pregnant women with OUD. We adopted constructs from the Consolidated Framework for Implementation Research (CFIR) to assess contextual factors that may influence implementation, and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model to comprehensively evaluate implementation outcomes. Discussion This article presents the protocol of an implementation study that is employing the CFIR and RE-AIM frameworks to implement and evaluate a perinatal OUD education and service coordination program in two rural counties. This protocol could serve as a model for clinicians and researchers seeking to implement improvements in perinatal care for women with OUD in other rural communities. Trial registration NCT04448015 clinicaltrials.gov.

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US Trends in Drug Overdose Mortality Among Pregnant and Postpartum Persons, 2017-2020

Bruzelius

Martins

2022

JAMA

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Trends in pregnancy-associated mortality involving opioids in the United States, 2007–2016

Cited by 94 publications

References 5 publications

Long-term mortality in mothers of infants with neonatal abstinence syndrome: A population-based parallel-cohort study in England and Ontario, Canada

Long-term mortality in mothers of infants with neonatal abstinence syndrome: A population-based parallel-cohort study in England and Ontario, Canada

Addressing opioid use disorder among rural pregnant and postpartum women: a study protocol

US Trends in Drug Overdose Mortality Among Pregnant and Postpartum Persons, 2017-2020

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