“One death every four days”: suicide, leading cause of maternal mortality in France

“One death every four days”: suicide, leading cause of maternal mortality in France

Suicide, leading cause of maternal mortality in France

On average, each year, around 90 women die from causes linked to pregnancy or childbirth, according to a joint study by Inserm and Public Health France over the period 2016- 2018. A death occurs every four days. Among the causes, suicide occupies 1st place, ahead of cardiovascular diseases.

For the period 2016-2018, 272 maternal deaths were identified on French territory by the research team in perinatal and pediatric obstetric epidemiology (EPOPé) of Inserm, with the support from Public Health France. This 7th edition is based on data from the Confidential National Survey on Maternal Deaths (ENCMM) and covers the 2016-2018 triennium.

This represents around 90 deaths annually, or 1 death every 4 days in France from a cause linked to pregnancy, childbirth or their consequences. This number of 272 women who died corresponds to a maternal mortality ratio (MMR) of 11.8 deaths up to one year after the end of the pregnancy.

Cardiovascular causes in the face of obstetric hemorrhages which are stabilizing

If the figures for maternal mortality remain constant compared to previous years, a notable result is the preponderant place of suicides and psychiatric causes of death which is confirmed for the period 2016-2018. They are now the leading cause of maternal mortality considered up to one year (17%), with an MMR of 1.9/100,000 live births, or approximately one maternal death from psychiatric causes every three weeks.

If we consider the 12 months following childbirth, the suicide rate therefore doubles that of cardiovascular diseases as a cause of maternal death. However, cardiovascular diseases remain the main cause of mortality (14% of maternal deaths) during the 42 days following the end of pregnancy.

As for obstetric hemorrhages, which were still the leading cause of maternal mortality a decade ago, they are stabilizing (0.9/100,000 live births) at a level twice as low as ;around fifteen years ago. Thus, during the period 2016-2018, venous thromboembolisms, amniotic embolisms, cerebrovascular accidents (CVAs) and hemorrhages are among the other most frequently observed causes, with an average ratio of approximately 0, 9 deaths per 100,000 live births.

Women aged over 35 more at risk

The risk of maternal mortality increases with the age of women, compared to those aged 20 to 24. Indeed, the relative risk is 1.4 for this age group, then it rises to 2.6 for women aged 35 to 39, and reaches 5.3 for women over 40. .

In addition to age, various other characteristics place women at increased risk of maternal mortality. For example, women born in sub-Saharan Africa have a risk 3.1 times higher than those born in France. In addition, obesity and socio-economic vulnerability accentuate this risk: women suffering from obesity have a risk of maternal mortality twice as high as those of normal weight (26% compared to 13%), while vulnerable women have a risk of 34% compared to 22% for those who are not.

Finally, geographic location plays an important role. Overseas departments and regions present a risk of maternal mortality doubled compared to the metropolitan average. However, this ratio tends to decrease compared to previous studies. In mainland France, the Provence-Alpes-Côte d’Azur, Hauts-de-France and Île-de-France regions have maternal mortality rates of between 13 and 14.5 per 1000 live births, close to those of the DROMs . On the other hand, the Occitanie region has the lowest ratio in the country, with less than 7 deaths per 100,000 live births.

30 key messages to improve the situation

The authors estimate that "60% of maternal deaths are probably (for 17%) or possibly (for 43%) preventable ", the factor most often involved being the inadequacy of the care provided. The committee of experts therefore produced a document of 30 key messages to improve prevention, screening and coordination of care. It is stipulated that "risk factors, personal and family, of " or even that "any respiratory symptoms" should lead to the search for a cardiac origin.

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