Maternal mortality and psychiatric morbidity in the perinatal period: challenges and opportunities for prevention in the Australian setting

Abstract

Maternal mortality associated with psychiatric illness in the perinatal period (pregnancy to the end of the first year postpartum) has until recently been under‐reported in Australia due to limitations in the scope of the data collection and methods of detection. The recent United Kingdom report Why mothers die 2000–2002 identified psychiatric illness as the leading cause of maternal death in the UK. Findings from the last three reports on maternal deaths in Australia (covering the period 1994–2002) suggest that maternal psychiatric illness is one of the leading causes of maternal death, with the majority of suicides occurring by violent means. Such findings strengthen the case for routine perinatal psychosocial screening programs, with clear referral guidelines and assertive perinatal treatment of significant maternal psychiatric morbidity. Data linkage studies are needed to measure the full extent of maternal mortality associated with psychiatric illness in Australia.

Early life programming as a target for prevention of child and adolescent mental disorders

“…When considering the use, and hence exposure, to antidepressants in pregnancy, the issues relevant to child development and mental health outcomes are not just those that relate to exposure per se but also to the impact of untreated maternal mental illness. There is mortality data in both the UK and Australia that suggest mental illness is a leading indirect cause of maternal deaths [127]. In addition, untreated depression potentially impacts on the capacity of women to self-care in pregnancy, particularly in important areas that are increasingly associated with optimal fetal growth and development, such as nutrition and exercise.…”

The long-term psychiatric and medical prognosis of perinatal mental illness

“…Postpartum depression is one of the greatest causes of maternal mortality and long-term morbidity [17,18]. Women with PPD are at increased risk of maternal suicide, infanticide, decreased maternal sensitivity, and attachment with the infant [17,19,20].…”

Is Perceived Discrimination in Pregnancy Prospectively Linked to Postpartum Depression? Exploring the Role of Education

“…Women experiencing postpartum depression tend to feel overwhelmed by their parental role (Edhborg et al 2005) and may have thoughts of harming their infant (Jennings et al 1999). Suicides and homicides are rare among depressed women (Samandari et al 2011); yet, suicide remains a leading cause of maternal death in high-income countries (Austin et al 2007; Esscher 2013). Depressed women are less likely to breastfeed (Dennis & McQueen, 2007), use preventive pediatric care (Field 2010), and follow recommended safety practices, including using a car seat and covering electric outlets (Balbierz et al 2015; McLearn et al 2006).…”