ImportanceThe rate of maternal mortality in the United States is 2-fold to 3-fold greater than that in other high-income countries. While many national initiatives have been developed to combat maternal mortality, these efforts often fail to include mental illness.ObjectiveTo highlight the underrecognized contribution of mental illness to maternal mortality, which is nearly double that of postpartum hemorrhage.Evidence ReviewA topic outline was developed to include challenges in measuring perinatal mental conditions and mortality rates; contributions of social determinants of health to mental conditions and mortality; perinatal psychiatric disorder characterization; mechanisms by which maternal mental illness increases mortality, specifically, suicide and addictive disorders; access limitations and care “deserts”; prenatal stress and its impact on reproductive outcomes; increasing clinician expertise through cross-disciplinary education; intervention sites and models; and asserting that mental health is fundamental to maternal health. Publications in the last 3 years were prioritized, particularly those relating to policy. References were selected through consensus. Sources were PubMed, Ovid, direct data published on government websites, and health policy sources such as the Policy Center for Maternal Mental Health.FindingsPriority was given to recent sources. Citations from 2022-2023 numbered 26; within the last 5 years, 14; and historical references, 15. Recommendations to address each topic area serve as concluding statements for each section. To mitigate the contributions of mental illness to the maternal mortality risk, a coordinated effort is required across professional and governmental organizations.Conclusions and RelevanceConcrete programmatic and policy changes are needed to reduce perinatal stress and address trauma, standardize the collection of social determinant of health data among perinatal patients, increase access to reproductive psychiatry curricula among prescribers, reduce perinatal mental health and obstetrical deserts, institute paid parental leave, and support seamless integration of perinatal and behavioral health care. Moreover, instead of focusing on a relatively minor portion of the contributors to health that current medical practice targets, fortifying the social foundation strengthens the prospects for the health of families for our current and future generations.

中文翻译：

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在解决发病率和死亡率问题时优先考虑孕产妇心理健康

重要性美国的孕产妇死亡率是其他高收入国家的 2 至 3 倍。虽然已经制定了许多国家举措来降低孕产妇死亡率，但这些努力往往未能包括精神疾病。目的强调精神疾病对孕产妇死亡率的贡献未被充分认识，其几乎是产后出血死亡率的两倍。证据审查制定了主题大纲以包括衡量围产期精神状况和死亡率方面的挑战；健康问题社会决定因素对精神状况和死亡率的影响；围产期精神疾病特征；产妇精神疾病增加死亡率的机制，特别是自杀和成瘾性疾病；准入限制和护理“沙漠”；产前应激及其对生殖结果的影响；通过跨学科教育提高临床医生的专业知识；干预地点和模型；并断言心理健康是孕产妇健康的基础。过去三年的出版物被优先考虑，特别是与政策相关的出版物。参考文献是通过协商一致选择的。来源包括 PubMed、Ovid、政府网站上发布的直接数据以及孕产妇心理健康政策中心等卫生政策来源。调查结果优先考虑最新来源。2022-2023 年引用次数为 26；过去 5 年内，14；和历史参考文献， 15. 针对每个主题领域的建议作为每个部分的结论性陈述。为了减轻精神疾病对孕产妇死亡风险的影响，需要专业组织和政府组织的协调努力。结论和相关性需要进行具体的计划和政策变革，以减少围产期压力并解决创伤问题，规范健康数据社会决定因素的收集在围产期患者中，增加处方者获得生殖精神病学课程的机会，减少围产期心理健康和产科沙漠，实行带薪育儿假，并支持围产期和行为保健的无缝整合。此外，加强社会基础不是关注当前医疗实践所针对的相对较小的健康贡献者，而是加强我们当代和子孙后代家庭健康的前景。