Intimate partner violence, substance use and mental illness may be as threatening to health and survival during pregnancy as medical issues, according to a new study.
In the study, researchers from the Boston University Medical Center note that mortality rates for pregnant women are increasing in the U.S. Many are due to medical causes thought to be directly related to pregnancy, such as hemorrhage, thromboembolism and hypertensive disease.
Although substance use, serious mental illness and intimate partner violence may also be exacerbated by pregnancy and are known to worsen perinatal outcomes, deaths specifically due to these causes are not included in current definitions of U.S. maternal mortality, the researchers noted.
For their study, which was published in the American Journal of Public Health, researchers reviewed cases of all women who died during or within a year of pregnancy in Philadelphia from 2010 to 2014. They extracted cause of death, contributing factors and any recorded history of health care use from the case summaries created by the medical examiner’s office.
They found that approximately half — 42 of 85 — of pregnancy-associated deaths were from unintentional injuries, homicide, or suicide.
Drug overdose was the leading cause of death, they discovered, while substance use was noted during or around events leading to death in almost half of non-overdose deaths.
A history of serious mental illness was found in more than a third of non-suicide deaths. And a history of intimate partner violence was documented in 15 of 77 non-homicide deaths.
Regardless of cause of death, nearly half of all the women who died had an unscheduled hospital visit documented within a month of their death, suggesting missed opportunities to intervene in these deaths, the researchers noted.
“Our analysis used a broader framework than traditional studies of death during pregnancy and found that a narrow focus on the medical causes of maternal mortality may be inadequate,” said lead author Pooja Mehta, M.D., M.S.H.P., assistant professor of obstetrics and gynecology at Boston University School of Medicine.
“Even women who died from medical causes frequently had histories of substance use disorder, serious mental illness or partner violence — hidden potential contributors to maternal mortality.”
Traditionally, public health and physician efforts to make pregnancy safer have focused on medical causes, for example, the prevention of excessive bleeding, blood clots, high blood pressure, and heart disease.
The researchers believe there are missed opportunities to intervene on behalf of those who are struggling during pregnancy, not just during labor and delivery, but also in emergency rooms, triage settings and in the community.
“Out-of-the-box strategies such as shifting resources, screening and support to these other settings may be important for pregnant people at risk for poor outcomes who turn to the health system for a helping hand,” Mehta said.
Source: Boston University Medical Center