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Fatal and Nonfatal Overdose Among Pregnant and Postpartum Women in Massachusetts

Schiff, Davida M., MD, MSc; Nielsen, Timothy, MPH; Terplan, Mishka, MD, MPH; Hood, Malena, MPH; Bernson, Dana, MPH; Diop, Hafsatou, MD, MPH; Bharel, Monica, MD, MPH; Wilens, Timothy E., MD; LaRochelle, Marc, MD, MPH; Walley, Alexander Y., MD, MSc; Land, Thomas, PhD

doi: 10.1097/AOG.0000000000002734
Opioids: Original Research: PDF Only

OBJECTIVE: To estimate fatal and nonfatal opioid overdose events in pregnant and postpartum women in Massachusetts, comparing rates in individuals receiving and not receiving pharmacotherapy for opioid use disorder (OUD).

METHODS: We conducted a population-based retrospective cohort study using linked administrative and vital statistics databases in Massachusetts to identify women with evidence of OUD who delivered a liveborn neonate in 2012–2014. We described maternal sociodemographic, medical, and substance use characteristics, computed rates of opioid overdose events in the year before and after delivery, and compared overdose rates by receipt of pharmacotherapy with methadone or buprenorphine in the prenatal and postpartum periods.

RESULTS: Among 177,876 unique deliveries, 4,154 (2.3%) were to women with evidence of OUD in the year before delivery, who experienced 242 total opioid-related overdose events (231 nonfatal, 11 fatal) in the year before or after delivery. The overall overdose rate was 8.0 per 100,000 person-days. Overdoses were lowest in the third trimester (3.3/100,000 person-days in the third trimester) and then increased in the postpartum period with the highest overdose rate 7–12 months after delivery (12.3/100,000 person-days). Overall, 64.3% of women with evidence of OUD in the year before delivery received any pharmacotherapy in the year before delivery. Women receiving pharmacotherapy had reduced overdose rates in the early postpartum period.

CONCLUSION: Pregnant women in Massachusetts have high rates of OUD. The year after delivery is a vulnerable period for women with OUD. Additional longitudinal supports and interventions tailored to women in the first year postpartum are needed to prevent and reduce overdose events.

Opioid overdose events decline during pregnancy but increase after delivery; receipt of pharmacotherapy is associated with reduced overdose events in pregnant and postpartum women.

Division of General Academic Pediatrics, MassGeneral Hospital for Children, the Department of Pediatrics and the Section of General Internal Medicine, Boston Medical Center, and the Massachusetts Department of Public Health, Boston, Massachusetts; the Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia; and the Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, and the Division of Preventive and Behavioral Medicine and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.

Corresponding author: Davida M. Schiff, MD, MSc, 125 Nashua Street, Boston, MA 02114; email: Davida.schiff@mgh.harvard.edu.

Dr. Schiff was supported by HRSA T32HP10028; Dr. Larochelle was supported by NIDA (K23 DA042168) and a Boston University School of Medicine Department of Medicine Career Investment Award; Mr. Nielsen was supported by the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists and funded by the Centers for Disease Control and Prevention Cooperative Agreement Number 1U38OT000143-04.

Presented at the Massachusetts Perinatal Quality Collaborative Meeting: Improving the Care of Opioid-Exposed Newborns and their Families, September 27, 2017, Framingham, Massachusetts.

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank the Massachusetts Department of Public Health for creating the unique, cross-sector database used for this project and for providing technical support for the analysis; Drs. Susan Manning and Nick Somerville who provided feedback on the project design; and Drs. Elsie Taveras, Mardge Cohen, and Simeon Kimmel for their critical reviews of an earlier version of the manuscript.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received February 15, 2018. Received in revised form April 13, 2018. Accepted April 26, 2018.

Received February 15, 2018

Received in revised form April 13, 2018

Accepted May 09, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.