[Perinatal maternal suicide: How to prevent?]

Area of Science:

• Public Health
• Psychiatry
• Obstetrics & Gynecology

Background:

• Maternal mortality remains a critical public health concern globally.
• The sixth report of the National Confidential Survey on Maternal Deaths in France (2013-2015) provides updated data on causes and preventability.
• Suicide has emerged as a significant, yet often overlooked, cause of maternal death.

Purpose of the Study:

• To analyze the frequency, risk factors, causes, care adequacy, and preventability of maternal deaths in France between 2013 and 2015.
• To specifically investigate the circumstances and contributing factors of maternal suicides.
• To identify key areas for improving care and prevention strategies.

Main Methods:

• Exhaustive identification and confidential analysis of maternal deaths occurring during pregnancy or up to one year postpartum.
• Information collection by volunteer assessors including medical history, pregnancy course, and circumstances of death.
• Review and classification by a National Committee of Experts, including psychiatrists, to determine cause, care adequacy, and preventability.

Main Results:

• Suicide was the second leading cause of maternal death (13.4%), with 35 cases over the triennium.
• Maternal suicides occurred primarily postpartum (77% between 43 days and 1 year after birth).
• Suboptimal care (72% of cases) was linked to lack of multidisciplinary management and poor patient-system interaction, with 91% of preventable deaths attributed to these factors.

Conclusions:

• Suicide is a major preventable cause of maternal mortality, necessitating enhanced mental health screening and support.
• Improved multidisciplinary management, early detection of psychiatric issues, and better coordination between healthcare providers are essential.
• Recommendations include structured psychiatric history screening, early postnatal assessments, and integrated medico-psycho-social support systems.