Abortion restrictions in US states were linked to higher maternal deaths during pregnancy and within 42 days after birth, a new study suggests.

The research examined links between different abortion restrictions introduced across US states between 2005 and 2023 and deaths during pregnancy or in the first 42 days after giving birth.

Unlike much earlier work, it used a broad definition of maternal deaths, including deaths from any cause such as homicide, suicide and drug overdose, as well as medical causes.

A total of 22,482 maternal deaths were identified over the study period. The annual incidence rose from 21.3 per 100,000 live births in 2005 to 33.6 per 100,000 live births in 2023.

Violence was the leading cause at 10.6 per cent, followed by unintentional drug overdose at 10.2 per cent and cardiovascular disease at 9.6 per cent.

Presented at the Society for Maternal-Fetal Medicine annual meeting by Marie Anderson of Columbia University Irving Medical Center in New York City, the study found states with five or more types of abortion restriction had an average of 16.1 additional maternal deaths each year compared with less restrictive states.

Anderson said: “When states adopt multiple abortion restrictions, we see measurable increases in deaths among pregnant and postpartum people.

“The associations we observed were broad, affecting deaths from any cause, cardiovascular disease, and violence, and underscore that reproductive health policy is inseparable from maternal health.

“Traditional definitions of maternal deaths exclude homicide, suicide, and unintentional drug overdoses, but these often overlooked causes of death are an important part of the abortion conversation as there are data which show that being denied a wanted abortion is associated with worse mental health outcomes, intimate partner violence, and lasting economic hardship.”

At the start of the study period in 2005, only five states were classed as more restrictive. By 2023, that number had reached 27.

The US Supreme Court’s Dobbs decision in 2022, which overturned the federal right to abortion, prompted a wave of new restrictions.

Of 10 types of restriction examined, six were linked to higher rates of maternal death.

These included bans on public funding for abortion, bans on coverage through health insurance marketplace plans, laws requiring biased counselling, second trimester bans, mandatory waiting periods and compulsory ultrasound requirements.

Public funding bans, insurance coverage bans, waiting periods and physician-only requirements were also associated with higher rates of violent death.

David Hackney, of Case Western Reserve University in Cleveland, who was not involved in the research, said including those factors was the right approach.

Hackney said: “There’s so many different ways that abortion bans could increase the mortality rates and I think it was absolutely correct to include homicide, suicide, and drug use because those, unfortunately, are risks of being pregnant when you don’t want to be pregnant,”

Stroke prevention requires aggressive blood pressure control and rapid recognition of symptoms in pregnancy and postpartum, a new scientific statement urges.

The guidance details risk factors for pregnancy-related stroke and offers suggestions for prevention, rapid diagnosis, timely treatment and recovery during pregnancy and postpartum.

A stroke occurs in approximately 20 to 40 of every 100,000 pregnancies and is estimated to account for around four to six per cent of pregnancy-related deaths annually in the US.

The statement was published by the American Heart Association and endorsed by the American College of Obstetricians and Gynecologists.

Eliza Miller is chair of the writing group and associate professor of neurology at the University of Pittsburgh.

She said: “When a stroke occurs during pregnancy or the postpartum period, it can lead to serious complications for both the mother and baby, including neurological deficits, long-term disability, increased risk of future strokes and death.

“Controlling blood pressure and other stroke risks before and after delivery, responding immediately to stroke warning signs and providing timely treatment can help save lives and improve outcomes for mothers and their babies.”

There are two types of stroke: an ischaemic stroke occurs when a blood vessel supplying blood to the brain is blocked by a clot, while a haemorrhagic stroke occurs when a blood vessel ruptures and bleeds into the brain.

Risk factors for pregnancy-associated stroke include chronic hypertension (high blood pressure before pregnancy or diagnosed before 20 weeks), preeclampsia (a dangerous condition causing high blood pressure in pregnancy), advanced maternal age (35 years or older), diabetes, obesity, migraine with aura, infections, heart disease and clotting disorders.

Stroke disproportionately affects people of racial and ethnic minorities. A 2020 meta-analysis found that pregnant Black women are twice as likely to have a stroke compared with pregnant white women, even after adjusting for socioeconomic factors.

