Homicide, suicide leading causes of maternal death in US
Key takeaways:
- Pregnant women are more likely to die of violence than any medical cause in the U.S.
- Domestic violence firearm legislation was associated with fewer maternal deaths.
Pregnant women are more likely to die of violence than any medical cause in the U.S. and are at greater risk for violent death compared with nonpregnant women, underscoring the need for intimate partner violence screening, data show.
In an analysis of CDC mortality data presented at The Pregnancy Meeting, researchers also found that domestic violence firearm legislation was associated with a reduction in homicide and firearm death in pregnancy.
“Violence is way more common in pregnancy than we think,” Hooman A. Azad, MD, MPH, a medical resident in obstetrics and gynecology at Columbia University Irving Medical Center, told Healio. “We do not often consider violence when we think about maternal mortality, especially not homicide. When we do not think about it, we do not do anything to address it. The primary goal of this study is awareness — understanding homicide and suicide are major causes of maternal death. The additional goals are to help prompt additional investigation into these causes of death and better understand how we can intervene.”
The researchers analyzed case-level data on deaths among U.S. women aged 15 to 44 years between 2005 and 2022, using the CDC’s Limited Mortality File, with cause of death and pregnancy status (including the first 42 postpartum days) identified by ICD-10 codes. A “pregnancy checkbox” identified additional deaths in pregnancy.
Researchers compared violent death rates among pregnant women and nonpregnant controls and identified associations between domestic violence firearm laws and violent deaths in pregnancy in a separate analysis.
During the 18-year study period, 20,421 pregnant women died. Of those, 11% were violent deaths; 61% were homicides and 39% were suicides; 55% of deaths involved firearms. Violence was the most common cause of death in pregnancy, with the incidence of death by violence doubling between 2005 and 2022. Violent death was also more frequent among pregnant women than nonpregnant controls, with rates of 3.2 vs. 1.2 deaths per 100,000 population.
In the separate analysis on domestic violence firearm laws, such legislation was associated with reductions ranging from 17% to 32% in homicide and firearm death in pregnancy. Laws requiring relinquishment of firearms among domestic violence perpetrators were most strongly associated with reduced death rates.
“Every health care professional should be screening for intimate partner violence, speaking to pregnant people alone to allow for a safe space for people to share if they have been experiencing violence, and understanding whether there is access to lethal means such as firearms in the home,” Azad told Healio. “However, it is important not to place additional burden on an individual already experiencing intimate partner violence. We must have mechanisms in place to refer and care for people who disclose intimate partner violence.”
Azad said more work is needed on how to best ask patients about intimate partner violence, take care of patients who report experiencing it and how health care professionals can reimagine prenatal care and maternity care to incorporate the importance of violence reduction and prevention.
“Understanding the context in which people live, the availability of community support and the presence or absence of legal restrictions is important to be able to have an impact on this important cause of maternal morbidity and mortality,” Azad told Healio.
For more information:
Hooman A. Azad, MD, MPH, can be reached at ha2617@cumc.columbia.edu; X (Twitter): @HoomanAAzad.