The number of women who have died during pregnancy or soon after has risen sharply to its highest levels for 20 years, prompting concern from experts.
The maternal death rate increased to 13.41 deaths per 100,000 pregnancies between 2020 and 2022, according to figures published by the MBRRACE-UK investigation into maternal deaths in the UK. The figure was 8.79 in the period 2017 to 2019.
It is the highest death toll since 2003-05, when the maternal death rate stood at 13.95 deaths per 100,000.
Even when excluding maternal deaths as a result of coronavirus, the maternal death rate between 2020 and 2022 (11.54 deaths per 100,000) remains higher than the rate between 2017 and 2019.
Prof Marian Knight, the director of national perinatal epidemiology unit and MBRRACE-UK maternal reporting lead, said she was concerned by the figures, adding: “These data show that the UK maternal death rate has returned to levels that we have not seen for the past 20 years.”
An NHS England spokesperson said: “While the NHS has made significant improvements to maternity services over the last decade, we know further action is needed to improve the experiences of women and their families across the country.”
A separate study has found that women who experience depression during pregnancy or in the first year following the birth of a child are also more than twice as likely to die prematurely, particularly due to suicide.
Perinatal depression is one of the most common complications of pregnancy, affecting as many as 20% of women around delivery. Despite the huge numbers afflicted worldwide, the association between perinatal depression and risk of death has not been seriously examined until now.
The association cannot be explained by shared family factors and is independent of pre-existing psychiatric disorders, the study shows. The researchers said women who are affected, their families, and health professionals should be aware of these severe health hazards.
“Women with clinically diagnosed perinatal depression are at an increased risk of mortality independent of psychiatric history and familial factors,” the researchers wrote in the BMJ. “The association is stronger for unnatural death, particularly due to suicide, and during the first year after diagnosis.”
An international team of researchers set out to determine whether women with perinatal depression are at an increased risk of death compared with unaffected women and sisters.
Using Swedish national registry data from 2001 and 2018, they identified 86,551 women with a first ever diagnosis of perinatal depression and 865,510 unaffected women matched by age and calendar year at delivery.
To control for shared family factors, they also compared data for 24,473 of the women who had perinatal depression with 246,113 unaffected full sisters who delivered at least one baby during the study period.
A range of known risk factors for both depression and premature death were taken into account, including socioeconomic status, pre-existing psychiatric disorders, adverse birth outcomes, and death of a child within the first year after birth.
The results show that women with perinatal depression were more than twice as likely to die than women who did not have perinatal depression, The BMJ said. Results were similar when comparing deaths between sisters and among women who did and did not have a pre-existing psychiatric disorder.
The increased risk associated with perinatal depression was most pronounced in the first year after diagnosis. It reduced over time but remained higher throughout the 18 years of study follow-up.
Although suicide was rare, women with perinatal depression were six times as likely to die from suicide, and three times as likely to die from an accident, than women who did not have perinatal depression.
These were observational findings and the researchers highlighted several limitations, such as only including women who sought specialist care for their depression and possible misclassification of some suicide events as accidents.
And while they controlled for a range of factors, including those shared within families, they could not rule out the possibility that some other unmeasured factors may have influenced their results.
However, they concluded: “Women affected with perinatal depression, their families, and health professionals, particularly those working in primary, maternal, and mental care, need to be aware of the serious health hazards regardless of psychiatric history.
“Early detection and treatment are needed for groups at high risk of perinatal depression to prevent the fatal outcomes.”
In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@samaritans.ie. In the US, you can call or text the National Suicide Prevention Lifeline on 988, chat on 988lifeline.org, or text HOME to 741741 to connect with a crisis counsellor. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org
