Maternal Deaths From Suicide and Overdose in Colorado, 2004-2012
Maternal Deaths From Suicide and Overdose in Colorado, 2004-2012
复制标题
DOI：
10.1097/aog.0000000000001695
复制
发表时间：
2016-12-01
影响因子：
7.2
通讯作者：
Binswanger, Ingrid A.
中科院分区：
文献类型：
--
作者：
Metz, Torri D.;Rovner, Polina;Binswanger, Ingrid A.
目的：为了确定人口统计学和临床特征的孕产妇死亡自伤（意外用药过量或自杀），以确定机会prevention.METHODS：我们报告了一系列的妊娠相关死亡造成的自伤在科罗拉多州之间的2004年和2012年。从几个来源，包括死亡证明，查明了自残死亡。出生和死亡证明沿着以及验尸官、产前护理和分娩住院记录被提取。进行了描述性分析。背景下，我们描述了人口统计学特征的妇女与产妇死亡的自我伤害和所有妇女的活产在科罗拉多。结果：在211总孕产妇死亡在科罗拉多在研究期间，30%（n=63），由于自我伤害。药物过量导致的妊娠相关死亡率为5.0（95%置信区间[CI] 3.4-7.2）/100，000例活产，自杀导致的妊娠相关死亡率为4.6（95% CI 3.0-6.6）/100，000例活产。获得了94%（n=59）因自残而死亡的妇女的详细记录。在产后第一年（平均产后6.21+/-3.3个月），死亡人数平均分布，只有6名产妇在怀孕期间死亡。17%（n=10）有已知的物质使用障碍。54%（n=32）记录了既往精神病诊断，10%（n=6）记录了既往自杀企图。虽然有一半（n=27）死于自残的妇女在怀孕时服用了精神药物治疗，但其中48%的人在怀孕期间停止了药物治疗。50名妇女的毒理学测试;药物阿片类药物是最常见的药物确定（n=21）。结论：自我伤害是最常见的原因妊娠相关的死亡率，大多数死亡发生在产后期间。包括妇女、卫生保健提供者、卫生保健系统以及社区和国家一级的政府和组织在内的四管齐下的教育和方案建设努力可能会减少孕产妇死亡。
OBJECTIVE: To ascertain demographic and clinical characteristics of maternal deaths from self-harm (accidental overdose or suicide) to identify opportunities for prevention.METHODS: We report a case series of pregnancy-associated deaths resulting from self-harm in the state of Colorado between 2004 and 2012. Self-harm deaths were identified from several sources, including death certificates. Birth and death certificates along with coroner, prenatal care, and delivery hospitalization records were abstracted. Descriptive analyses were performed. For context, we describe demographic characteristics of women with a maternal death from self-harm and all women with live births in Colorado.RESULTS: Among the 211 total maternal deaths in Colorado over the study interval, 30% (n=63) resulted from self-harm. The pregnancy-associated death ratio from overdose was 5.0 (95% confidence interval [CI] 3.4-7.2) per 100,000 live births and from suicide 4.6 (95% CI 3.0-6.6) per 100,000 live births. Detailed records were obtained for 94% (n=59) of women with deaths from self-harm. Deaths were equally distributed throughout the first postpartum year (mean 6.21+/-3.3 months postpartum) with only six maternal deaths during pregnancy. Seventeen percent (n=10) had a known substance use disorder. Prior psychiatric diagnoses were documented in 54% (n=32) and prior suicide attempts in 10% (n=6). Although half (n=27) of the women with deaths from self-harm were noted to be taking psychopharmacotherapy at conception, 48% of them discontinued the medications during pregnancy. Fifty women had toxicology testing available; pharmaceutical opioids were the most common drug identified (n=21).CONCLUSION: Self-harm was the most common cause of pregnancy-associated mortality, with most deaths occurring in the postpartum period. A four-pronged educational and program building effort to include women, health care providers, health care systems, and both governments and organizations at the community and national levels may allow for a reduction in maternal deaths.