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Am J Obstet Gynecol. 2019 Mar 5. pii: S0002-9378(19)30435-1. doi: 10.1016/j.ajog.2019.02.056. [Epub ahead of print]

Maternal Self-Harm Deaths: An Unrecognized and Preventable Outcome.

Author information

1
Department of Psychiatry, Columbia University Medical Center, New York, NY. Electronic address: Kam2319@cumc.columbia.edu.
2
Department of Obstetrics & Gynecology, University of Colorado School of Medicine/Denver Health & Hospital Authority, Denver, Colorado.
3
Division of Behavioral Medicine, Department of Psychiatry, Columbia University Medical Center, New York, NY.
4
Division of Behavioral Medicine, Department of Psychiatry, Columbia University Medical Center, New York, NY; New York State Psychiatric Institute, New York, NY; Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY.

Abstract

Maternal mortality continues to be a public health priority in national and international communities. Maternal death rates secondary to medical illnesses such as cardiovascular disease, preeclampsia, and postpartum hemorrhage are well documented. The rates of maternal death secondary to self-harm, including suicide and overdose, have been omitted from published rates of maternal mortality, despite growing attention to the prevalence of perinatal mood disorders, estimated at up to 15% of pregnant and postpartum women in the United States. Underlying psychiatric disorder, including depression, is a consistently identified as a risk factor in substance abuse and suicide. The rate of opioid associated morbidity and mortality has recently been deemed a national crisis. Pregnancy does not protect against these risks and the postpartum period has been identified as a particularly vulnerable time. The lack of consistent and inclusive data on self-harm deaths in the pregnancy-postpartum period is alarming. This review will identify barriers to reporting and ascertainment of maternal suicide and overdose deaths, summarize geographic-specific data available, address potential social and psychological biases that have led to neglect of the topic of maternal self-harm deaths, and suggest recommendations that incorporate the "whole woman" in prenatal care and thus prevention of this devastating outcome.

KEYWORDS:

“maternal morbidity”; “maternal mortality”; “maternal self-harm”; “maternal suicide”; “neonatal abstinence syndrome”; “postpartum suicide”; “pregnancy opiate prescriptions”; “pregnancy opiates”; “pregnancy substance abuse”; “pregnancy suicide”

PMID:
30849358
DOI:
10.1016/j.ajog.2019.02.056

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