Pregnant women with mental health problems should consult an expert before tapering off their medications, state officials said in a brief statement released Wednesday by the Maternal Mortality Review Board.
The recommendation was one of several made in the issue letter as part of a larger statewide effort to focus on maternal health.
Other recommendations included depression screening for pregnant women and better coordination between antenatal care providers and mental health professionals.
“Our findings are shocking and clear,” said Dr. Marilyn Kacica, medical director of the State Department of Health’s Division of Family Health. “Based on our latest data, mental illness contributed to 1 in 5 pregnancy-related deaths…Mental health is a core component of physical health and should be addressed throughout a person’s pregnancy and postpartum journey.”
What to know
Women taking psychiatric drugs may not automatically stop taking them after they become pregnant, according to a new release from the state’s Maternal Mortality Review Board.
Officials said mental illness was the third leading cause of pregnancy-related deaths in New York in 2018.
In the issue letter, the review board highlighted recommendations and resources to help health care providers recognize and treat pregnant women with mental health conditions.
Officials said mental illness is the third leading cause of pregnancy-related deaths in all of New York, after embolisms and bleeding. Those findings were released earlier this year by the Maternal Mortality Review Board in a 2018 study of pregnancy-related deaths.
That report found that of the 41 pregnancy-related deaths in 2018, 15% were due to mental illness. It also showed that black and non-Hispanic women had pregnancy-related death rates five times higher than white, non-Hispanic women.
The review committee determined that the mental health-related deaths were “potentially preventable”, with the majority occurring between 43 and 365 days after the end of pregnancy.
The issue briefing – the first in a series – was released Wednesday to highlight these findings and provide resources and guidance to providers.
Dr. Kristina M. Deligiannidis, director of Women’s Behavioral Health at Northwell Health’s Zucker Hillside Hospital in Glen Oaks, Queens, described the findings as “startling,” saying it’s also a reminder that mental health is physical health.
“Just as we pay attention to all the other medical things we need to take care of in our perinatal patients, from their blood pressure to their blood sugars, it’s just as important to know if that patient is doing well emotionally and behaviorally,” she said . said.
An important recommendation to clinicians is that psychiatric medications should not be automatically discontinued just because a patient is pregnant. In some cases, pregnant women stop taking their medication because they are concerned that it may adversely affect the fetus.
“They really need to talk to an expert who knows how the medication they’re taking can affect the pregnancy,” says Karen Boorshtein, president and CEO of the nonprofit Family Service League in Huntington. “They can also change the medication. Many women have difficulties during pregnancy and that can catapult them into depression.”
Boorshtein said pregnant women often struggle with other issues, such as food insecurity and unemployment.
“If you’re depressed and you’re not treated for it while you’re pregnant, the consequences can be devastating,” she said.
Another recommendation in the order was better training of emergency care providers so they can better recognize symptoms of mental illness in pregnant patients.
Deligiannidis is also medical director of reproductive psychiatry for the New York State Project TEACH, which helps health care providers assess the treatment and management of mental health problems. She said providing these types of resources, referrals and other services to health care providers is especially important for those whose primary training was not in mental health.
“If we had the right screening, if we had the right care coordination, and we had enough providers to care for patients with mood and anxiety disorders and other psychiatric conditions or substance use disorders… we could have prevented these deaths “, she said.