Maternal mortality affects one woman every four days in France. According to a study published this Wednesday, April 3 by Inserm and Public Health France, 272 maternal deaths were recorded between 2016 and 2018. The maternal mortality ratio (11.8 deaths per 100,000 live births), which is within the European average, has not changed compared to previous surveys, according to the 7th edition of this ENCMM survey (confidential national survey on maternal deaths).
To measure this mortality, the ENCMM included all deaths “associated with pregnancy”, that is to say “occurring during pregnancy or up to one year following its end, whatever the cause and mode termination”. The ENCMM therefore differs from most countries by not only counting deaths occurring up to 42 days after pregnancy, the classic period for studying maternal health. “Advanced knowledge shows that women’s health remains affected by pregnancy beyond these 42 days. Thus, the WHO recommends, for countries that can do so, to extend the window to one year, including ‘late’ maternal deaths, that is to say those which occur between 43 and 365 days after the end of the pregnancy”, indicates the report.
“Maternal mortality remains rare, but we must remain vigilant”, summarizes with of the world Catherine Deneux-Tharaux, research director at Inserm and scientific manager of the survey. According to this report, 60% of maternal deaths are considered “probably” (17%) or “possibly” (43%) preventable. “This proportion of more than half of potentially preventable maternal deaths shows that a reduction in maternal mortality is possible and must be achieved, the objective being to prevent all avoidable deaths”, we can read in this report.
Suicide becomes the leading cause
Suicide (45 deaths), with other psychiatric causes, has become the leading cause of maternal mortality in France (17%), ahead of cardiovascular diseases (39 deaths, 14%). “It was the second cause, it becomes the first: it is not a radical change in trend but an increased confirmation of the weight of suicides,” Catherine-Deneux Tharaux told AFP. As noted The world, the peak of suicides occurs around four to five months after childbirth. These are often women who are pregnant for the first time, and who have already had a proven psychiatric history or eating disorders.
In the 42 days after the end of pregnancy alone, 197 deaths occurred between 2016 and 2018, caused primarily by cardiovascular diseases. “The two leading causes of maternal deaths, suicides and cardiovascular diseases, are extra-obstetrical, and their absolute levels are increasing a little”, notes to AFP Catherine-Deneux Tharaux, this specialist in perinatal epidemiology, inviting us to “consider the women’s health overall.
Furthermore, for around ten years, obstetric hemorrhages are no longer predominant. Reduced by half in 15 years, mortality due to this excessive bleeding during childbirth or in the following 24 hours is now stagnating, at the top of the range for European countries, with around twenty cases recorded in France.
Significant inequalities
Strong territorial and socio-demographic inequalities persist in maternal mortality. The risk is thus doubled overseas, compared to mainland France, whereas this gap was higher previously. For migrant women, mortality is on average twice that of native French women. Socially vulnerable women are also 1.5 times more represented among maternal deaths.
Age also increases the risk, “markedly” after 35 years. “From a certain age, complications are more frequent, and when there is a complication, the capacity of the woman’s body to fight against this event is less good, recalls in the world Catherine-Deneux Tharaux. However, although these women are more numerous and more at risk, they do not die more, our healthcare system managing to compensate for this increase in risk. And that’s good news.”
Another factor, obesity, also increases the risk of death, with twice as many maternal deaths among obese women. “Improvement is possible, because more than half of maternal deaths are considered probably or possibly preventable, and, in two thirds of cases, the care provided was not optimal,” underlines the study.
Better prevent and detect mental disorders
Prevention, screening, coordinated and multidisciplinary care remain recommended. The authors of the report break down these recommendations into 30 key messages. To avoid suicides, “personal and family risk factors for perinatal depression must be known to professionals […] and sought throughout the monitoring of pregnancy and postpartum”, underline the experts.
In addition to the involvement of all caregivers to detect symptoms of mental disorders up to the year following childbirth, they also recommend informing pregnant women, those around them and the general public about perinatal depression. Postpartum depression should also be taken into account. Catherine-Deneux Tharaux observes that “women still feel strong guilt in experiencing sadness, a lack of pleasure with their child, a feeling of not being a good mother, but verbalize little.”
In the world, this time, a woman dies every two minutes from complications linked to pregnancy or childbirth (up to 42 days later), according to estimates, in 2023, from United Nations organizations. There were around 287,000 maternal deaths in 2020, mainly in the poorest and conflict-affected regions. The main causes are serious hemorrhages, high blood pressure, infections linked to pregnancy, complications of unsafe abortions and conditions likely to be aggravated by pregnancy (AIDS, malaria, etc.).