718: Drug-related maternal deaths in Utah, 2013-2016

Abstract

The Utah Perinatal Mortality Review is a multi-disciplinary committee that reviews all maternal and infant deaths in Utah. We described causes of maternal deaths in Utah from 2013-16, and evaluated the impact of committee classification of drug-related deaths as pregnancy-related (rather than pregnancy-associated) beginning in 2015. Retrospective review of all Utah maternal deaths from 2013-16. Pregnancy-associated (PA) death defined as death of a woman during pregnancy or within one year of the end of pregnancy, regardless of cause. Pregnancy-related (PR) death defined as death of a woman in the same time period, from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy. Accidental drug-related deaths included deaths from prescribed and illicit drugs. Contributing factors, defined by Centers for Disease Control and Prevention, were identified for each death. Beginning in 2015, the Committee classified accidental drug-related deaths as PR given mounting evidence that substance use disorder (SUD) and mental health (MH) conditions may be aggravated during pregnancy and in the post-partum period. To assess the impact of reclassifying accidental drug-related death as PR, we compared the PR mortality ratio in Utah in 2013-2016 using test of trend. In 2015-2016, 40 PA deaths and 26 PR deaths occurred: accidental drug toxicity was the leading cause of both PA (n=10, 25%) and PR (n=10, 38%) death (Figure 1). In 2015-2016, all women with accidental drug-related deaths had MH conditions and 80% of these deaths occurred 43-365 days postpartum. For all PA deaths (n=40), contributing factors included SUD (n=18, 45%), mental health conditions (n=16, 40%) and clinical issues, namely inadequate screening and treatment for SUD and MH conditions (n=15, 38%). In 2013-2014, there were 44 PA deaths. Leading causes were motor vehicle accident (n=10, 20%) followed by accidental drug-related death (n=7, 17.5%) (Figure 1). From 2013-2016, there was no significant increase in PR deaths attributable to reclassification of drug-related deaths as PR (p=0.06) (Figure 2). Accidental drug-related death was the most common identifiable cause of PR death in Utah in 2015-6 following reclassification of drug-related deaths as PR. Effective interventions aimed at identifying and treating pregnant and postpartum women with SUD and MH conditions are imperative.View Large Image Figure ViewerDownload Hi-res image Download (PPT)