Women’s Health
Association between pregnancy loss and risk of subsequent drug overdose Tosin Oyetunji* Tosin Oyetunji Oyetunji Department of Public Health, University of California, Merced; Merced, CA USA
Pregnancy-associated overdose morbidity and mortality have risen, yet the incidence of nonfatal overdose after pregnancy loss and whether the risk differs by prior overdose history compared with live delivery remains unclear. Using longitudinally linked California hospital discharge and emergency department (ED) data (2016–2021), we created cohorts of individuals with an index live delivery (N = 1,659,293) or pregnancy loss (N = 171,170). We compared these cohorts’ risks of an ED visit for nonfatal drug overdose within 365 days after the index pregnancy outcome; we also examined whether a prior overdose modified the association between pregnancy outcome and subsequent overdose. We used generalized linear models to estimate adjusted odds ratios with 95% confidence intervals (CIs) for pregnancy loss versus live delivery; moderation analyses included an interaction term with prior overdose history. Models controlled for age, insurance type, residence, prior pregnancy outcome, and comorbid alcohol, drug, psychotic, mood, and anxiety disorders. Within 365 days after index visit, 2,731 individuals (0.15%) experienced a nonfatal overdose ED visit (0.12% after live delivery vs. 0.44% after pregnancy loss). Pregnancy loss was associated with significantly higher odds of overdose compared with live delivery (aOR = 2.57; 95% CI: 2.35, 2.81). Prior overdose strongly predicted subsequent overdose (aOR = 2.93; 95% CI: 2.17, 3.95), but there was no evidence that the association between pregnancy outcome and overdose differed by prior overdose history (aOR for interaction term = 0.90; 95% CI: 0.59, 1.39). These findings suggest that pregnancy loss is associated with substantially higher nonfatal overdose morbidity than live delivery, without evidence of differential risk among individuals with a history of overdose. Targeted screening, treatment, and support services following pregnancy loss may help mitigate overdose risk. Future research should examine longer-term overdose trajectories beyond the first postpartum year.