916: The trend in opioid-related maternal deaths in the State of Michigan: Need for action!

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Opioid-related deaths are the leading cause of death for reproductive-age women in the United States. Our objective was to review pregnancy associated, not related (PANR) deaths attributed to opioid use disorder (OUD) in Michigan in order to better understand and identify opportunities for intervention. Using the Michigan Department of Health and Human Services Michigan Maternal Mortality Surveillance Program database, we performed a retrospective cohort study of all PANR deaths from 2007-2015. PANR death is defined as a death of a woman during pregnancy or within 1 year from the end of pregnancy due to a cause unrelated to pregnancy. We reviewed associated comorbidities and described the demographics in opioid-related deaths. Chi-square was used to compare rates of opioid- and non-opioid-related deaths From 2005 to 2015, 424 PANR deaths were identified, The OUD-related PANR and non-OUD-related PANR mortality rates were 9.7 and 30.8 deaths per 100,000 live births, respectively (p< 0.05). There is a steady increase in OUD-related PANR deaths throughout the study years (Figure 1). The racial distributions of OUD-related non-OUD-related PANR deaths were significantly different [White (72.5 vs. 54.3%) and African American (17.6 vs. 38.5%), respectively]. OUD was identified in 102 (24.1%) of the PANR deaths and 72.5% of the OUD-related PANR deaths occurred during the postpartum period. Among postpartum OUD-related PANR deaths, 89.2% cases occurred within 6 weeks to 1 year after delivery. Among OUD-related PANR cases who had a live birth, 45.0% had UDS at delivery, with 16.7% showing negative results. Medication assisted treatment (MAT), was noted in 16.3% and 13.5% of the OUD-related PANR deaths in pregnancy and time of death, respectively. Opioid is a major and increasing cause of maternal deaths, recently accounting for over 1 in 5. Nearly three quarters of opioid-related maternal deaths occurred postpartum and the vast majority occurred after 6 weeks and in women who did not receive MAT, strongly suggesting the need for appropriate medical and social intervention.