AJOG MFM at a Glance
- AWhy 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.
- BWhat 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.
- CWhat 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.
Keywords
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Article Info
Publication History
Accepted:
November 9,
2022
Received in revised form:
October 14,
2022
Received:
August 1,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
