New York State Department of Health Releases Issue Brief On Pregnancy Associated Deaths: #Maternalhealthmatters

Spotlights Mental Health, the Third Leading Cause of Pregnancy-related Deaths

Using 2018 State Data, NYS Maternal Mortality Review Board Found All Pregnancy-Related Deaths Due to Mental Health Conditions to be Preventable; 100% of Pregnancy-Related Deaths Attributed to Mental Health Conditions Occurred Post-Pregnancy

New Issue-Based Briefs Designed to Offer Multi-Disciplinary Providers an In-Depth Examination of Key Recommendations to Prevent Maternal Mortality

Offers a Composite Case of a Fictitious Patient Based on Several Reviewed Cases to Increase Issue Awareness, Reduce Stigma, and Educate Providers About Prevention Tactics and Resources

Recommendations for Providers and Public Include Consideration for Continued Treatment, Screening for Depression, Coordinating Continuous Care, and Expanding Maternal Mental Health Education

To support maternal care providers, NYSDOH recommends State Office of Mental Health's free Project TEACH Services

Albany, N.Y. (November 22, 2022) – The New York State Department of Health (NYSDOH) released an issue brief from its Maternal Mortality Review Board (MMRB) focusing on mental health conditions – the third leading cause of pregnancy-related deaths. Offering a fictitious case that represents mental health issues common to many cases reviewed by the MMRB, the issue brief is the first in a series designed to offer multi-disciplinary providers an in-depth examination of key recommendations to raise awareness, reduce stigma, and provide education on prevention strategies and resources to reduce mental-health related causes of maternal mortality.

"Maternal health matters," State Health Commissioner Dr. Mary T. Bassett said. "But managing a patient who is both pregnant and experiencing mental health issues is complex. For example, providers often are concerned that taking medication for mental health reasons may adversely affect the pregnancy and may even decide the patient be taken off that medication. But in fact, treating mental health issues during and following an individual's pregnancy with the safe use of medication can prevent maternal deaths. This new issue brief with a composite case study, developed through expert review, serves as an actionable guide to providers who – in consultation with their patients and mental health professionals – can use these recommendations and Project TEACH resources to materially improve the lives and outcomes of pregnant and postpartum people and their families."

As reported in "The New York State Report of Pregnancy-Associated Deaths in 2018," mental health conditions were the third leading cause of pregnancy-related deaths statewide. The MMRB determined that all of these deaths were potentially preventable and occurred post-pregnancy, with the majority occurring between 43 and 365 days after the end of pregnancy. Mental health conditions were considered contributing factors in 19.5 percent of pregnancy-related deaths, including cases where mental health conditions were not considered an underlying cause of death.

New York State Office of Mental Health Commissioner Dr. Ann Sullivan said, "It is so important that the Department of Health is urging providers to use Project TEACH, which increases access to mental health services for children, families, and pregnant and postpartum women across the state. It has been a key resource for pediatricians and primary care physicians, providing consultation and support for practitioners who want to help their patients get the mental health services they need. And now with the expansion of expertise in maternal mental health, this service will be readily available for physicians treating women during and after their pregnancies."

To spotlight this issue through increased awareness and education for New York providers and New Yorkers, the issue brief includes a composite case of a fictitious patient based on several reviewed cases. The fictitious composite case for this brief is available here.

Christa R. Christakis, Executive Director, ACOG District II said, "The release of the Spotlight on Perinatal Mental Health issue brief offers tangible recommendations for multi-disciplinary providers and community-based organizations to prevent maternal mortality and morbidity in this state. As we continue to confront the confluence of the maternal and mental health crises exacerbated by the pandemic, this issue brief is a timely and critical resource that will better providers' understanding of the causes and contributing factors to maternal mortality in New York State with important recommendations for the prevention of future deaths."

Co-Chairs of the NYS Maternal Mortality Review Board, Dr. Vanessa M. Barnabei, Dr. Christopher Glantz, and Dr. Amanda Victory said,"Mental health conditions are important factors in a significant number of maternal deaths reviewed by the New York State Maternal Mortality Review Board (MMRB). This Perinatal Mental Health brief presents a composite representative case as an example, followed by four recommendations made to address common contributory factors identified during the MMRB reviews. These recommendations—particularly relevant given the COVID-related stresses in recent years—are straightforward, can be utilized by a range of provider types and hospital systems, and have potential to avert additional maternal deaths."

