Maternal drug-related death and suicide are leading causes of postpartum death in California

Am J Obstet Gynecol. 2019 Nov;221(5):489.e1-489.e9. doi: 10.1016/j.ajog.2019.05.045. Epub 2019 Jun 4.


Background: Reducing maternal mortality is a priority in the United States and worldwide. Drug-related deaths and suicide may account for a substantial and growing portion of maternal deaths, yet information on the incidence of and sociodemographic variation in these deaths is scarce.

Objective: We sought to examine incidence of drug-related and suicide deaths in the 12 months after delivery, including heterogeneity by sociodemographic factors. We also explored maternal decedents' health care utilization prior to death.

Study design: This retrospective, population-based cohort study followed up 1,059,713 women who delivered a live-born infant in California hospitals during 2010-2012 to ascertain maternal death. Analyses were conducted using statewide, all-payer, longitudinally-linked hospital and death data.

Results: A total of 300 women died during follow-up, a rate of 28.33 deaths per 100,000 person-years. The leading cause of death was obstetric-related problems (6.52 per 100,000 person-years). Drug-related deaths were the second leading cause of death (3.68 per 100,000 person-years), and suicide was the seventh leading cause (1.42 per 100,000 person-years); together these deaths comprised 18% of all maternal deaths. Non-Hispanic white women, Medicaid-insured women, and women residing in micropolitan areas were especially likely to die from drugs/suicide. Two thirds of women who died, including 74% of those who died by drugs/suicide, made ≥1 emergency department or hospital visit between their delivery and death.

Conclusion: Deaths caused by drugs and suicide are a major contributor to mortality in the postpartum period and warrant increased clinical attention, including recognition by physicians and Maternal Mortality Review Committees as a medical cause of death. Importantly, emergency department and inpatient hospital visits may serve as a point of identification of, and eventually prevention for, women at risk for these deaths.

Keywords: accidental death; depression; maternal morbidity; maternal mortality; opioid overdose; poisoning.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • California / epidemiology
  • Cohort Studies
  • Drug Overdose / mortality
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Humans
  • Maternal Mortality
  • Medicaid
  • Pregnancy
  • Pregnancy Complications / mortality
  • Retrospective Studies
  • Substance-Related Disorders / mortality*
  • Suicide, Completed / statistics & numerical data*
  • United States
  • Urban Population
  • Young Adult