Perinatal mental health and pregnancy-associated mortality: opportunities for change.

Maternal outcomes Maternity care Perinatal mental health Pregnancy-associated mortality Veterans

Journal

Archives of women's mental health
ISSN: 1435-1102
Titre abrégé: Arch Womens Ment Health
Pays: Austria
ID NLM: 9815663

Informations de publication

Date de publication:
04 Jan 2024
Historique:
received: 18 09 2023
accepted: 17 11 2023
medline: 4 1 2024
pubmed: 4 1 2024
entrez: 3 1 2024
Statut: aheadofprint

Résumé

Perinatal mental health conditions have been associated with adverse pregnancy outcomes, including maternal death. This quality improvement project analyzed pregnancy-associated death among veterans with mental health conditions in order to identify opportunities to improve healthcare and reduce maternal deaths. Pregnancy-associated deaths among veterans using Veterans Health Administration (VHA) maternity care benefits between fiscal year 2011 and 2020 were identified from national VHA databases. Deaths among individuals with active mental health conditions underwent individual chart review using a standardized abstraction template adapted from the Centers for Disease Control and Prevention (CDC). Thirty-two pregnancy-associated deaths were identified among 39,720 paid deliveries with 81% (n = 26) occurring among individuals with an active perinatal mental health condition. In the perinatal mental health cohort, most deaths (n = 16, 62%) occurred in the late postpartum period and 42% (n = 11) were due to suicide, homicide, or overdose. Opportunities to improve care included addressing (1) racial disparities, (2) mental health effects of perinatal loss, (3) late postpartum vulnerability, (4) lack of psychotropic medication continuity, (5) mental health conditions in intimate partners, (6) child custody loss, (7) lack of patient education or stigmatizing patient education, and (8) missed opportunities for addressing reproductive health concerns in mental health contexts. Pregnancy-associated deaths related to active perinatal mental health conditions can be reduced. Mental healthcare clinicians, clinical teams, and healthcare systems have opportunities to improve care for individuals with perinatal mental health conditions.

Identifiants

DOI: 10.1007/s00737-023-01404-2 PMID: 38172275
pubmed: 38172275
doi: 10.1007/s00737-023-01404-2
pii: 10.1007/s00737-023-01404-2
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.

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Auteurs

Joan L Combellick (JL)

Department of Veterans Affairs, Veterans Health Administration, Office of Women's Health, 810 Vermont Ave NW, Washington, DC, 20420, USA. Joan.combellick@va.gov.
VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA. Joan.combellick@va.gov.
School of Nursing, Yale University, 400 West Campus Drive, Orange, CT, 06477, USA. Joan.combellick@va.gov.
ORCID: 0000-0003-3163-9467

Aryan Esmaeili (A)

Health Economics Resource Center (HERC), Palo Alto VA Medical Center, 795 Willow Road, Menlo Park, Palo Alto, CA, 94025, USA.

Amanda M Johnson (AM)

Department of Veterans Affairs, Veterans Health Administration, Office of Women's Health, 810 Vermont Ave NW, Washington, DC, 20420, USA.

Sally G Haskell (SG)

Department of Veterans Affairs, Veterans Health Administration, Office of Women's Health, 810 Vermont Ave NW, Washington, DC, 20420, USA.
VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA.
School of Medicine, Yale University, 333 Cedar St, New Haven, CT, 06510, USA.

Ciaran S Phibbs (CS)

Health Economics Resource Center (HERC), Palo Alto VA Medical Center, 795 Willow Road, Menlo Park, Palo Alto, CA, 94025, USA.
Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA.

Laura Manzo (L)

School of Nursing, Yale University, 400 West Campus Drive, Orange, CT, 06477, USA.
US Army, AMEDD Student Detachment, 187th Medical Battalion, Joint Base San Antonio, San Antonio, TX, 78234, USA.

Laura J Miller (LJ)

Department of Veterans Affairs, Veterans Health Administration, Women's Mental Health, Office of Mental Health and Suicide Prevention, 810 Vermont Ave NW, Washington, DC, 20420, USA.
Department of Psychiatry and Behavioral Sciences, Stritch School of Medicine, Loyola University, 2160 South First Avenue, Maywood, IL, 60153, USA.

Classifications MeSH