Mental Health Plays Pivotal Role in US Maternal Mortality Rates

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Despite numerous national initiatives aimed at reducing maternal mortality rates in the US, a critical aspect often overlooked in these efforts is the role of mental illness. New research highlights the impact of mental health conditions on maternal mortality, emphasizing the urgent need for comprehensive strategies to address both physical and mental well-being during the perinatal period.

The research, which was published in JAMA Psychiatry, evaluated various crucial aspects over the last 3 years, and a comprehensive topic outline was developed to explore key challenges.

Perinatal Psychiatric Disorders:

According to the findings, during pregnancy and the early postpartum period, a significant proportion of individuals experience new episodes of depression, with approximately 14.5% encountering depressive episodes during pregnancy and another 14.5% within the first 3 months after birth. Among individuals screened at 4 to 6 weeks postpartum, recurrent unipolar depression was the most prevalent primary diagnosis, affecting 68.5% of the sample, followed by bipolar disorder (22.6%) and anxiety disorders (5.6%). Additionally, postpartum psychosis, associated with bipolar disorder, occurs at a rate of 1.1 per 1000 births at delivery.

Mechanisms Associated With Maternal Mental Illness That Increase Maternal Morbidity and Mortality:

The data showed individuals with mental health diagnoses face an elevated risk of severe morbidity during delivery, including complications such as preeclampsia, gestational hypertension, preterm delivery, postpartum hemorrhage, cesarean delivery, and maternal death. Postpartum psychiatric presentations significantly increase the risk of mortality, with a nearly 4-fold higher mortality rate ratio compared with mothers without a psychiatric history, highlighting the heightened vulnerability. Alarmingly, 70.9% of maternal deaths due to suicide or overdose are associated with documented psychiatric disorders, showcasing the critical need for mental health interventions in maternal care.

Limitations to Reproductive Health Care:

Many regions across the US lack adequate access to obstetrical or mental health clinicians, resulting in maternity care deserts and areas with a mental health professional shortage. These access limitations to prenatal and postpartum care contribute to untreated health complications and impose significant stress on mothers who must travel long distances for care. Furthermore, restrictions on access to reproductive health care, including limitations on pregnancy termination, are correlated with higher suicide rates among reproductive-aged individuals, underlining the adverse consequences of restricted access to comprehensive reproductive health services.

Trauma and Prenatal Stress:

Maternal stress during pregnancy triggers maternal immune activation and alters fetal brain development, which can have profound implications for offspring outcomes, researchers found. Exposure to trauma and stress during pregnancy may induce epigenetic changes that transcend generations, perpetuating the cycle of adverse health outcomes. These findings underscore the importance of addressing maternal stress and trauma to improve long-term maternal and neonatal health outcomes.

Improving Care Through Maternal Mental Health Training and Education:

Enhancing interdisciplinary clinical training in obstetrics and mental health is imperative for the early identification and treatment of maternal mental health disorders. Collaborative care models and programs focused on preventing and treating postpartum depression have demonstrated efficacy in improving access to maternal mental health care, underscoring the value of comprehensive approaches to maternal mental health.

Reconceptualizing Maternal Mental Health Care:

Strengthening parity in insurance coverage of mental and physical health care benefits is critical for addressing the maternal mental health crisis. Shifting the focus towards addressing social determinants of health (SDOH) and systemic stressors is essential for improving maternal and infant outcomes. Efforts to integrate health care with community services and address SDOH have the potential to enhance prenatal care engagement and pregnancy outcomes, exhibiting the importance of holistic and inclusive approaches to maternal mental health care.

The research yielded significant insights, with 26 citations from 2022-2023—14 from the past 5 years, and 15 historical references. Each section concluded with recommendations aimed at addressing the identified challenges. The researchers noted the necessity of a coordinated effort across professional and governmental organizations to mitigate the contributions of mental illness to maternal mortality risk.

To ensure the validity and relevance of the findings, publications from the last 3 years were prioritized, with a particular focus on those addressing policy implications. References were meticulously selected through consensus from reputable sources such as PubMed, Ovid, government websites providing direct data, and health policy sources like the Policy Center for Maternal Mental Health.

“Instead of focusing on a relatively minor portion of the contributors to health that current medical practice targets, fortifying the social foundation strengthens the prospects for the future health of families through culturally relevant, patient-centered care," the authors concluded. "It is past time to embrace this conceptual shift to embrace health writ large. Mental health is fundamental to health.”

Reference

Wisner KL, Murphy C, Thomas MM. Prioritizing maternal mental health in addressing morbidity and mortality. JAMA Psychiatry. Published online February 21, 2024. doi:10.1001/jamapsychiatry.2023.5648