Pregnancy-associated mortality and morbidity due to drug use, self-harm, and violence: changes during the COVID-19 pandemic

PROJECT SUMMARY The goal of our Parent R01 (R01HD102319, "Pregnancy-associated mortality and morbidity due to drugs, self- harm, and violence in the United States") is to provide population-based estimates of incidence, trends, and disparities in mortality and morbidity during pregnancy and the first year postpartum due to drug use, self- harm, and violence, and to ascertain which factors can identify women at high risk of these outcomes in hospital and emergency department (ED) settings. We recently reported that pregnancy-associated mortality due to drugs, self-harm, and suicide made up 22.2% of all deaths during pregnancy and postpartum from 2010-2019 in the US. Pregnancy-associated deaths from these causes also increased substantially over the past decade, with drug-related deaths, in particular, increasing 190% from 2010 to 2019. We also know that the COVID-19 pandemic resulted in worsened mental health, increased social isolation, reduced utilization of preventive care, and increased financial instability and that, in the general US population, drug-related deaths and homicides increased approximately 30% during the first year of the pandemic. The overall goal of this Administrative Supplement, "Pregnancy-associated mortality and morbidity due to drug use, self-harm, and violence: changes during the COVID-19 pandemic" is thus to investigate the impacts of the COVID-19 pandemic on morbidity and mortality due to drugs, self-harm, and violence among pregnant and postpartum individuals, an especially vulnerable group. Our first aim is to examine incidence, trends, and disparities in pregnancy-associated mortality due to drugs, suicide, and homicide in the US in 2020 and 2021, and compare these estimates to the trends we observed from 2010-2019. Our second aim is to examine incidence, trends, and disparities in pregnancy-associated morbidity (i.e., emergency department utilization) due to drugs, deliberate self-harm, and violence in California in 2020 and 2021, coinciding with the onset of the COVID-19 pandemic in March 2020, and compare these estimates to pre-pandemic patterns. To achieve these aims, we will use both US vital statistics mortality and natality data as well as a unique set of linked California databases that include inpatient hospitalizations and emergency department visits. Achieving these aims will provide evidence for clinicians and public health professionals regarding the current burden of pregnancy-associated morbidity and mortality due to drug use, self-harm, and violent victimization in the context of the COVID-19 pandemic. Such evidence can be used to guide public health and clinical planning as well as future research efforts in areas such as screening, prevention, and treatment.