Pregnancy-associated deaths will increase in the COVID-19 era

Maternal mortality due to partner violence, suicide, and substance overdoses will increase due to COVID-19.

Do blog da Maternal Health Task Force

 

By: Kathryn Mishkin, DrPH, MPH, MA, Associate Director of Evaluation, March of Dimes; Rahul Gupta, MD, MPH, MBA, FACP, Chief Medical & Health Officer, SVP, March of Dimes; Roland Estrella, MS, MBA, Senior Director of Science, Data, and Evaluation, March of Dimes

 

COVID-19 has devastated the lives of the American people with over 250,000 deaths to date, and this impact is going to extend to pregnant and postpartum women.

This is terrifying considering that the United States entered the pandemic with the infamous status of having the highest maternal mortality rate among all developed nations. Already, researchers are concerned about an increase in maternal morbidity and mortality due to COVID-19’s effect on pregnant women’s immune systems, its contribution to cardiopulmonary complications, and the higher rates of hospitalizations and ICU visits among pregnant women with COVID. It is feared that Black women will be particularly affected, and this is troubling considering that Black women were already four times more likely to die in the maternal period compared to White women pre-COVID.

It is clear that COVID-19 will adversely affect pregnant and postpartum women’s physical health.

However, current predictions have not yet painted a full picture of how COVID-19 may contribute to an increase in maternal mortality in the United States. It is essential that we expand our discussion beyond medical causes of death to include maternal deaths due to suicide, substance overdose, and homicide as a result of partner violence.

We expect pregnant and postpartum women to die more frequently from these causes because we are seeing this happen in the general population. Since January, drug overdoses have spiked according to the Office of National Drug Control Policy. A physician in California says he has seen more deaths from suicide than COVID-19, with a year’s worth of suicide deaths occurring in just four weeks. The United Nations Population Fund predicts IPV rates will increase by 20% during a three-month quarantine. Physical distancing, while protective against COVID-19, exacerbates the risk of being abused and suffering from mental illness because of social isolation and increased stress. From a social perspective, women are now facing the brunt of increased responsibility for domestic responsibilities that comes with the “new normal”, and this added stress will have an impact on their health.

Furthermore, we know that pregnant and postpartum women were dying from these causes before the pandemic. A global study revealed that 13-36% of maternal deaths are due to suicide. In 2016, Philadelphia’s maternal mortality review reported that nearly half of pregnancy-associated deaths were due to injuries including homicide, suicide, and drug overdoses. In California, research shows that drug-related and suicide deaths are the second and seventh leading cause of maternal deaths, respectively, constituting 18% of all maternal deaths.

We also know that certain populations are at higher risk for these types of deaths. People living with underlying mental illness are at higher risk for dying from suicide and substance overdose deaths and women experiencing IPV are more likely to have a mental illness. Measures taken to limit the spread of the virus will result in reduced access to and use of care and support for some at-risk populations.

In sum, pregnant and postpartum women were already experiencing IPV, suffering from mental illness, and using substances, and COVID-19 will exacerbate these issues.

We call on public health leaders to join the #Blanket Change movement to raise awareness about the urgent health crisis moms and babies are facing in order to ramp up prevention and care and support documentation of these deaths.

Prevention of death due to these causes is possible but requires an effective and efficient health care and social support system. The American College of Obstetricians and Gynecologists provides recommendations for screening for substance use, IPV, and depression. In spite of this, screening appears to be lacking. For example, a recent report by the Centers for Disease Control and Prevention stated that 20% of women were not asked by their health care provider about depression symptoms in the prenatal period and 12.5% were not asked in the postpartum period, with a wide discrepancy in rates depending on where a woman was living.  We call on health care providers to improve screening for mental illness, IPV, and substance use to improve the health of moms and babies.

In addition to effective prevention, we call for all states to document the frequency of deaths due to suicide, IPV, and substance overdose through maternal mortality review.  Full documentation on a national scale will allow us to develop a better understanding of the reasons that pregnant and postpartum women are dying. Without a comprehensive review, our ability to develop critical recommendations to prevent future deaths will remain inadequate.