Suicide, drug overdose, and mental illness in the perinatal period are significant and preventable contributors to maternal deaths, said psychiatrists at a workshop on perinatal maternal mortality during the virtual annual meeting of the Academy of Consultation-Liaison Psychiatry.
“Overall, mental health conditions are on a par with hypertensive crisis and postpartum hemorrhage as causes of maternal mortality,” said James Levenson, M.D., a professor of psychiatry at the Virginia Commonwealth University.
During the workshop, perinatal psychiatrists presented data from the Centers for Disease Control and Prevention (CDC) and state-level data from Maternal Mortality Review Committees (MMRCs) in Massachusetts and Washington. MMRCs are multidisciplinary committees charged with reviewing cases of maternal death, determining causes and contributing factors, and developing recommendations to prevent deaths.
Analyzing data from 14 state MMRCs, the CDC Maternal Mortality Team determined that of 453 pregnancy-related deaths between 2008 and 2017, 46 were related to mental illness, including deaths by suicide (63%), nonsuicidal overdoses (24%), or other mental illness–related causes or injury of unknown intent (13%). Of these deaths, 65% occurred between 42 days and one year after giving birth. Analyses of perinatal maternal mortality data from Massachusetts and Washington State mirrored those results.
The data have resulted in recommendations from the American College of Obstetrics and Gynecology for a “new paradigm” of postpartum care: shifting from a single encounter at six weeks to care that is an ongoing, individualized, and woman-centered process. Likewise, the American Academy of Pediatrics recommends that primary care pediatricians screen mothers for depression at children’s one- , two- , four- , and six-month well visits.
Speakers at the meeting encouraged psychiatrists to participate in state MMRCs. “We know that the perinatal period is often associated with the first onset of mental illness, and psychiatric illness is under- or misdiagnosed in this period,” said Christina Wichman, D.O., a professor of psychiatry and behavioral medicine and obstetrics and gynecology at Medical College of Wisconsin. “Involvement of mental health professionals on these committees is really important.
For related information, see the Psychiatric News article “Study Finds Alarming Increase in Suicidality During Pregnancy.”
APA’s Next Town Hall to Examine How Racism Affects Diversity in Psychiatric Workforce
Register now for the town hall “Structural Racism & Psychiatric Residency Training: Recruitment, Retention, and Development,” to be held Monday, February 8, at 8 p.m. ET. Panelists will address the disproportionate number of minority psychiatrists, their experiences in different practice settings, and why having diversity in the psychiatric workforce psychiatry is important for everyone.
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