Maternal deaths are increasingly linked to suicide

Although they are rare, “maternal deaths” still exist in France, and suicide has become the leading cause, according to a study published Wednesday by Inserm and Public Health France. Around 90 women die annually from a cause linked to pregnancy or childbirth, one every four days on average, according to the 7th edition of this work supported by monitoring by gynecologists-obstetricians, anesthetists-resuscitators, wise men. -women and epidemiologists.

Between 2016 and 2018, 272 maternal deaths were recorded, over the period between conception and one year after the end of the pregnancy. The maternal mortality ratio (11.8 deaths per 100,000 live births), which is within the European average, has not changed compared to previous surveys.

But, this time, suicide - with other psychiatric causes - emerges as the leading cause of maternal mortality (17%), ahead of cardiovascular diseases (14%), such as high blood pressure in particular. “It was the second cause, it becomes the first: it is not a radical change in trend but an increased confirmation of the weight of suicides,” explains Catherine-Deneux Tharaux, research director at Inserm.

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In the 42 days alone after the end of pregnancy - the reference period for international comparisons - 197 deaths occurred between 2016 and 2018, caused primarily by cardiovascular diseases. “The two leading causes of maternal deaths, suicides and cardiovascular diseases, are extra-obstetrical, and their absolute levels are increasing a little,” notes the specialist in perinatal epidemiology, inviting us to “consider women’s health globally.”

For the past ten years, obstetric hemorrhages are no longer predominant, “good news,” she says. Reduced by half in 15 years, mortality due to excessive bleeding during childbirth or in the following 24 hours is now stagnating at the top of the range in European countries.

As for the period after 2018, not yet studied, “maternal mortality will increase because of the Covid pandemic, in particular because pregnant women were more at risk of serious forms”, according to Catherine-Deneux Tharaux.

Strong territorial and socio-demographic inequalities persist in the risk of maternal death. This is thus doubled in Overseas, compared to mainland France - however the gap was even greater before. For migrant women, mortality is on average twice that of native French women. And socially vulnerable women are 1.5 times more represented among maternal deaths. Age also increases the risk, “markedly” after 35 years. Obesity too, with twice as many maternal deaths among obese women.

“Improvement is possible, because more than half of maternal deaths are considered probably or possibly preventable, and, in two thirds of cases, the care provided was not optimal,” underlines the study. Prevention, screening, coordinated and multidisciplinary care remain recommended, broken down into 30 key messages. To avoid suicides, “personal and family risk factors for perinatal depression must be known to professionals (...) and sought throughout pregnancy and postpartum monitoring,” the experts emphasize.

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In addition to the involvement of all caregivers to detect symptoms of mental disorders up to the year following childbirth, they recommend informing pregnant women, those around them and the general public about perinatal depression. Added to this is postpartum depression, underlines the researcher, observing that “women still feel strong guilt in experiencing sadness, a lack of pleasure with their child, a feeling of not being a good mother, but rarely verbalize.