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Maternal Deaths Due to Suicide and Overdose in the State of Michigan 2008-2018

Published:November 11, 2022DOI:https://doi.org/10.1016/j.ajogmf.2022.100811

      AJOG MFM at a Glance

      • A
        Why was this study conducted? Maternal mortality due to behavioral health issues remains a leading cause of death, with rates of substance use and mental illness on the rise. This review provides a granular assessment of maternal and obstetric characteristics of patients who died of suicide or overdose.
      • B
        What are the key findings? Pregnant and postpartum individuals were not optimally treated for their substance use disorder or mental illness despite having multiple risk factors acknowledged in their medical records.
      • C
        What does this study add to what is already known? Most individuals were identified as having risk factors for mental illness and substance use disorder through screening in the perinatal period. Initiatives focusing on supporting and coordinating multidisciplinary care and treatment once patients are identified should be prioritized.

      Abstract

      Objective

      : To provide a granular assessment of maternal deaths due to suicide or drug overdose in the state of Michigan from 2008-2018.

      Methods

      : This retrospective study involved the secondary review of deceased patients’ records from 2008-2018 stored at the Michigan Department of Health and Human Services through the Michigan Maternal Mortality Surveillance Program. Pregnancy related and pregnancy associated deaths were reviewed. A descriptive analysis of maternal characteristics and identified trends are presented in de-identified aggregate form.

      Results

      : There were 237 maternal deaths due to suicide or overdose from 2008-2018 included in the review. Overall, 70.9% had a documented psychiatric illness in their medical chart, with 48.1% having two or more psychiatric illnesses. However, only 34.5% (58/168) of these patients had documentation of taking psychotropic medication for their illness. 71.1% (138/194) of those who died due to accidental or indeterminant substance overdose had a known history of substance use disorder. Only 27.4% (43/157) of patients with a documented substance use disorder received medication assisted treatment. Of the substance overdose deaths, 42.9% had an opioid prescription, 44.3% had a benzodiazepine prescription, and 32.5% had a prescription for both. Prescription opioids were the most common substance found on postmortem toxicology report, and of these patients, 45.9% had a physician prescribed opioid.

      Conclusion

      : Most pregnant individuals had documented significant risk factors for mental illness or substance use disorder, however very few had documented pharmacological therapy for their psychiatric or addiction illness. There is an urgent need to implement effective multidisciplinary health system mitigation strategies that address pregnancy and its intersection with behavioral health.

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