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Self-Harm a Cause of Death During Pregnancy

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The new findings, published in the December issue of Obstetrics & Gynecology, are based on records of maternal deaths in Colorado between 2004 and 2012. They included both deaths during pregnancy or in the year afterward.

Overall, 63 women died of suicide or a drug overdose — considered either accidental or “undetermined.” The most commonly detected drugs were prescription opioid painkillers, which include medications such as oxycodone (Oxycontin) and hydrocodone plus acetaminophen (Vicodin).

The fact that 30 percent of maternal deaths were attributed to self-harm is “just remarkable,” said Catherine Monk, an associate professor of psychiatry, and obstetrics & gynecology at Columbia University Medical Center in New York City.

Monk, who was not involved in the study, said the researchers should be “commended” for bringing the issue of maternal mental health to the foreground.

She agreed that women can face major obstacles in getting the help they need during and after pregnancy.

When it comes to substance abuse, for instance, women may fear having their baby taken away, Monk said. Depending on state laws, that fear may be founded or not, she noted.

As for depression screening, it should be done more often than it usually is, according to Monk — especially when a woman has a history of depression going into pregnancy.

“A history of psychiatric conditions should be a red flag,” she said.

But, Monk added, “screening alone is not enough.”

Women also need access to treatment, she stressed — not only medication, but also behavioral therapy.

Metz’s team found that of the 63 women who died of self-harm, just over half had documented mental health diagnoses — including six women with a previous suicide attempt.

And close to half of the 63 had been taking psychiatric medication when they became pregnant — mostly SSRI antidepressants. Many of those women stopped taking the drugs.

But while women may fear using medication during pregnancy, it’s important for those on antidepressants to not just quit on their own, Metz said.

She advised talking to your doctor first.

Silver agreed, saying that women can choose to stay on their antidepressant. In any event, he said, the depression needs to be addressed.

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