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• W2892978342 abstract "Despite concurrent increases in opioid- and pregnancy-associated mortality in the United States, little is known about the contribution of opioids to pregnancy-associated deaths. We describe levels and trends of pregnancy-associated mortality from any cause in which the death also involved opioids. We used death certificate and live birth data from the US National Vital Statistics System from 2007 to 2016. We identified pregnancy-associated deaths, defined as death from any cause while pregnant or within 1 year of pregnancy termination,1Horon I.L. Cheng D. Effectiveness of pregnancy check boxes on death certificates in identifying pregnancy-associated mortality.Public Health Rep. 2011; 126: 195-200Crossref PubMed Scopus (38) Google Scholar for women aged 15–49 years using the pregnancy checkbox on state death certificates. The checkbox indicates whether a female decedent was pregnant within the past year or at the time of death. To account for state differences in case ascertainment,2Davis N.L. Hoyert D.L. Goodman D.A. Hirai A.H. Callaghan W.M. Contribution of maternal age and pregnancy checkbox on maternal mortality ratios in the United States, 1978–2012.Am J Obstet Gynecol. 2017; 217: 352.e1-352.e7Abstract Full Text Full Text PDF Scopus (39) Google Scholar we limited our analysis to the 22 states and the District of Columbia that included the checkbox as of 2007. (The states included in the analysis were Connecticut, Delaware, Florida, Idaho, Kansas, Michigan, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Texas, Utah, Washington, and Wyoming). Pregnancy-associated deaths included International Classification of Diseases, 10th revision, codes A34 or O00-99, while opioid-related deaths had at least 1 opioid poisoning code (T40.0–T40.4, T40.6); deaths that were both pregnancy associated and involved opioids contained a combination of these codes. We calculated pregnancy-associated mortality ratios, expressed as deaths per 100,000 live births, for all deaths and for those involving opioids; ratios were calculated separately for all residents, non-Hispanic whites, and non-Hispanic blacks. We also calculated the distribution of pregnancy-associated deaths involving opioids by time of death and International Classification of Diseases–defined opioid type (eg, heroin [T40.1]; other natural/semisynthetic [T40.2]; methadone [T40.3]; and other synthetic [T40.4]). This study was classified as exempt by the Harvard School of Public Health Institutional Review Board. Materials to reproduce the analysis are available at https://github.com/MJAlexander/opioid-maternal. Between 2007 and 2016, the pregnancy-associated mortality ratio increased 34% (31.7 to 42.3). Concurrently, pregnancy-associated mortality involving opioids more than doubled in terms of both the rate (1.3 to 4.2; Figure) and the percentage of all pregnancy-associated deaths (4% to 10%). These increases were most pronounced for white women despite their lower risk of all-cause, pregnancy-associated mortality compared with non-Hispanic black women (Figure). The majority (70% in 2016) of pregnancy-associated deaths involving opioids occurred during pregnancy or within 42 days of pregnancy termination. The share of deaths involving methadone or natural/semisynthetic opioids (excluding heroin) declined substantially, and by 2016, 78% of deaths involving opioids were due to heroin or other synthetic opioids, up from 17% in 2007. Similar to trends in opioid-related mortality in the general population,3Gomes T. Tadrous M. Mamdani M.M. Paterson J.M. Juurlink D.N. The burden of opioid-related mortality in the United States.JAMA Network Open. 2018; 1: e180217Crossref PubMed Scopus (325) Google Scholar we find a substantial increase in pregnancy-associated mortality involving opioids between 2007 and 2016. The patterns we observe, including rising trends among white women and increases in deaths involving heroin and other synthetic opioids, also mirror the broader opioid epidemic.4Alexander M.J. Kiang M.V. Barbieri M. Trends in black and white opioid mortality in the United States, 1979–2015.Epidemiology. 2018; 29: 707-715Crossref PubMed Scopus (110) Google Scholar" @default.
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• W2892978342 date "2019-01-01" @default.
• W2892978342 modified "2023-10-14" @default.
• W2892978342 title "Trends in pregnancy-associated mortality involving opioids in the United States, 2007–2016" @default.
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• W2892978342 doi "https://doi.org/10.1016/j.ajog.2018.09.028" @default.
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