Homicides, Drugs Drove Rise in Pregnancy-Associated Deaths During the Pandemic

Pregnancy-associated deaths related to drug overdoses and homicides substantially increased during the first year of the COVID-19 pandemic, according to a cross-sectional study.

Among over 4,500 such deaths, those caused by drug overdoses increased by 55.3% from 2019 to 2020 while those from homicides increased by 41.2%, reported researchers led by Claire Margerison, PhD, of Michigan State University in East Lansing.

Both represented larger increases compared with changes from 2018 to 2019 (21% increase for overdoses and 23.5% for homicides).

In addition, deaths from obstetric causes rose by 28.4% during the early part of the pandemic versus 17.1% the year before, and deaths from other causes (most commonly vehicle crashes) rose by 56.7% from 2019 to 2020 after declining by 30.2% from 2018 to 2019, they noted in JAMA Network Open.

“These trends may reflect multiple population stressors during 2020, including COVID-19 pandemic-related economic strain, the murder of George Floyd, and the fentanyl epidemic,” Margerison and colleagues wrote, noting that “our analyses did not address causality.”

A previous study showed maternal deaths increased by 33.3% after March 2020, which was higher than the 22% overall excess death estimate expected to result from the pandemic.

Of note, pregnancy-associated deaths from suicide decreased by 7.1% from 2019 to 2020, after increasing by 9.5% in 2018 to 2019.

“Although pregnancy is considered an opportunity for screening and prevention related to physical, mental, and behavioral health, our data suggest that such opportunities were missed for hundreds of pregnant people during the pandemic,” Margerison and team wrote. “Our study findings suggest that there is a need for prevention and intervention efforts, including harm reduction strategies, tailored to pregnant and postpartum women, particularly during times of population stress and decreased utilization of preventive care, such as a pandemic.”

Since 2003, the U.S. death certificate has included a checkbox to indicate if the deceased person was pregnant within 42 days of death, or within 43 days to 1 year of death (the postpartum year).

For this study, Margerison and colleagues used cross-sectional U.S. death certificate records from January 2018 through December 2020 for females ages 15 to 44, and restricted the analysis to deaths occurring from April 1 to December 31 in each year, since the pandemic began in March 2020.

They acquired the number of live births for the same population and time frame from the CDC WONDER database. Live births declined by 0.8% from 2018 to 2019 and by 4.5% from 2019 to 2020.

They included 4,528 pregnancy-associated deaths in the study: 1,300 in 2018, 1,410 in 2019, and 1,818 in 2020.

The overall pregnancy-associated death ratio from April to December 2020 was 66.9 deaths per 100,000 live births, an increase of 35.0% from 2019.

Margerison and team noted that pregnancy-associated deaths, especially those later in the postpartum year, were likely underestimated in their study.