Maternal Mortality Review Committees (MMRCs) play a crucial role in understanding and preventing pregnancy-related deaths. These multidisciplinary bodies meticulously review cases to identify contributing factors and recommend actions for prevention. Data from MMRCs across 38 U.S. states in 2020, shared with the Centers for Disease Control and Prevention (CDC), reveals critical insights into the circumstances surrounding these tragic losses. Among these circumstances, mental health conditions, distinct from substance use disorders, emerge as a significant concern, highlighting the urgent need to address Mental Health Care During Pregnancy Bias Under Diagnosis.
While MMRCs meticulously analyze various factors, including obesity, discrimination, and substance use disorders, the spotlight on mental health conditions underscores a potentially overlooked crisis during pregnancy. It’s not merely about the presence of a mental health condition, but whether it contributed to the death, indicating a lapse in care, recognition, or effective management. This distinction is crucial when considering bias under diagnosis in mental health care during pregnancy.
The Critical Role of Mental Health in Maternal Mortality
MMRCs delve into whether a mental health condition, beyond substance use, played a role in pregnancy-related deaths. This includes documented diagnoses of depressive, anxiety, psychotic, and bipolar disorders. In cases lacking a formal diagnosis, committees consult experts to ascertain if diagnostic criteria were met. The core question is whether the mental health condition directly compromised the woman’s health or healthcare. For instance, a mental health condition could hinder a woman’s ability to manage pre-existing conditions like diabetes during pregnancy, ultimately contributing to a fatal outcome.
Unveiling Bias and Underdiagnosis in Maternal Mental Health Care
The data spotlighting mental health conditions as a contributing factor in 26% of pregnancy-related deaths in 2020 raises significant concerns about bias under diagnosis in mental health care during pregnancy. Several factors may contribute to this alarming statistic:
- Stigma surrounding mental health: Societal stigma can prevent women from seeking help or disclosing mental health concerns during pregnancy. Healthcare providers, too, may hold implicit biases that downplay or dismiss mental health symptoms in pregnant individuals, attributing them to hormonal changes or pregnancy-related stress.
- Diagnostic overshadowing: Physical health complaints during pregnancy might overshadow underlying mental health issues. Symptoms of depression or anxiety could be misinterpreted as normal pregnancy discomforts, leading to delayed or missed diagnoses.
- Lack of integrated care: Mental health care is often siloed from routine prenatal care. Insufficient screening, referral pathways, and collaboration between obstetric and mental health professionals can result in gaps in care and missed opportunities for intervention.
- Systemic inequities: Racial and ethnic minorities, low-income women, and those in rural areas face disparities in access to mental health care. These populations are also disproportionately affected by maternal mortality, suggesting that bias under diagnosis in mental health care during pregnancy exacerbates existing health inequities.
Figure 3. Committee Determination on Mental Health Conditions Other Than Substance Use Disorder as a Circumstance Contributing to the Death, Data From Maternal Mortality Review Committees in 38 U.S. States, 2020a
This chart illustrates the committee’s assessment of mental health conditions, excluding substance use disorders, as a factor contributing to pregnancy-related deaths in 2020.
Data Speaks: Mental Health Conditions as a Major Contributor
MMRCs determined that mental health conditions, other than substance use disorders, were a contributing circumstance (Yes or Probably) in 26% of pregnancy-related deaths in 2020. This is a significant proportion, highlighting the critical need for improved mental health care during pregnancy and strategies to combat bias under diagnosis.
It’s crucial to remember that this percentage is based on cases where MMRCs determined a contribution. The actual prevalence of mental health conditions among pregnant women may be even higher, and the impact of bias under diagnosis could mean that mental health’s role in maternal mortality is underestimated.
Other Circumstances Contributing to Pregnancy-Related Deaths
While mental health care during pregnancy bias under diagnosis is a central focus, the MMRC data also sheds light on other significant contributing factors:
- Obesity: Committees identified obesity as a contributing factor in 32% of pregnancy-related deaths. Obesity can complicate pregnancy and delivery, and may interact with mental health conditions, further increasing risk.
Figure 1. Committee Determination on Obesity as a Circumstance Contributing to the Death, Data From Maternal Mortality Review Committees in 38 U.S. States, 2020a
This graph shows the committee’s findings on obesity as a factor contributing to deaths related to pregnancy in 2020.
- Discrimination: Discrimination was deemed a contributing factor in 30% of pregnancy-related deaths. Bias in healthcare settings can lead to poorer quality care, misdiagnosis, and delayed treatment, particularly impacting mental health assessment and support.
Figure 2. Committee Determination on Discrimination as a Circumstance Contributing to the Death, Data From Maternal Mortality Review Committees in 38 U.S. States, 2020a
This visual represents the committee’s conclusion on discrimination as a factor contributing to deaths during pregnancy in 2020.
- Substance Use Disorder: Substance use disorder contributed to 25% of pregnancy-related deaths. While distinct from other mental health conditions in the MMRC analysis, substance use disorders often co-occur with other mental health issues, further complicating mental health care during pregnancy and potentially exacerbating the impact of bias under diagnosis.
Figure 4. Committee Determination on Substance Use Disorder as a Circumstance Contributing to the Death, Data From Maternal Mortality Review Committees in 38 U.S. States, 2020a
This chart depicts the committee’s determination regarding substance use disorder as a factor contributing to pregnancy-related deaths in 2020.
Data-Driven Action for Improved Maternal Mental Health
The data from MMRCs serves as a powerful call to action. Addressing mental health care during pregnancy bias under diagnosis is paramount to reducing maternal mortality. Key steps include:
- Universal screening for mental health conditions during pregnancy and postpartum: Implementing routine screening can help identify women at risk and facilitate timely intervention.
- Training healthcare providers to recognize and address mental health conditions: Education on perinatal mental health, implicit bias, and culturally competent care is essential for all healthcare professionals involved in maternal care.
- Integrating mental health services into prenatal and postpartum care: Seamless integration of mental health professionals into obstetric settings can improve access and coordination of care.
- Reducing stigma associated with mental illness: Public awareness campaigns and destigmatizing mental health conditions can encourage women to seek help without fear of judgment.
- Addressing systemic inequities: Efforts to improve access to quality mental health care for underserved populations are critical to achieving equitable maternal health outcomes.
By acknowledging the significant contribution of mental health conditions to pregnancy-related deaths and actively combating bias under diagnosis in mental health care during pregnancy, we can strive towards a future where every pregnant woman receives the comprehensive and compassionate care she deserves, ultimately saving lives.
Data Sources and Methods: Data for this analysis were collected and shared by jurisdictional MMRCs through the Maternal Mortality Review Information Application (MMRIA). The data encompasses pregnancy-related deaths occurring in 2020 among residents of 38 U.S. states.
Definition: Pregnancy-related death is defined as a death during pregnancy or within one year of the end of pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy.
