Drugs and Death in Las Vegas: A Novel Use of Coroner Data to Create a Toxicology Surveillance System in Pregnant Women [33O

Abstract

INTRODUCTION: Existing studies in the literature analyze self-reported use of substances or utilize prenatal laboratory testing to assess the prevalence of illicit substances in pregnant women. Our study explores a novel use of quantitative autopsy toxicology to understand trends and associations in maternal mortality. METHODS: This study was a retrospective review of pregnant women referred to the Clark County medical examiner from 2000-2015. Medical records were reviewed. These patients were all confirmed pregnant by autopsy diagnosis, and underwent whole blood toxicology analysis. Statistical analysis was performed using student t-test for continuous variables and chi-square for categorical variables. RESULTS: 67 women were included in the analysis. 40% had positive toxicology for any drug, and 28% were positive for illegal drugs. Methamphetamine was most prevalent (16%), followed by ethanol (15%). Individuals not receiving prenatal care had a significantly higher prevalence of illicit drugs 44% vs 7% (p=0.0121), ethanol 25% vs 3% (p=0.0437), and methamphetamine 30% vs 7% (p=0.0051). A positive marijuana result in those not receiving prenatal care, though increased, did not reach significance at 16% vs 7% (p=0.689). Some other trends were noted in the data. 30% (n=20) had documented mental illness. Further, the first trimester had the highest prevalence of illicit drugs and ethanol. Also, 39% (n=26) were victims of domestic violence with non-married women significantly more so than married women (p=0.0001). CONCLUSION: As Vital Statistics does not record routine toxicology in non-overdose cases, a toxicology surveillance system using Coroner data would provide important insights into the growing national problem of substance abuse in pregnancy.