Comparing Antepartum and Postpartum Opioid-Related Maternal Deaths in the State of Michigan From 2007 to 2015

Objective Opioid use disorder (OUD) continues to be a leading cause of maternal death in the United States. The impact of OUD on pregnancy has dramatically grown in recent years, with OUD-related maternal deaths between 2007 and 2016 nearly doubling. However, the characteristics of pregnancy-associated-not-related (PANR) deaths from opioid overdose are not well understood. Specifically, the timing of OUD-related maternal deaths relative to the partum periods has not been fully described. In this study, we aimed to better characterize high-risk time periods for people with OUD, with the goal of elucidating factors that may contribute to opioid-related PANR deaths. Methods In this retrospective cohort study, we analyzed the Michigan Department of Health and Human Services Maternal Mortality Surveillance Program database from 2007 to 2015 to investigate the temporal trends in opioid-related PANR deaths. Results There was an over fourfold increase in opioid-related PANR from 2007 to 2015 and a maternal mortality ratio of 23.0 per 100,000 births attributable to opioid-related PANR deaths. Ante- and postpartum opioid-related PANR deaths shared similar demographic distribution, were associated with polysubstance use, and had low rates of medication-assisted treatment (MAT). Most opioid-related PANR deaths occurred at a steady rate during the postpartum period. Only 3.6% of people who died in the postpartum period were uninsured, compared to 42.1% of people who died in the antepartum period. Conclusion Though ante and postpartum deaths share many characteristics, our study revealed key distinctions that can help better inform the care of pregnant patients with OUD.