The number of pregnant women and new mothers dying from drug overdoses grew dramatically as the pandemic took hold, reaching a record high in 2020, a new study finds.
The research, published Tuesday in JAMA, provides a stark look at how substance use disorder is harming pregnant people who are less likely than others to seek or receive help for a dependency on opioids and other drugs.
"Drug use is incredibly stigmatized in general," said Dr. Nora Volkow, director of the National Institute on Drug Abuse. "It goes to an ever higher level of stigma among pregnant women."
Researchers at Columbia University Mailman School of Public Health looked at the death certificates of 7,642 people who died while pregnant or had just given birth from 2017 through 2020. Of those, 1,249 died of a drug overdose — usually from methamphetamine, cocaine or the synthetic opioid fentanyl.
During that time, the rate of overdose deaths in that group nearly doubled, from 6.56 to 11.85 per 100,000. And the rate of overdose deaths particularly sped up in 2020, said Emilie Bruzelius, a doctoral candidate of epidemiology at Columbia. She does not work with pregnant women or those with substance use disorder, but did crunch the numbers for the new research.
"When you stop and take a minute and think about those 1,200 deaths, it's incredibly sad," she said.
Drug overdoses of women in their childbearing years in general also increased, especially during 2020, Bruzelius's study found.
While the rate of overdose deaths among women of childbearing age was higher — 19.76 per 100,000 in 2020, compared with 14.37 per 100,000 in 2017 — the rate of increase was much faster among pregnant women and those who’d given birth within the previous year.
Dr. Tricia Wright, an obstetrician and addiction medicine expert at the University of California, San Francisco, was unsurprised by the latest research.
"Overdose deaths in general have increased, and pregnant women aren't immune to the effects of addiction," Wright said.
Medications to help drug withdrawal
Opioid use among pregnant women has been skyrocketing for more than a decade, increasing by 131% from 2010 to 2017, according to the Centers for Disease Control and Prevention. Left untreated, their babies are more likely to be born too early and at a low birth rate, and must go through drug withdrawal that can last for weeks.
Medications like methadone and buprenorphine to treat the disorder can be used safely in pregnant women and greatly increases the chances mom will carry the baby to full term, said Dr. Stephen Patrick, a neonatologist and director of the Vanderbilt Center for Child Health Policy in Nashville.
"It's not even a question. We know — convincingly — that outcomes are better with these medications," he said. He was not involved with the new research.
Even doctors who treat opioid use disorder may be unlikely to help a woman if she's pregnant. Patrick led a 2020 study that found pregnant women who called treatment centers were less likely than other women to get an appointment.
"Oftentimes what we find is addiction medicine doctors not comfortable taking care of pregnant women, and obstetricians not comfortable taking care of addiction," Patrick said. Pregnant people are left stuck in the middle.
"Pregnant women became even more vulnerable during Covid because access to treatments for anything that wasn't Covid went down," said Dr. Anna Lembke, a professor of psychiatry and addiction medicine at Stanford University School of Medicine.
"So now you've got a population of patients who already have barriers to treatment, are reluctant to access treatment, and then access to treatment isn't readily available," Lembke said. She was not involved in the new study.
"At the same time, fentanyl was increasing everywhere throughout the country," Wright said. "It was kind of a perfect storm."
A Biden administration report, released in October, called for broader access to opioid treatment medication among pregnant women and de-stigmatize addiction treatment during pregnancy.
"The power of stigma is exceptional," Patrick said. "It drives people away from treatment, and kills them."