The statement authors emphasise that the majority of maternal strokes are preventable with earlier and more aggressive blood pressure control.

“Preeclampsia and eclampsia can occur before, during or after delivery, and the early postpartum period is actually the highest risk time for stroke.

“Very close monitoring of blood pressure is essential,” said Miller.

The statement urges all healthcare professionals who care for pregnant patients, including obstetricians, family medicine practitioners and nurses, to be trained to recognise stroke symptoms so they can promptly start treatment.

“It is crucial for women who are pregnant or have recently given birth and have symptoms of new neurological deficits or severe headache, especially if they also have elevated blood pressure, to be immediately evaluated for possible stroke,” said Miller.

The authors emphasise that pregnancy is not a reason to delay or interfere with recommended treatment for acute stroke.

Various anti-clotting medications are available that are safe for pregnant and lactating women, and mechanical thrombectomy (surgical removal of a blood clot) may be needed for patients with large-vessel blockages.

Survivors of pregnancy-associated stroke face unique challenges such as caring for an infant and require support from a multidisciplinary rehabilitation team.

Mood and sleep disorders are common after stroke and may be intensified by postpartum factors such as hormonal shifts, breastfeeding and disrupted sleep.

Miller said: “Babies depend on their mothers’ well-being, and supporting recovery after stroke, both emotionally and practically, is essential so mothers can heal and families can thrive.”

Seven in 10 UK mothers feel overloaded and almost half have a mental health issue such as anxiety or depression, new research finds.

A survey of mothers’ experiences in 12 European countries also found most of those in Britain still do the majority of household tasks and caregiving alone, and that the UK was among the worst for motherhood disadvantaging a woman’s career.

The research was conducted by pan-European campaign group Make Mothers Matter, which surveyed 800 mothers in each of the 12 countries about the psychological impact of giving birth and the pressures of motherhood.

It found that 71 per cent of UK mothers feel overloaded, compared with 67 per cent across Europe, while 47 per cent report mental health issues including burnout, compared with 50 per cent in Europe as a whole.

Some 31 per cent of UK respondents felt motherhood had a negative effect on their career, higher than the 27 per cent average, with Ireland the highest at 36 per cent.

However, some measures showed UK mothers find it easier to balance work and caring. Only 11 per cent said their partner did not take paternity leave, far lower than the 25 per cent average across the 12 countries.

The findings prompted calls for GPs and NHS maternity and health visiting services to routinely ask mothers about their mental wellbeing and provide more help to those who need it.

Prof Alain Gregoire, a perinatal psychiatrist and honorary president of the Maternal Mental Alliance UK, said that despite improvements in NHS care in recent years, too many mothers were left “suffering in silence.”

“Much of the suffering maternal mental ill-health causes goes undetected, despite mothers’ repeated contact with maternity staff, health visitors and GPs.

“There’s a stigma associated with seeking mental health help and support, there’s not enough of that around, so women face enormous barriers to getting help, and health professionals don’t get enough training in spotting maternal mental health problems.”

He said easy access to talking therapies, which offer psychological support, would “provide an unstigmatised way of accessing help and relieve huge amounts of the suffering for mothers and families.”

Angela McConville, chief executive of the NCT parenting charity, said: “Pregnancy, birth and early parenthood are periods of heightened vulnerability, but significant gaps remain in the care and services offered to women and new parents, particularly after birth.

“After birth, women need services that provide localised mental health support, unbiased and evidence-based information, and regular, reliable touchpoints, from health visitors through to postnatal GP check-ups.”

“Instead, many women encounter a fragmented postnatal care system that is dangerously underfunded and understaffed, leaving them feeling isolated at a time when support is most critical.”

Make Mothers Matter said mothers across Europe are experiencing higher levels of stress, cognitive overload and emotional exhaustion today than when it undertook a similar survey in 2011.

A Department of Health and Social Care spokesperson said: “Every mother deserves to feel supported when it comes to their mental health, and we are determined to ensure help is there when it’s needed.

“A wide range of support is available on the NHS for new and expectant mothers, including access to specialist perinatal services, talking therapies and help from health visitors.

“We are investing more in mental health services with an extra £688m this year, we’ve hired an extra 7,000 mental health workers, and we’re providing more NHS talking therapies.”