Skip Navigation LinksReports

Maternal, Child and Adolescent Health Division

California Pregnancy-Associated Mortality Review (CA-PAMR)

Maternal Suicides 2002-2012

Key Findings:

  • 51% of suicide cases had a good to strong chance of preventability with missed opportunities to intervene.
  • The majority of women (83%) died in the late postpartum period, 43-365 days following the end of pregnancy: 36% died between 43 days and 6 months and 47% died more than 6 months postpartum.
  • Mental health conditions were highly prevalent: 62% of women had reported mental health conditions before becoming pregnant and 25% had new onset conditions noted during or after pregnancy. Nearly a quarter of women (23%) had a reported family history of mental health conditions.
  • Depression (54%), psychosis (24%), and bipolar disorder (17%) were the most prevalent diagnostic impressions identified. Substance use, including alcohol and tobacco, was a common co-occurring condition with all mental health disorders.
  • Nearly one-third (32%) of women used illicit drugs (methamphetamine, cocaine, heroin) or abused prescription opioids during or after pregnancy; heavy alcohol use was noted in 17% of women. Substance abuse was identified as a precipitating factor to the suicide in 29% of women.
  • Approximately 85% of women had one or more psychosocial stressors documented near the time of death (e.g., interpersonal conflict with partner, financial hardship, exposure to violence as a child or adult).

Obstetric Deaths 2002-2007

Key Findings:

  • 41% of pregnancy-related obstetric deaths had a good-to-strong chance of preventability. 
  • Cardiovascular disease is the leading cause of pregnancy-related death.
  • Racial and ethnic disparities persist: African-American women continue to ex-perience 3- to 4-fold higher risk of a pregnancy-related death.
  • Multiple patient, facility, and health care provider factors contributed to pregnancy-related deaths.
  • Case reviews informed public health prevention programs and led to the de-velopment of maternity care quality improvement strategies, also known as California Toolkits to Transform Maternity Care.
Page Last Updated :