Maternal deaths due to suicide and overdose in the state of Michigan from 2008 to 2018

Published:November 11, 2022DOI:


      Recent reports indicate that the contribution of deaths related to suicide and overdose are increasing, and may be the leading contributors to maternal mortality up to one year postpartum.


      This study aimed to provide a granular assessment of maternal deaths due to suicide or drug overdose in the state of Michigan from 2008 to 2018.


      This retrospective study involved a secondary review of deceased patients’ records from 2008 to 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 was presented in deidentified aggregate form.


      There were 237 maternal deaths due to suicide or overdose from 2008 to 2018 included in the review. Overall, 70.9% had a documented psychiatric illness in their medical chart, with 48.1% having ≥2 psychiatric illnesses. However, only 34.5% (58/168) of these patients had documentation of taking psychotropic medication for their illness. Of those who died because of accidental or indeterminate substance overdose, 71.1% (138/194) 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 those with 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.


      Most pregnant individuals had documented significant risk factors for mental illness or substance use disorder; however, very few had documented pharmacologic 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.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology MFM
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • MacDorman MF
        • Declercq E
        • Cabral H
        • Morton C.
        Recent increases in the U.S. maternal mortality rate: disentangling trends from measurement issues.
        Obstet Gynecol. 2016; 128: 447-455
        • Margerison CE
        • MPH PhD,
        • Roberts MA, MH
        • Gemmill PhD, AMPH
        • Goldman-Mellor PhD, SMPH
        Pregnancy-associated deaths due to drugs, suicide, and homicide in the United States, 2010–2019.
        Obstet Gynecol. 2022; 139: 172-180
        • Mangla K
        • Hoffman MC
        • Trumpff C
        • O'Grady S
        • Monk C
        Maternal self-harm deaths: an unrecognized and preventable outcome.
        Am J Obstet Gynecol. 2019; 221: 295-303
        • McKee K
        • Admon LK
        • Winkelman TNA
        • et al.
        Perinatal mood and anxiety disorders, serious mental illness, and delivery-related health outcomes, United States, 2006-2015.
        BMC Womens Health. 2020; 20: 150
        • Admon LK
        • Dalton VK
        • Kolenic GE
        • et al.
        Trends in suicidality 1 year before and after birth among commercially insured childbearing individuals in the United States, 2006-2017.
        JAMA Psychiatry. 2021; 78: 171-176
        • Kountanis JA
        • Muzik M
        • Chang T
        • et al.
        Relationship between postpartum mood disorder and birth experience: a prospective observational study.
        Int J Obstet Anesth. 2020; 44: 90-99
        • Kountanis JA
        • Kirk R
        • Handelzalts JE
        • Jester JM
        • Kirk R
        • Muzik M.
        The associations of subjective appraisal of birth pain and provider-patient communication with postpartum-onset PTSD.
        Arch Womens Ment Health. 2022; 25: 171-180
        • Goldman-Mellor S
        • Margerison CE.
        Maternal drug-related death and suicide are leading causes of postpartum death in California.
        Am J Obstet Gynecol. 2019; 221 (489.e1–9)
        • Hall OT
        • Hall OE
        • Rood KM
        • McKiever ME
        • Teater J
        • Senay A.
        Pregnancy-associated mortality due to accidental drug overdose and suicide in Ohio, 2009-2018.
        Obstet Gynecol. 2020; 136: 654-656
        • Smid MC
        • Stone NM
        • Baksh L
        • et al.
        Pregnancy-associated death in Utah: contribution of drug-induced deaths.
        Obstet Gynecol. 2019; 133: 1131-1140
        • Zaharatos J
        • St Pierre A
        • Cornell A
        • Pasalic E
        • Goodman D.
        Building U.S. Capacity to review and prevent maternal deaths.
        J Womens Health (Larchmt). 2018; 27: 1-5
      1. Michigan maternal mortality surveillance program. Found. Maternal deaths in Michigan. 2015. Available at: Accessed February 7, 2022.

