Pregnancy-Associated Drug Overdose Mortality in the United States, 2018–2023

OBJECTIVE: To evaluate changes in pregnancy-associated drug overdose mortality in the United States from 2018 to 2023 and compare this with drug overdose mortality among reproductive-aged nonpregnant female decedents. Secondarily, to assess types and combinations of drugs that contribute to overdose mortality, regional patterns, and overdose timing. METHODS: This was a cross-sectional study that used 2018-2023 National Center for Health Statistics death certificate data. Drug overdose deaths were identified using International Classification of Diseases, Tenth Revision codes, and specific drugs involved were identified using T codes. Among all female decedents of reproductive age (15-44 years), pregnancy-associated drug overdose deaths were identified from the pregnancy checkbox. We calculated absolute and relative changes in drug overdose mortality rates for pregnancy-associated deaths and non-pregnancy-associated deaths among reproductive-aged female individuals. The annual pregnancy-associated drug mortality rates were also calculated by drug type and U.S. region (Northeast, Midwest, South, and West). RESULTS: There were 2,573 pregnancy-associated drug overdose deaths identified. Pregnancy-associated overdose mortality increased from 8.0 per 100,000 live births to 13.0 deaths per 100,000 live births (relative increase: 62.2%). The drug overdose mortality rate among female individuals of reproductive age increased from 16.8 per 100,000 live births to 22.3 per 100,000 live births across the same period (relative increase: 33.0%). The fentanyl-involved pregnancy-associated overdose mortality rate was higher than other drugs. The psychostimulant-involved rate increased across time (from 2.9 deaths/100,000 live births to 7.5 deaths/100,000 live births). Drug overdose mortality rates were highest in the South. Polysubstance-involved overdose deaths were also common, with fentanyl and psychostimulants accounting for 24.8% of deaths. CONCLUSION: The relative increase in the drug overdose mortality rate among pregnant and postpartum individuals was nearly double that of nonpregnant female individuals of reproductive age, driven by fentanyl, increasing psychostimulant, and polysubstance overdose deaths.