ST. GEORGE — Utah prescribes more opioids to pregnant women than any other state in the country, and a recent study has found that opioid use is now the leading cause of pregnancy-related deaths in Utah.
The study was performed by researchers at the University of Utah Health, led by Marcela Smid, an assistant professor of maternal and fetal medicine at the University of Utah Health. It found that drug overdoses are the leading cause of pregnancy-related deaths in Utah, most of which occur during postpartum.
The retrospective study looked at the 136 pregnancy-associated deaths – including the pregnancy and up to one year after – that occurred in Utah from 2005-2014. Using data collected by the Utah Perinatal Mortality Review committee, researchers looked at each mother’s autopsy report, medical history, social work records, mental health records, law enforcement reports and any other relevant data.
“From all those different sources we were able to study what were the contributing factors to these moms’ deaths,” Smid said.
What they found was that 26 percent of all pregnancy-related deaths were drug-induced, which is equal to the next two most common causes of death combined, which are blood clots, which made up 13% of deaths, and car accidents 12%.
The other 49% of deaths were caused by hypertension, infections, homicide or suicide, hemorrhage, malignancy and other causes.
Of the drug-related deaths, 89% of them occurred during postpartum, within a year after birth. Most of them happened in the late postpartum period, which is defined as 43 days to one year after giving birth.
Most of the women in the study died by accidental overdose, not suicide. Many of the women who died were taking opioids before becoming pregnant, but during pregnancy most either stop taking opioids or significantly decreased their use.
“Addiction hijacks your brain, but pregnancy can hijack it back. And most women, generally 90% of women, will achieve abstinence or certainly decrease their use,” Smid said.
However, after giving birth, with the stresses of having a baby and without proper treatment, relapse is likely to occur, which can easily cause an accidental overdose. After a period of abstinence, a person’s tolerance to the drug will decrease. And even if the person takes a smaller dose of opioids when they relapse, it can still be too much for their body to handle.
Nationally, around one in five pregnant women were prescribed an opioid in 2007, and in Utah, that number was doubled, according to a study published by the National Institutes of Health.
Pregnant women are most commonly prescribed opioids to relieve back pain, migraines, pelvic pain, abdominal pain and other pregnancy side-effects, Smid said.
Little research is available regarding the reason why Utah providers are prescribing more opioids to pregnant women than in other states.
The POPPY Study Act, sponsored by U.S. Rep. John Curtis, R-Utah, and signed into law in October, is part of an amendment to a larger bill that provides $6 billion in funding and research to help communities combat the opioid crisis. The act will fund research to help determine why Utah prescribes opioids to pregnant women at such a high rate and look into safer alternatives.
The POPPY Study Act aims to benefit research into current opioid prescribing practices to pregnant women, develop recommendations to reduce misuse during pregnancy, learn about alternative pain management options for pregnant women and increase awareness of opioid use disorder and how it affects mothers and their unborn babies.
“Health care experts, providers, patients, and local county leaders that are fighting this head-on all told me that there is simply too much we don’t know about why pregnant women are being prescribed opioids,” Curtis said in a statement. “My bill increases research on current opioid prescribing practices during pregnancy, provides more data on prescription opioid misuse during pregnancy, and evaluates and encourages non-opiate pain management therapies that are safe and effective during pregnancy.”
Opioid use disorder in pregnant women can cause serious pregnancy complications and can harm the baby. It can cause placental abruption, a condition in which the placenta separates from the uterus too soon which can cause painful symptoms to the mother, deprive the baby of oxygen and nutrients, cause fetal growth problems, premature birth and, in some cases, death to the baby, according to the American College of Obstetricians and Gynecologists.
The most common side-effect to opioid use disorder in pregnant women is neonatal abstinence syndrome, or NAS. A baby with NAS is born with an opioid dependency and will have temporary withdrawal symptoms such as shaking, issues feeding, crying, fever, diarrhea, vomiting and trouble sleeping, which can last for days or weeks after birth.
While unpleasant for the baby, NAS is treatable and does not put the baby at risk for addiction once it has recovered.
Smid recommends that expectant mothers with opioid use disorder seek medically assisted treatment by taking either methadone or suboxone, which help to ease a person off of opioids and does not put the baby at risk.
She is working to destigmatize opioid use disorder in pregnant women. She said that people often look to put the blame of the overdose on the mother for not seeking help, when in fact, none of the women in the study were screened for drug use by their provider and less than half received a social work consultation or mental health counseling.
“It’s not just, did she seek help, but was the help there and was the help offered.”
Smid suggests that the best way to counter this issue in Utah is to have a community response to the issue by providing facilities and systems of care that work to discover opioid use disorder in expectant mothers and then provide proper treatment to increase their chances of successful remission.
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