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Am J Obstet Gynecol. 2019 Jun 4. pii: S0002-9378(19)30747-1. doi: 10.1016/j.ajog.2019.05.045. [Epub ahead of print]

Maternal drug-related death and suicide are leading causes of post-partum death in California.

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Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, California. Electronic address:
Department of Epidemiology & Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan.



Reducing maternal mortality is a priority in the U.S. 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.


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' healthcare utilization prior to death.


This retrospective, population-based cohort study followed 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.


A total of 300 women died during follow-up, a rate of 28.33 deaths per 100,000 person-years (p-y). The leading cause of death was obstetric-related problems (6.52 per 100,000 p-y). Drug-related deaths were the second leading cause of death (3.68 per 100,000 p-y), and suicide was the 7th leading cause (1.42 per 100,000 p-y); 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.


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


Maternal mortality; accidental death; depression; maternal morbidity; opioid overdose; poisoning


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