Overdoses and suicides were among the most common reasons for mothers dying within a year of giving birth in California, according to a new study from Michigan State University and the University of California, Merced.
Lead author Sidra Goldman-Mellor, a psychiatric epidemiologist at UC Merced, and co-author Claire Margerison, a perinatal epidemiologist at MSU, studied more than 1 million California hospital records from 2010 to 2012 to investigate the most common causes of postpartum death.
The study is published in the American Journal of Obstetrics and Gynecology and was funded by the National Institutes of Health.
While maternal death rates during and after pregnancy are on the rise in the United States, California is below the national average. Nevertheless, drug overdose was the second leading cause of death among California mothers within the first year after giving birth, and suicide ranked seventh.
Together, the two causes made up nearly 20% of all California postpartum deaths in those years. Risk of postpartum mortality due to drug overdose and suicide was higher among non-Hispanic white and low-income women.
These deaths are rare but devastating for families. We need to place more emphasis on prevention."
Claire Margerison, perinatal epidemiologist at MSU
While both researchers agree that two years of data is not enough to identify trends, the study could be a jumping-off point for future work into drug- and suicide-related issues surrounding maternal health. The research could also be indicative of what's happening across the U.S.
"Reducing maternal mortality is a priority in the U.S. and worldwide," Goldman-Mellor said. "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."
Mortality rates have declined in recent years in California because of concerted efforts to improve quality of care, but the researchers pointed out that their data shows mental health and substance use issues are still affecting a large number of new mothers.
"Most of these deaths occur in the second half of the year after birth," Goldman-Mellor said.
It's because of this, Margerison added, that the later postpartum period is an important time to continue providing women with substance use and mental health resources.
One reason contributing to these deaths might be the stigma and potential legal repercussions that remain around admitting to and getting help for substance abuse or psychiatric problems, especially among new mothers, Goldman-Mellor said.
The researchers, who studied epidemiology together as graduate students at UC Berkeley, said they plan to work together to learn more about this and other topics surrounding maternal health outcomes.
Goldman-Mellor said further studies could deepen researchers' understanding of why certain women faced higher and/or lower risk for postpartum death due to drug overdose or suicide, including potentially important factors related to their socioeconomic status, health care access and cultural sources of support.
And, because about 75% of the women who died in the first year had accessed hospital emergency rooms at least once after giving birth, potential intervention points could be identified, as well.
"These deaths are likely just the tip of the iceberg in terms of substance use and mental distress," Margerison said. "We need to take the next steps to understand how to help women who experience these problems during and after pregnancy."
Michigan State University
Goldman-Mellor, S & Margerison, C.E (2019) Maternal drug-related death and suicide are leading causes of post-partum death in California. American Journal of Obstetrics & Gynecology. doi.org/10.1016/j.ajog.2019.05.045.