Maternal deaths: suicide now the leading cause of death in France among women before or after childbirth

Une étude pointe le suicide désormais comme cause principale de mort maternelle en France. Illustration Pixabay

Si elles sont rares, les "morts maternelles" existent toujours en France, et le suicide en est devenu la première cause, selon une étude publiée mercredi par l'Inserm et Santé publique France, n'incluant pas la période de la pandémie de Covid.

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-intensivists, midwives 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. In the European average, the ratio maternal mortality (11.8 deaths per 100,000 live births) has not changed compared to previous surveys.

From second to first cause

But, this time, suicide – with other psychiatric causes – emerges as the leading cause of maternal mortality (17%), ahead of cardiovascular diseases (14%).< /p>

"It'was the second cause, it becomes the first: it's not a radical change in trend but an increased confirmation of the weight of suicides", declared to AFP Catherine-Deneux Tharaux, research director at Inserm.

Only 42 days after the end of pregnancy – reference period for international comparisons -, 197 deaths occurred between 2016 and 2018, caused primarily by cardiovascular diseases.

High inequalities

"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 "to consider women's health globally".

For around 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 now stagnates, at the top of the range in European countries.

Beyond 2018, "maternal mortality will increase because of the Covid pandemic, in particular because pregnant women were more at risk of serious forms& quot;, according to Catherine-Deneux Tharaux.

For these deaths, strong territorial and socio-demographic inequalities persist. The risk is thus doubled in Overseas France, compared to mainland France – the gap was higher previously.

For migrant women, mortality is on average twice that of natives of France. 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 were not optimal, underlines the study.

Guilt

Prevention, screening, coordinated and multidisciplinary care remain recommended, broken down into 30 key messages.

To prevent suicides, "personal and family risk factors for perinatal depression must be known to professionals (…) and sought throughout pregnancy and postpartum monitoring", underline the experts.

In addition to the involvement of all caregivers in detecting symptoms of mental disorders up to the year following childbirth, they recommend informing pregnant women, those around them and the general public on perinatal depression.

S'adds 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.

Globally, a woman dies every two minutes from complications related to pregnancy or childbirth (up to 42 days later), according to estimates, in 2023 , United Nations agencies.

There were approximately 287,000 maternal deaths in 2020, mainly in the poorest and conflict-affected regions. Main causes: severe bleeding, high blood pressure , infections linked to pregnancy, complications of unsafe abortions, conditions likely to be aggravated by pregnancy (AIDS, malaria, etc.).