Heed precursors of postpartum suicide.(News)

SEATTLE -- The risk of a maternal postpartum suicide attempt increases more than threefold after a fetal or infant death, findings of a large case-control study show.

An analysis linking Washington state hospital records to detailed state-mandated fetal birth and death data for the period 1987-2001 found that fetal or infant death was associated with a 3.1-fold increased risk of hospitalization for a postpartum suicide attempt, Dr. Melissa A. Schiff said at the annual meeting of the American Association of Suicidology.

For all women who gave birth, Dr. Schiff found that a history of a prior psychiatric and/or substance abuse diagnosis was even more potent as a risk factor for maternal suicidal behavior.

Women with a history of psychiatric hospitalization had a 19.6-fold greater risk of a postpartum suicide attempt than those with no psychiatric diagnosis.

Those with a history of a substance use disorder had a 6.9-fold increased risk. Dual diagnosis patients with psychiatric and substance abuse diagnoses were at 11.4-fold elevated risk.

Women who smoked prenatally were at 2.7-fold increased risk relative to nonsmokers. One possible explanation is that smoking in pregnancy may in some cases represent a form of self-medication aimed at relieving psychological stress, said Dr. Schiff, who is trained as an obstetrician/gynecologist.

In the area of live births, the analysis found that 1 in 2,276 in the state during that time period was followed within the next year by a maternal suicide attempt resulting in hospitalization.