Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality

Abstract

The Confidential Enquiry into Maternal Deaths 1997 to 1999 finds that psychiatric disorder, and suicide in particular, is the leading cause of maternal death. Suicide accounted for 28% of maternal deaths. Women also died from other complications of psychiatric disorder and a significant minority from substance misuse. Some of the findings of the Confidential Enquiry confirm long established knowledge about postpartum psychiatric disorder. The findings highlight the severity and early onset of serious postpartum mental illness and of the risk of recurrence following childbirth faced by women with a previous history of serious mental illness either following childbirth or at other times. These findings led to the recommendation that all women should be asked early in their pregnancy about a previous history of serious psychiatric disorder and that management plans should be in place with regard to the high risk of recurrence following delivery. Other findings of the Enquiry were new and challenged some of the accepted wisdoms of obstetrics and psychiatry. It is likely that the suicide rate following delivery is not significantly different to other times in women's lives and for the first 42 days following delivery may be elevated. This calls into question the so-called 'protective effect of maternity'. The overwhelming majority of the suicides died violently, contrasting with the usual finding that women are more likely to die from an overdose of medication. Compared to other causes of maternal death, the suicides were older and socially advantaged. The Enquiry findings suggest that the risk profile for women at risk of suicide following delivery may be different to that in women at other times and in men. None of the women who died had been admitted at any time to a Mother and Baby Unit and their psychiatric care had been undertaken by General Adult Services. None of the women who died had had a previous episode correctly identified and none had had adequate plans for their proactive care. The conclusion is that there is a need for both Psychiatry and Obstetrics to acknowledge the substantial risk that women with a previous psychiatric history of serious mental illness face following delivery.

Impact of socioeconomic deprivation on maternal perinatal mental illnesses presenting to UK general practice

“…Perinatal mental illness, especially depression, is a leading cause of maternal morbidity and mortality in high-income countries 1,2 and has unfavourable impacts on short-term and long-term physical and mental health of offspring. [3][4][5] Guidance from the UK's National Institute for Health and Clinical Excellence (NICE) has emphasised that perinatal mental illness is one of the most important issues in women's health 6 yet up-to-date estimates of these conditions identified or treated at primary care level are not available.…”

Perinatal suicide in Ontario, Canada: a 15-year population-based study

“…[1][2][3][4][5] Existing Canadian data suggest that suicide is the fourth leading cause of death in the perinatal period. 6 However, rates may be underestimated, because they typically include only "maternal deaths" in pregnancy or up to 6 weeks (42 d) after the birth, despite the fact that the burden of suicide related to postpartum mental illness is likely to extend beyond 6 weeks postpartum.…”

“…Data from Europe suggest that underreporting of perinatal suicide on death certificates is in the range of 26% to 56%, 10,11 given that the presence of a child, or perhaps a birth, does not always emerge during the investigation of a death. 1,4,9,12,13 Despite high-profile media attention and calls to increase knowledge, with the goal of encouraging policy change, little is known about the true extent of the problem in Canada or the steps that can be taken to prevent it. 14,15 Greater knowledge about the suicide rate during pregnancy and the postpartum period, as well as the characteristics and patterns of health service use of women who die by suicide, is critical to inform suicide prevention strategies for perinatal women, and ultimately to reduce maternal mortality.…”

Evaluation of the Decision-Making Capacity of Two Cases Planning to Undergo Uterine Evacuation

“…(Dudzinski 2006). Perinatal dönemde yaygın gö-rülen ruhsal bozukluklar hem anne hem de fetüs için ciddi mortalite ve morbidite nedenidir (Oates 2003, Zalpuri ve ark. 2015 Yaklaşık dört gebe kadından birinin DSM-IV-TR'ye göre herhangi bir psikiyatrik bozukluğun ölçütlerini, yaklaşık on iki kadından birinin ise gebelikte başlayan bir psikiyatrik bozukluğun ölçütlerini karşıladığı saptanmıştır (Vesga-Lopez ve ark.…”