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Cited by 318Maternal Mental Health During Pregnancy and PostpartumHomicide, Infanticide, and Child AbuseMaternal and fetal healthcare

Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality

Oates, Margaret·2003·British Medical Bulletin
DOI 10.1093/bmb/ldg011
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Abstract

The Confidential Enquiry into Maternal Deaths 1997 to 1999 finds that psychiatric disorder, and suicide in particular, is the leading cause of maternal death. Suicide accounted for 28% of maternal deaths. Women also died from other complications of psychiatric disorder and a significant minority from substance misuse. Some of the findings of the Confidential Enquiry confirm long established knowledge about postpartum psychiatric disorder. The findings highlight the severity and early onset of serious postpartum mental illness and of the risk of recurrence following childbirth faced by women with a previous history of serious mental illness either following childbirth or at other times. These findings led to the recommendation that all women should be asked early in their pregnancy about a previous history of serious psychiatric disorder and that management plans should be in place with regard to the high risk of recurrence following delivery. Other findings of the Enquiry were new and challenged some of the accepted wisdoms of obstetrics and psychiatry. It is likely that the suicide rate following delivery is not significantly different to other times in women's lives and for the first 42 days following delivery may be elevated. This calls into question the so-called 'protective effect of maternity'. The overwhelming majority of the suicides died violently, contrasting with the usual finding that women are more likely to die from an overdose of medication. Compared to other causes of maternal death, the suicides were older and socially advantaged. The Enquiry findings suggest that the risk profile for women at risk of suicide following delivery may be different to that in women at other times and in men. None of the women who died had been admitted at any time to a Mother and Baby Unit and their psychiatric care had been undertaken by General Adult Services. None of the women who died had had a previous episode correctly identified and none had had adequate plans for their proactive care. The conclusion is that there is a need for both Psychiatry and Obstetrics to acknowledge the substantial risk that women with a previous psychiatric history of serious mental illness face following delivery.

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  • Suicide has been identified as a leading cause of maternal death in some developed countries.

    “Suicide has been identified as a leading cause of maternal death in some developed countries [41]”

    From The global prevalence of postpartum psychosis: a systematic review (2017) · cites this paper as [41]

  • Psychological distress among perinatal women correlates with increased maternal morbidity and mortality rates.

    “Psychological distress among perinatal women correlates with increased maternal morbidity and mortality rates (Khalifa et al., 2016; Oates, 2003), poor infant health outcomes (Gelaye et al., 2016), and adverse early childhood developmental trajectories encompassing cognitive, emotional, and developmental delays (Slomian et al., 2019), making it a substantial public health concern.”

    From Developing and validating the Sierra Leone perinatal psychological distress scale through an emic-etic approach (2025) · cites this paper as Oates, 2003

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Authors
Oates, M.
Affiliations
University of Nottingham (GB)
Corresponding author
Oates, Margaret
Venue
British Medical Bulletin
Publisher
Oxford University Press (OUP)
Published
2003-12-01
Volume
67
Issue
1
Pages
219-229
ISSN
  • 0007-1420 (ISSN-L)
  • 1471-8391
DOI
10.1093/bmb/ldg011
OpenAlex
W2137670496
Cited by
317
References
16
Citations by year
2026: 8 · 2025: 12 · 2024: 16 · 2023: 13 · 2022: 17 · 2021: 20 · 2020: 17 · 2019: 22 · 2018: 18 · 2017: 18 · 2016: 21 · 2015: 21 · 2014: 21 · 2013: 18 · 2012: 12
FWCI
4.06
Type
journal article
Language
en
Open access
closed
Locations
  • British Medical Bulletin (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
Keywords
perinatal psychiatric disorders, maternal mortality, maternal suicide, postpartum mental disorders, severe mental illness, substance abuse, confidential enquiry into maternal deaths, maternal morbidity
MeSH terms
Female, Humans, Maternal Mortality, Pregnancy, Psychotic Disorders, Puerperal Disorders, Recurrence, Risk, Suicide

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