Most pregnant individuals who died of suicide or overdose in one state sample had diagnoses of mental health or substance use conditions – but few received proper therapy before death – a study suggests.
Michigan Medicine researchers examined 237 maternal overdoses or suicides between 2008 and 2018, finding that nearly two-thirds involved a documented mental health condition.
However, only one third of these patients received psychotropic medications such as antidepressants, mood stabilizers, or anti-anxiety medication prior to their deaths.
Similar to the death from substance overdose, nearly two-thirds of those who were killed had a documented substance abuse condition. Only a third of these patients received medication assisted therapy such as suboxone to combat opioid addiction.
“It’s concerning to see that the majority of these maternal deaths involved documented mental health and substance use conditions, but that so many lacked pharmacological treatment to mitigate their symptoms and improve their health,” said lead author Joanna Kountanis (M.D.., clinical assistant professor at the University of Michigan Medical School. “These findings suggest an urgent need to implement effective strategies across multiple specialty areas to address the relationship between pregnancy and behavioral health.”
The majority of deaths occur within three months, but more than half of all deaths took place between 4 and 12 months after birth. According to the findings of the American Journal of Obstetrics and Gynecology – Maternal Fetal Medicine.
“The later postpartum period may present a time of increased vulnerability due to less frequent scheduling of obstetrical and pediatric healthcare visits,” Kountanis said.
Prescription opioids were found to be the most prevalent substance in postmortem toxicology. Nearly half of those with substance overdose deaths had a prescription for a opioid. There were 42.9% who had overdosed, 44.3% had a prescription to benzodiazepine and 32.5% had both.
The retrospective study involved a secondary review of deceased patients’ records over a decade at the Michigan Department of Health and Human Services through the Michigan Maternal Mortality Surveillance Program. Researchers looked at both pregnancy-related and associated deaths.
Recent data suggests that overdose and maternal suicide are rising in maternal deaths. These may be leading causes of maternal mortality for up to one year after delivery.
“We know that untreated substance use and mental health conditions can put a person’s life in severe danger during and after pregnancy,” said coauthor Lindsay Admon M.D., a researcher and obstetrician-gynecologist at University of Michigan Health Von Voigtlander Women’s HospitalMichigan Medicine.
“Increased demand and barriers to behavioral health care during the pandemic may mean even fewer women and pregnant individuals are receiving the treatment they need. To ‘solve’ the maternal health crisis, it is urgent that we address and prioritize access to behavioral healthcare among pregnant and postpartum individuals.”
Mary Roberts M.D., DFAPA, Roger Smith M.D. are additional authors.; Allison Cropsey, B.S. Melissa E. Bauer (D.O.
Refer to: “Maternal deaths due to suicide and overdose in the state of Michigan from 2008 to 2018,” American Journal of Obstetrics and Gynecology – Maternal Fetal Medicine. DOI: 10.1016/j.ajogmf.2022.100811
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