Importance Knowledge about characteristics of US pregnancy-associated decedents is needed to guide responses. Objective To examine individual sociodemographic characteristics and residing county's health care resources and socioeconomic factors among pregnancy-associated overdose decedents in comparison with obstetric decedents and overdose decedents who were not pregnant in the past year. Design, Setting, and Participants This cross-sectional, exploratory study included 1457 pregnant and postpartum overdose decedents, 4796 obstetric decedents, and 11 205 nonpregnant overdose decedents aged 10 to 44 years from 2018 to 2021. Data were analyzed August 2023. Exposures Decedents from the 2018-2021 Multiple Cause of Death Files linked to the 2021 Area Health Resources Files and the 2018-2021 County Health Rankings data at the county level. Main Outcomes and Measures Pregnancy-associated deaths were defined as deaths during pregnancy or within 1 year of pregnancy termination. This study focused on unintentional drug overdoses or drug overdoses with undetermined intent involving the most common psychotropic drugs of misuse. Results From 2018 to 2021, across the pregnancy-postpartum continuum, pregnancy-associated overdose mortality ratios consistently increased among women aged 10 to 44 years. Mortality ratio more than tripled among pregnant and postpartum women aged 35 to 44 years from 4.9 (95% CI, 3.0-8.0) per 100 000 mothers aged 35 to 44 years with a live birth in January to June 2018 to 15.8 (95% CI, 12.3-20.4) in July to December 2021 (average semiannual percentage changes, 15.9; 95% CI, 8.7-23.6; P < .001). Compared with pregnant obstetric decedents, pregnant overdose decedents had increased odds of being aged 10 to 34 years (75.4% vs 59.5%; range of odds ratios [ORs], 1.8 [95% CI, 1.3-2.5] for ages 10 to 24 years to 2.2 [95% CI, 1.7-2.8] for ages 25 to 34 years), being non-college graduates (72.1% vs 59.4%; range of ORs, 2.7 [95% CI, 1.7-4.3] for those with some college education to 3.9 [95% CI, 2.4-6.1] for those with less than high school education), being unmarried (88.0% vs 62.1%; OR, 4.5; 95% CI, 3.7-6.0), and dying in nonhome, non-health care settings (25.9% vs 4.5%; OR, 2.5; 95% CI, 1.8-3.6) and were associated with decreased odds of dying in health care settings (34.7% vs 77.6%; range of ORs, 0.1 [95% CI, 0.1-0.1] for those who died in hospital inpatient settings to 0.4 [95% CI, 0.3-0.6] for those who died in hospital outpatient/emergency room settings). Conclusions and Relevance From 2018 to 2021, the mortality ratio more than tripled among pregnant and postpartum women aged 35 to 44 years, consistent with increases in overdose mortality across US populations. Most pregnancy-associated overdose deaths occurred outside health care settings, indicating the need for strengthening community outreach and maternal medical support. To reduce pregnancy-associated overdose mortality, evidence-based interventions are urgently needed at individual, health care, local, and national levels, along with nonpunitive approaches incentivizing pregnant and postpartum women to seek substance use disorder treatments.

中文翻译：

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COVID-19 大流行之前和期间美国因怀孕和产后药物过量死亡的情况。

重要性 需要了解美国妊娠相关死者的特征来指导应对措施。目的了解妊娠相关服药过量死者与产科死者和过去一年未怀孕的服药过量死者的个人社会人口学特征、居住县卫生保健资源和社会经济因素。设计、背景和参与者 这项横断面探索性研究包括 2018 年至 2021 年间 1457 名怀孕和产后用药过量死者、4796 名产科死者和 11 205 名 10 至 44 岁非怀孕用药过量死者。数据分析于 2023 年 8 月。 2018-2021 年多重死因档案与 2021 年地区卫生资源档案和 2018-2021 年县级健康排名数据相关联。主要结果和措施 妊娠相关死亡被定义为妊娠期间或妊娠终止后 1 年内的死亡。这项研究的重点是无意的药物过量或意图不明的药物过量，涉及最常见的精神药物滥用。结果从 2018 年到 2021 年，在整个怀孕-产后连续过程中，10 岁至 44 岁女性中与怀孕相关的药物过量死亡率持续上升。35 岁至 44 岁孕妇和产后妇女的死亡率增加了两倍多，从 2018 年 1 月至 6 月每 10 万名 35 至 44 岁活产母亲中 4.9 例（95% CI，3.0-8.0）升至 15.8 例（95% CI ，12.3-20.4），2021 年 7 月至 12 月（平均半年百分比变化，15.9；95% CI，8.7-23.6；P < .001）。与怀孕的产科死者相比，怀孕过量死者的年龄在 10 至 34 岁的几率增加（75.4% vs 59.5%；10 至 24 岁的比值比范围 [ORs]，1.8 [95% CI，1.3-2.5]） 2.2 [95% CI, 1.7-2.8]（年龄 25 至 34 岁），非大学毕业生（72.1% vs 59.4%；OR 范围，2.7 [95% CI, 1.7-4.3]）受教育程度达到 3.9 [95% CI, 2.4-6.1]（对于高中以下教育程度的人）、未婚（88.0% vs 62.1%；OR，4.5；95% CI，3.7-6.0）、在非家中、非家庭场所死亡- 医疗保健机构（25.9% vs 4.5%；OR，2.5；95% CI，1.8-3.6），并且与医疗机构中死亡几率降低相关（34.7% vs 77.6%；OR 范围，0.1 [95%] CI，0.1-0.1]（对于在医院住院环境中死亡的患者）至 0.4（对于在医院门诊/急诊室环境中死亡的患者，CI，0.3-0.6）。结论和相关性 从 2018 年到 2021 年，35 岁至 44 岁孕妇和产后妇女的死亡率增加了两倍多，这与美国人口用药过量死亡率的增加一致。大多数与妊娠相关的药物过量死亡发生在医疗机构之外，这表明需要加强社区外展和孕产妇医疗支持。为了降低与妊娠相关的药物过量死亡率，