The PCORI MORE study is among many efforts aimed at understanding and ultimately improving care for families affected by perinatal substance use and opioid use disorder. This month, we are sharing about the broader landscape of perinatal health in the United States, and specifically efforts in our region to make a positive impact.
Across the country, as opioid and fentanyl related deaths continue to rise, the impact on people of childbearing age has seen the sharpest increase. In VT, opioid related deaths totaled 201 in 2021, a 33% increase in one year and among the highest in the nation. In NH, substance use related deaths are the leading cause of death in the perinatal period, that is the time during pregnancy and in the first year after birth. NH’s Maternal Morbidity and Mortality Review Committee, (MMRC) a multidisciplinary group that meets regularly to perform comprehensive reviews of deaths that occur during pregnancy and within the year after birth, and makes recommendations on prevention, has targeted substance related deaths as a focus for prevention.
The NH MMRC along with MMRCs across the country, contribute data to the Center for Disease Control’s (CDC) data collection effort known as ERASE MM- Enhancing Reviews and Surveillance to Eliminate Maternal Mortality. Improvements in data collection efforts are essential to understand and prevent maternal deaths, and have contributed to the increase in reporting and awareness of significant health disparities in the US. According to the CDC, pregnancy related death in the United States has risen from 8 deaths per 100,000 live births in 2000, to 23.8 in 2020. The rates for Black women and birthing people are 3-4 times higher than white women. And while the causes of death vary and include overdose, it is estimated that 60% of pregnancy related deaths are preventable.
Coordinated efforts among organizations working to improve the health and wellbeing of pregnant and birthing people has led to the development of the Alliance on the Innovation of Maternal Health (AIM). AIM’s efforts include the development of Safety Bundles; guidelines of care to help hospitals and perinatal care providers follow best practices, improve health and prevent deaths. Because the majority of pregnancy related deaths in NH are related to substance use, NH’s MMRC’s recommendations include implementation of the AIM Safety Bundle, Care for Pregnant and Postpartum People with Substance Use Disorder . The Safety Bundle directs providers in best practices in areas of screening, communication and treatment. Directives include providing standardized screening tools on every patient, referral to community supports and services as needed, and to “engage in open, transparent, and empathetic communication with the pregnant and postpartum people and their identified support person(s) to understand diagnosis, options, and treatment plans.” The Safety Bundles also encourage health care professionals to be educated in “Respectful Equitable and Supportive Care.”
In NH, ME and VT, health care professionals who care for families affected by Substance Use Disorder are able to learn about the AIM Safety Bundle and receive education and resources for its implementation through the Northern New England Quality Improvement Network (NNEPQIN). Webinars are held monthly and participants learn about validated screening tools, the distribution of narcan, a drug given to help prevent overdose deaths, and how to improve communication skills. Resources for continued learning, including past webinars and trainings, are available through NNEPQIN and the NH Center for Excellence resource page. Together, we can help reduce pregnancy related deaths and improve care for families affected by perinatal substance use.