The MMRB found the presence of a mental illness to represent a significant risk factor for adverse maternal health outcomes. To prevent mental health-related deaths in pregnant people in the year following their child's birth, the MMRB recommends providers deliver individualized, person-centered management of mental health conditions for all pregnant people with a history of mental health concerns, which should always include close coordination between the prenatal care and mental health providers. Further, the continuity of care after delivery is essential as individuals are particularly vulnerable to complications during the postpartum period. Shared decision making regarding the appropriate course of treatment before, during, and after pregnancy is recommended.

Specifically, the MMRB recommends the following to prevent mental health-related deaths among pregnant people:

  1. Consider Continuing Treatments: Psychiatric medications should not be automatically discontinued just because a patient is pregnant.The use of psychiatric medications during pregnancy is not automatically contraindicated, and careful consideration of the risks and benefits should be undertaken prior to any change or withdrawal of such medications.
  2. Screen for Depression: Screening should be conducted during all pregnancies and is considered the standard of care. NYS Pregnancy Risk Assessment Monitoring System 2020 data shows 10 percent of pregnant people indicated they had depression during their pregnancy and 10.1 percent of postpartum women reported experiencing depressive symptoms.
  3. Coordinate Continuous Care: Enhanced coordination of care between prenatal care providers and mental health providers is needed.Coordination between prenatal care providers and mental health providers is recommended for patients with mental health disorders, both during the pregnancy and the postpartum period. After delivery, care coordination ensures postpartum mental health treatment needs are met. Simply advising the patient to seek a mental health appointment is insufficient during this time of increased stress and risk. A closed-loop referral should be made, and an appointment confirmed, prior to discharging patient. Ensuring on-going connection to care and a warm handoff to psychiatric treatment is essential.
  4. Expand Education: Enhance knowledge and awareness among emergency medicine providers regarding perinatal mental health conditions.Emergency medicine providers should be aware that pregnant people who present frequently, offer vague symptoms, and/or display challenging behaviors should be assessed for mental health conditions.

NYSDOH urges the use of the NYSOMH's Project TEACH service as a fundamental resource to support healthcare treating providers pregnant and post-partum New Yorkers. Part of a cross-systems effort to combat maternal depression and related mood and anxiety disorders, Project TEACH offers maternal and pediatric primary care clinicians with telephone consultations for mild-to-moderate mental health concerns, direct face-to-face consultations for pediatric patients, CME-certified training on how to assess, treat and manage mental health concerns, referrals to mental health professionals and community resources across the state, and linkage to key resources that your patients and their families need in their communities. Psychiatrists may also use Project TEACH for consultation on treatment of their pregnant and post-partum patients. Project TEACH is available for these providers in New York State at no cost thanks to funding through NYSOMH. Providers can learn more at the website here, FAQ page here, or by calling (855) 227-7272.

Learn more about maternal mortality at NYSDOH's new dedicated website,

For more resources for healthcare providers caring for pregnant and post-partum New Yorkers, see the webpage here. For more resources for pregnant and post-partum New Yorkers, see the webpage here.

About New York State's Maternal Mortality Review Board (MMRB)

The New York State MMRB is comprised of a diverse, multidisciplinary group of experts in maternal health-related fields charged with reviewing maternal deaths. Through the process, members identify the factors contributing to deaths, leading causes of death, and develop recommendations to the State's Health Commissioner to prevent similar deaths in the future. Through a collaboration with New York City Maternal Mortality and Morbidity Review Committee (M3RC), the MMRB reviews deaths outside of NYC while the M3RC reviews deaths within the city, which the Department combines into a comprehensive statewide set of results. The Maternal Mortality Review Board (MMRB) works in concert with the State's Maternal Mortality & Morbidity Advisory Council (MMMAC) to further refine and expand on recommendations. Advisory Council members include community members, home visitors, health care providers, doulas, and advocates who work collectively to uplift community voice in the shared recommendations.