Background
Reducing maternal mortality is a priority in the United States and worldwide. Drug-related
deaths and suicide may account for a substantial and growing portion of maternal deaths,
yet information on the incidence of and sociodemographic variation in these deaths
is scarce.
Objective
We sought to examine incidence of drug-related and suicide deaths in the 12 months
after delivery, including heterogeneity by sociodemographic factors. We also explored
maternal decedents’ health care utilization prior to death.
Study Design
This retrospective, population-based cohort study followed up 1,059,713 women who
delivered a live-born infant in California hospitals during 2010–2012 to ascertain
maternal death. Analyses were conducted using statewide, all-payer, longitudinally-linked
hospital and death data.
Results
A total of 300 women died during follow-up, a rate of 28.33 deaths per 100,000 person-years.
The leading cause of death was obstetric-related problems (6.52 per 100,000 person-years).
Drug-related deaths were the second leading cause of death (3.68 per 100,000 person-years),
and suicide was the seventh leading cause (1.42 per 100,000 person-years); together
these deaths comprised 18% of all maternal deaths. Non-Hispanic white women, Medicaid-insured
women, and women residing in micropolitan areas were especially likely to die from
drugs/suicide. Two thirds of women who died, including 74% of those who died by drugs/suicide,
made ≥1 emergency department or hospital visit between their delivery and death.
Conclusion
Deaths caused by drugs and suicide are a major contributor to mortality in the postpartum
period and warrant increased clinical attention, including recognition by physicians
and Maternal Mortality Review Committees as a medical cause of death. Importantly,
emergency department and inpatient hospital visits may serve as a point of identification
of, and eventually prevention for, women at risk for these deaths.
Key words
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Article Info
Publication History
Published online: June 04, 2019
Accepted:
May 29,
2019
Received in revised form:
May 17,
2019
Received:
April 1,
2019
Footnotes
This study was supported, in part, through National Institutes of Health grant R15 MH113108-01 (to S.G.-M.), as well as through National Institutes of Health grant K01-HL128843 (to C.M.). Neither sponsor had any role in the study design; collection, analysis, or interpretation of data; writing of the report; or decision to submit the article for publication.
The authors report no conflict of interest.
Cite this article as: Goldman-Mellor S, Margerison CE. Maternal drug-related death and suicide are leading causes of postpartum death in California. Am J Obstet Gynecol 2019;221:489.e1-9.
Identification
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© 2019 Elsevier Inc. All rights reserved.