        • St Pierre A
        • Zaharatos J
        • Goodman D
        • Callaghan WM.
        Challenges and opportunities in identifying, reviewing, and preventing maternal deaths.
        Obstet Gynecol. 2018; 131: 138-142
      2. State of Michigan. Michigan Department of Health and Human Services (MDHHS) through the Michigan Maternal Mortality Surveillance Program. Available at:

        • Kotelchuck M.
        An evaluation of the Kessner Adequacy of prenatal Care Index and a proposed Adequacy of prenatal Care Utilization Index.
        Am J Public Health. 1994; 84: 1414-1420
      3. KFF. Medicaid postpartum coverage extension tracker. 2022. Available at: Accessed September 23, 2022.

      4. ACOG Committee Opinion No. 736: optimizing postpartum care.
        Obstet Gynecol. 2018; 131: e140-e150
        • Bennett WL
        • Chang HY
        • Levine DM
        • et al.
        Utilization of primary and obstetric care after medically complicated pregnancies: an analysis of medical claims data.
        J Gen Intern Med. 2014; 29: 636-645
        • Bryant AS
        • Haas JS
        • McElrath TF
        • McCormick MC.
        Predictors of compliance with the postpartum visit among women living in healthy start project areas.
        Matern Child Health J. 2006; 10: 511-516
        • Cox EQ
        • Sowa NA
        • Meltzer-Brody SE
        • Gaynes BN.
        The perinatal depression treatment cascade: baby steps toward improving outcomes.
        J Clin Psychiatry. 2016; 77: 1189-1200
        • Flynn HA
        • Blow FC
        • Marcus SM.
        Rates and predictors of depression treatment among pregnant women in hospital-affiliated obstetrics practices.
        Gen Hosp Psychiatry. 2006; 28: 289-295
        • Sauter H
        • Haak P
        • Hardy J.
        2019 birth year maternal and infant health summary tables.
        Michigan Department of Health and Human Services, Lifecourse Epidemiology and Genomics Division, Lansing, MI2021
      5. Committee Opinion No. 711: opioid use and opioid use disorder in pregnancy.
        Obstet Gynecol. 2017; 130: e81-e94
        • Desai RJ
        • Hernandez-Diaz S
        • Bateman BT
        • Huybrechts KF.
        Increase in prescription opioid use during pregnancy among Medicaid-enrolled women.
        Obstet Gynecol. 2014; 123: 997-1002
        • Hernandez I
        • He M
        • Brooks MM
        • Zhang Y.
        Exposure-response association between concurrent opioid and benzodiazepine use and risk of opioid-related overdose in medicare part D beneficiaries.
        JAMA Netw Open. 2018; 1e180919
        • Ogawa Y
        • Takeshima N
        • Hayasaka Y
        • et al.
        Antidepressants plus benzodiazepines for adults with major depression.
        Cochrane Database Syst Rev. 2019; 6CD001026
        • Thorsness KR
        • Watson C
        • LaRusso EM.
        Perinatal anxiety: approach to diagnosis and management in the obstetric setting.
        Am J Obstet Gynecol. 2018; 219: 326-345
        • Cohen LS
        • Altshuler LL
        • Harlow BL
        • et al.
        Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment.
        JAMA. 2006; 295: 499-507
      6. National Wraparound Implementation Center. Special guidance report: managing and responding to coronavirus (COVID-19). 2020. Available at: Accessed November 15, 2021.

        • Shields LE
        • Wiesner S
        • Fulton J
        • Pelletreau B.
        Comprehensive maternal hemorrhage protocols reduce the use of blood products and improve patient safety.
        Am J Obstet Gynecol. 2015; 212: 272-280
        • Main EK
        • Cape V
        • Abreo A
        • et al.
        Reduction of severe maternal morbidity from hemorrhage using a state perinatal quality collaborative.
        Am J Obstet Gynecol. 2017; 216 (298.e1–11)
      7. Alliance for Innovation on Maternal Health. Care for pregnant and postpartum people with substance use disorder. 2021. Available at: Accessed October 5, 2022.