An increase in ectopic pregnancy deaths in Florida appears to be associated with illicit drug use and delays in seeking health care, according to a new report by the Centers for Disease Control and Prevention (CDC).

Deaths from ectopic pregnancies rose fourfold in the past decade in Florida, according to HealthDay. Ectopic pregnancy is a life-threatening condition, which occurs when an egg is fertilized outside of the uterus, generally in the fallopian tube. If it is not detected, the pregnant woman may die from a hemorrhage caused by a rupture of the tube.

Between 1999 and 2008, there were 13 deaths in Florida due to ectopic pregnancies. In 2009-2010, there were 11 such deaths, the researchers reported in the CDC’s Morbidity and Mortality Weekly Report. Women who died in that one year were more likely to have collapsed from a hemorrhage before they saw a health care provider compared with women who died in the previous decade from ectopic pregnancies. Of the eight women who collapsed during 2009-2010, six tested positive for illicit drug use, including four who tested positive for cocaine. It is not possible to compare the rate of illicit drug use in this group with women who died between 1999 and 2008, because testing for illicit drugs was performed much less often during that period.

“The high prevalence of illicit drug use among the women who died highlights the need to raise public awareness about health risks associated with drug exposure during pregnancy,” the researchers wrote.