Suicide and Overdose Equal Medical Conditions as Reasons for Maternal Mortality
September 24, 2018
The recent HealthStream Webinar, “Maternal Mental Health Risk Assessment and Intervention Before, During, and After Pregnancy,” featured Susan Kendig, an attorney and nurse practitioner with more than 35 years of experience in the healthcare industry. This blog post is the first in a series based on this webinar that will focus on maternal mental health.
The CDC estimates that almost 20 percent of women will experience some type of depressive episode during or after pregnancy. Untreated, this can have a devastating effect on women and their families. Importantly, maternal suicide within a year of giving birth is emerging as a significant cause of maternal mortality, and it's probably under-reported in the United States. States are now looking at maternal mortality reviews and incorporating review of suicidality during pregnancy or the first year postpartum. Both in Colorado and Illinois, they have found that suicides, when you look at maternal deaths both during pregnancy and that first year postpartum, from suicide or drug overdose, seem to be outpacing all medical conditions combined and are emerging as one of the top causes of maternal mortality. Certainly, this staggering statistic is something to consider in terms of prevention strategies and recognition strategies. There are significant implications, especially that women who are having issues in terms of depression and anxiety may not adhere to their prescribed medical regimen.
High-risk Patients and Depression Are a Dangerous Mix
High-risk patients are those women who have severe hypertensive disorders, diabetes, etc. Having an overlay of mental health conditions may actually contribute to less than optimal outcomes. Certainly, there are issues with the newborn, not the least of which would be a potential for failure to thrive, increased risk of pediatric issues, and at the very least missing those really important pediatric appointments and immunizations.
Anxiety should also be considered during the prenatal and postpartum period because the prenatal and postpartum prevalence, particularly when you look at the full spectrum of anxiety disorders, equals or surpasses that of depression during pregnancy, and prenatal anxiety is really a very strong predictor of perinatal depression as well. Outcomes tend to be similar.
Recommendations for Screening for Depression and Anxiety
Because of the statistics and the recognition of the importance of depression and anxiety and its impact on maternal and women's health outcomes as well as newborn outcomes, several professional groups have issued recommendations around screening for depression and anxiety.
American Academy of Paediatrics Advises Screening During Newborn Visits
The American Academy of Paediatrics was the first to come on board with this, recommending that pediatricians screen mothers for depressive symptoms at child visits at one, two, and four months. They have since updated that recommendation to continue those during the first year. The important thing to remember is if your pediatricians are implementing this protocol, there needs to be some type of feedback loop back to the women's health care provider as well as her primary care provider. The woman is screened during that pediatric encounter, because the theory here is many women will attend the newborn visits. However, about 40% of women across the board miss their postpartum visits. So, having pediatricians screen is an excellent idea. The next step would be having that feedback loop because if she does come to her women's health care provider or her primary care provider for a variety of reasons and they don't know that she has had a screen that indicates risks, there again maybe a missed opportunity.
ACOG and Others Also Endorse Screening
In May 2015, The American College of Obstetricians and Gynecologists (ACOG) published a committee opinion, the American College of Obstetricians and Gynecologists, to screen at least once during the prenatal period and the US Preventive Services Task Force followed that with a statement including depression screening for pregnant women both in the antepartum and postpartum period. A significant body of research recommended that screening occur during the prenatal and postpartum periods, which led the Council on Patient Safety to develop a maternal mental health patient safety bundle and widely recognized that there are multiple conditions that come under that umbrella of mental health, certainly things like bipolar disorder, schizophrenia, etc.
Future blog posts will examine the maternal mental health patient safety bundle.
Access the full Webinar recording here.