Substance Use Disorder-Related Deaths and Maternal Mortality in New Mexico, 2015-2019.

BACKGROUND: In recent decades, maternal mortality has increased across the U.S. Experiences of pregnant and postpartum people with Substance Use Disorder (SUD)-related deaths have not been previously evaluated in New Mexico. The aim of this study was to analyze risk factors related to substance use and explore substance use patterns among pregnancy-associated deaths in New Mexico from 2015 to 2019. METHODS: We conducted an analysis of pregnancy-associated deaths to assess the association between demographics, pregnancy factors, circumstances surrounding death, treatment of mental health conditions, and experiences with social stressors among Substance Use Disorder (SUD)-related and non-SUD-related deaths. We performed univariate analyses of risk factors using chi-square tests to assess the differences between SUD-related and non-SUD-related deaths. We also examined substance use at time of death. RESULTS: People with SUD-related deaths were more likely to die 43-365 days postpartum (81% vs. 45%, p-value = 0.002), have had a primary cause of death of mental health conditions (47% vs 10%, p < 0.001), have died of an overdose (41% vs. 8%, p-value = 0.002), have had experienced any social stressors (86% vs 30%, p < 0.001) compared to people with non-SUD-related deaths, and received treatment for SUD at any point before, during, or after pregnancy (49% vs. 2%, p < 0.001). The substances most used at time of death were amphetamines (70%), and most cases engaged in polysubstance use (63%). CONCLUSIONS FOR PRACTICE: Providers, health departments, and community organizations must prioritize supporting people using substances during and after pregnancy to prevent death and improve quality of life for pregnant and postpartum people.

Associations Between Maternity Care Practices and 2-Month Breastfeeding Duration Vary by Race, Ethnicity, and Acculturation.

Objectives This study examines the associations between specific maternity care practices and breastfeeding duration for Spanish-speaking Hispanic, English-speaking Hispanic, non-Hispanic Native American, and non-Hispanic White women. Methods We analyzed data from the 2012-2014 New Mexico Pregnancy Risk Assessment Monitoring System. We used survey language as a proxy measure of acculturation and categorized women as Spanish-speaking Hispanic, English-speaking Hispanic, non-Hispanic Native American, and non-Hispanic White. We conducted bivariate analyses to compare rates of breastfeeding at 2 months and experiences of maternity care practices and logistic regression analysis to estimate the effects of these practices on breastfeeding duration for each group. Results Hispanic women were less likely than non-Hispanic women to breastfeed for at least 2 months (67.9% vs. 76.6%; p = 0.000); however, this varied significantly by acculturation level: 78.1% of Spanish-speaking Hispanic women compared to 66.1% of English-speaking Hispanic women breastfed for at least 2 months (p = 0.000). The effects of specific maternity care practices on duration varied across groups. Among non-Hispanic White, Native American, and English-speaking Hispanic women, breastfeeding while at the hospital had the strongest effect (AOR 2.09, 95% CI 1.67-2.61; AOR 2.71, 95% CI 2.08-3.52; and AOR 1.99, 95% CI 1.76-2.25, respectively). Among Spanish-speaking Hispanic women, being encouraged to breastfeed on demand had the strongest effect (AOR 5.179, 95% CI 3.86-6.94). Conclusions for Practice The effects of maternity care practices on breastfeeding duration vary by race, ethnicity, and acculturation level. Health care systems must acknowledge the diversity of their patient populations when seeking to develop and implement breastfeeding-friendly practices.