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Depression and obesity are major causes of maternal death in Britain

BMJ 2004; 329 doi: (Published 18 November 2004) Cite this as: BMJ 2004;329:1205
  1. Madeleine Brettingham
  1. London

    Depression and obesity are now the major causes of deaths related to pregnancy among women in the United Kingdom, a report published by the Royal College of Obstetricians and Gynaecologists said last week. Although numbers of deaths as a result of direct physiological complications such as thromboembolism have fallen broadly, indirect psychological and lifestyle factors continue to pose a significant risk.

    The Confidential Enquiry into Maternal Death assessed 391 deaths over a period of three years, from 2000 to 2002, to arrive at its findings. “There has been a vast reduction in the number of direct obstetric complications, and that shows a great improvement in medical science,” said Richard Congdon, the enquiry's chief executive. “But there are a number of areas where the situation has not improved and there is evidence that in some cases it has got worse.”

    Forty per cent of maternal deaths are now attributed to indirect causes. Depression and suicide were singled out as areas of particular concern. Psychological factors are now the leading cause of death among young mothers or expectant women, and the report emphasised the need for patients to be assessed and counselled effectively before the birth.

    “Half of those women who committed suicide due to serious mental illness had a history of mental problems,” said Margaret Oates, consultant perinatal psychiatrist at Nottingham University Hospital. “It is important for professionals to have clear and relevant information about the patient to enable them to give appropriate care.”

    The report suggests several improvements, among them the development of a standard national checklist to ascertain the social and inherited risk factors that may affect a woman and the establishment of a specialist perinatal psychiatric team in every locality.

    Obesity is also a problem. Thirty five per cent of the women covered by the study were obese, 50% more than among the general population. No single complication was associated with these deaths, but there was thought to be a relation between obesity and broader lifestyle factors such as smoking and social exclusion.

    The team pointed out that in some cases extreme obesity could even be a barrier to care. Gwyneth Lewis, director of the study and adviser on maternal death at the World Health Organization, said, “It is difficult to say whether obesity is an increasing problem. But if you look at what is happening to the general population I think it is fair to assume so.”

    The report also claims that “over half of the women who died had some aspect of substandard clinical care.” The number of deaths related to anaesthesia has doubled and has been attributed to junior anaesthetists working under inadequate supervision.

    The number of deaths resulting from catastrophic haemorrhage and ectopic pregnancy also grew in the three years of the study.

    The average number of maternal deaths in the United Kingdom is 13.1 in every 100 000 maternities. “We are always raising the goalposts in terms of the standards of care we expect mothers to receive,” said Dr Lewis. “Nevertheless, we believe that some—though not all—of these deaths are avoidable.”

    Why mothers die: the 50th Anniversary report by the Confidential Enquiry into Maternal Deaths can be purchased from the Royal College of Obstetricians and Gynaecologists' bookshop on 020 7772 6275, price £19.50 for RCOG fellows and members; £16 for non-members

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