Drug overdose deaths among pregnant and postpartum women increased more than 180 percent in the past five years, according to a new study conducted at Columbia University Mailman School of Public Health. The analysis also revealed that the number of pregnancy-associated overdose deaths reached a record high in 2020, likely exacerbated by social, economic, and healthcare disruptions associated with the COVID-19 pandemic. The findings are published in Journal of Pediatrics.

We've seen significant increases in fatal and nonfatal overdose in the general population during the pandemic. It now appears that pregnant and postpartum womenare being affected as well."

Emilie Bruzelius, MPH, doctoral student in the Department of Epidemiology at Columbia Mailman School and first author

Pregnancy-associated overdose deaths between 2017 and 2020 were identified from national death certificate data which includes information on whether the death occurred among a person who was currently or recently pregnant. The researchers calculated annual overdose mortality rates and examined the specific drug types involved in each overdose. For comparison, the researchers also calculated overdose mortality rates among reproductive age women overall (who were not pregnant).

Of the 7,642 pregnancy-associated deaths occurring among pregnant and postpartum women, 1,249 were due to drug overdose. Over the four-year period, overdose mortality increased more than 80 percent to a high of 11.85 per 100,000 in 2020, compared to a 38 percent increase among reproductive age women overall. For both groups, increases in overdose mortality in 2020 were more were more pronounced than increases in any other prior year.

Pregnancy-associated overdose deaths involving benzodiazepines, heroin and prescription opioids were mostly stable from 2017 and 2020, versus large increases in deaths involving fentanyl, methamphetamines and cocaine. Increases in fentanyl-involved deaths were especially marked in 2020, nearly doubling.

"Pregnant and postpartum people are known to face barriers to accessing drug treatment and harm reduction services, that when compounded by pandemic-associated stressors, healthcare shutdowns, and an increasingly volatile unregulated drug supply, may have increased fatal overdose risk," said Bruzelius.

"Enhanced strategies supporting substance use prevention, treatment, and harm reduction efforts among pregnant and postpartum people are critical and much needed. We expect new and improved approaches will help address the concerning trends we are seeing," noted Silvia Martins, MD, PhD, professor of epidemiology and senior author.