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Mental health conditions leading cause of maternal mortality

More pregnant women and new mothers die in the United States than any high-income country in the world, but the leading cause is often left out of initiatives to combat that crisis.

Woman sits on the floor, hugging knees while leaning against a crib
Researchers recommend increasing mental health screening for women and improving education about the issue for both obstetricians and psychiatrists.

Mental health is the leading cause of death in pregnant women and new mothers in the United States, but national initiatives aimed at reducing maternal mortality often do not address mental conditions, according to an evidence review and Special Communication published in JAMA Psychiatry.

“Very little attention is paid to the mental health component,” said co-author Megan Thomas, M.D., clinical assistant professor of obstetrics and gynecology at the University of Kansas Medical Center. “Most of the obstetrical literature focuses on preeclampsia, or high blood pressure and pregnancy, hemorrhage and things like that, when in fact, depression, anxiety, PTSD (post-traumatic stress disorder), all of those things are much more prevalent.”

Mental health causes of death also include substance abuse and addiction, suicide and domestic violence, Thomas said.

Maternal mortality is a U.S. public health emergency. The rate at which pregnant women and new mothers die in the United States is two to three times greater than it is in other high-income countries, and it’s rising. The situation is even worse for Black women, who suffer a maternal mortality rate that is 2.6 times the rate for white mothers. “The appalling reality is that pregnancy is more likely to be associated with maternal death in the United States than any other developed country,” the researchers wrote in their commentary.

The researchers reviewed data about associations between maternal mortality and perinatal mental conditions, stress, social determinants of health, suicide and addictive disorders and barriers to health care.

The commentary cites data published in 2022 by the Centers for Disease Control and Prevention (CDC) demonstrating that mental health-related conditions led to 23% of pregnancy-related deaths from 2017 to 2019. The second leading cause was hemorrhage, which accounted for 14% of deaths, followed by cardiac and coronary conditions, which claimed 13%.

Social determinants of health also tremendously affect maternal mental health. “We know that women who have barriers to things like education, food, transportation, housing issues, their mental health risk is super high,” said Thomas, who treats patients with high-risk pregnancies at The University of Kansas Health System. “I think it can actually be tied to a variety of obstetric issues. I can't expect somebody to come to prenatal care if they can't even afford food, if they can't afford transportation.”

The researchers outlined recommendations for ways to improve the health of pregnant women and new mothers. These included increasing mental health screening for women, improving training for obstetricians and psychiatrists, reducing health care “deserts,” increasing access to reproductive psychiatry curricula among prescribers, instituting paid parental leave and integrating perinatal and behavioral health care. They also recommended screening for social determinants of health to enable hospital and community partners to identify and connect pregnant people with resources to improve health outcomes.

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