Summary: Between 2010 and 2012, suicides and drug overdoses accounted for nearly 20% of postpartum deaths among women in California.
Source: UC Merced
Overview
A new population-based study finds that drug overdoses and suicide were among the leading causes of death for mothers in California within one year after childbirth. The research examined statewide hospital and death records for more than 1 million women who delivered live infants between 2010 and 2012 and highlights the importance of mental health and substance use screening, follow-up care, and targeted prevention in the postpartum period.
The study, led by Sidra Goldman-Mellor, Ph.D., a professor of psychiatric epidemiology, with coauthor Claire Margerison, Ph.D., a perinatal epidemiologist, was supported by the National Institutes of Health. Using longitudinally linked, all-payer hospital and mortality data, the authors assessed causes of death in the first 12 months after delivery and examined differences by sociodemographic factors and recent healthcare use.
Key findings
- Out of 1,059,713 women followed, 300 died within one year of delivery, a rate of 28.33 deaths per 100,000 person‑years.
- The leading cause of death was obstetric-related complications (6.52 deaths per 100,000 person‑years).
- Drug-related deaths were the second leading cause (3.68 deaths per 100,000 person‑years) and suicide ranked seventh (1.42 deaths per 100,000 person‑years).
- Together, drug-related deaths and suicide made up 18% of all postpartum deaths in the study period.
- Risk from overdose and suicide was higher among non-Hispanic white women, women insured by Medicaid, and women living in micropolitan areas.
- Approximately two-thirds of women who died had at least one emergency department or hospital visit between delivery and death; among those who died from drugs or suicide, 74% had such visits, suggesting potential points for intervention.
Timing and implications for care
The researchers observed that most deaths from overdose and suicide occurred in the later months of the first postpartum year. This pattern indicates that attention to maternal wellbeing should extend beyond the early postpartum checks commonly scheduled in the first weeks after childbirth. Continued screening for mental health conditions and substance use, along with accessible treatment and social support, are crucial throughout the first year after delivery.
“These deaths are rare but devastating for families. We need to place more emphasis on prevention.” — Claire Margerison
Barriers and risk factors
Goldman-Mellor and Margerison note that stigma and possible legal or social consequences for admitting substance use or psychiatric problems may deter new mothers from seeking help. Financial barriers, gaps in access to behavioral health services, and uneven availability of postpartum support may also contribute to the elevated risk observed in certain demographic groups.
Next steps and research priorities
The authors describe this analysis as an initial step toward deeper study of drug-related and suicide-related postpartum deaths. They emphasize the need for further research to identify the social, economic, and healthcare-related factors that explain why some women face higher or lower risk. In particular, understanding how Medicaid coverage, geographic context, cultural supports, and access to behavioral health care influence outcomes could guide targeted prevention.
Because many decedents had recent emergency department or inpatient encounters, the study suggests an opportunity to develop protocols that identify at-risk women during these visits and connect them to comprehensive postpartum mental health and substance use services.
Conclusions
Deaths due to drug overdose and suicide are significant contributors to postpartum mortality and deserve increased clinical attention and public health action. The findings support extending postpartum care and resources throughout the first year after delivery, improving screening and referral systems in emergency and inpatient settings, and addressing barriers that prevent women from obtaining mental health and substance use treatment.
Source:
UC Merced — Lorena Anderson, UC Merced
Image source:
The image is in the public domain.
Original research:
“Maternal drug-related death and suicide are leading causes of post-partum death in California.” Sidra Goldman-Mellor, Ph.D., and Claire E. Margerison, Ph.D., American Journal of Obstetrics and Gynecology. DOI: 10.1016/j.ajog.2019.05.045
Abstract (summary)
This retrospective, population-based cohort study followed 1,059,713 California women who delivered live infants in 2010–2012 to examine fatal drug-related and suicide deaths within 12 months after delivery. The study found that drug-related deaths and suicide together comprised 18% of postpartum deaths, with notable sociodemographic disparities and frequent prior emergency or hospital care among decedents. The authors conclude that drug- and suicide-related deaths warrant increased clinical recognition and that inpatient and emergency visits may offer opportunities to identify and prevent these deaths.