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Pregnancy-Associated Death in Utah

Contribution of Drug-Induced Deaths

Smid, Marcela C. MD; Stone, Nicole M. MPH; Baksh, Laurie MPH; Debbink, Michelle P. MD, PhD; Einerson, Brett D. MD; Varner, Michael W. MD; Gordon, Adam J. MD; Clark, Erin A. S. MD

doi: 10.1097/AOG.0000000000003279
Contents: Maternal Morbidity and Mortality: Original Research

OBJECTIVE: Drug-induced deaths, defined as intentional or unintentional consumption of illicit substances or diverted medications leading to death, are the leading cause of death for reproductive-age women in the United States. Our objective was to describe pregnancy-associated deaths attributed to drug-induced causes to identify opportunities for intervention.

METHODS: Using the Utah Perinatal Morality Review Committee database, we performed a retrospective cohort study of all pregnancy-associated deaths—death of a woman during pregnancy or within 1 year from the end of pregnancy—from 2005 to 2014. We performed a detailed descriptive analysis of women with drug-induced deaths. We compared characteristics of women with drug-induced and other pregnancy-associated deaths.

RESULTS: From 2005 to 2014, 136 pregnancy-associated deaths were identified. Drug-induced death was the leading cause of pregnancy-associated death (n=35, 26%) and 89% occurred in the postpartum period. More specifically, those with a drug-induced death were more likely to die in the late postpartum period, defined as death occurring within 43 days to 1 year of the end of the pregnancy, (n=28/35, 80%) compared with women whose deaths were from other pregnancy-associated causes (n=34/101, 34%) (P<.001). The majority of drug-induced deaths were attributed to opioids (n=27/35, 77%), prescription opioids (n=21/35, 60%), and polysubstance use (n=29/35, 83%). From 2005 to 2014, the pregnancy-associated mortality ratio increased 76%, from 23.3 in 2005 to 41.0 in 2014. During this same time period, the drug-induced pregnancy-associated mortality ratio increased 200%, from 3.9 in 2005 to 11.7 in 2014.

CONCLUSION: Drug-induced death is the leading cause of pregnancy-associated death in Utah and occurs primarily in the late postpartum period. Interventional studies focused on identifying and treating women at risk of drug-induced death are urgently needed.

Drug-induced deaths are the leading cause of pregnancy-associated death in Utah, and 89% occur in the postpartum period.

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, the Division of Maternal Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, the Maternal and Infant Health Program, Utah Department of Health, the Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, and the Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, Salt Lake City VA Health Care System, Salt Lake City, Utah.

Corresponding author: Marcela C. Smid, MD, 30N 1900 E #2B200 Salt Lake City, UT 84132; email:

Marcela C. Smid is supported by Women's Reproductive Health Research (WRHR K12, 1K12 HD085816) Career Development Program.

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

Presented in part as a poster at the Society for Maternal-Fetal Medicine’s annual meeting, January 29–February 3, 2018, Dallas, Texas.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.