Pregnancy-associated deaths—those arising from unrelated conditions that occur within 1 year of pregnancy—are largely under-investigated contributors to maternal mortality rates, according to a study published by Obstetrics & Gynecology.

Modest AM, Prater LC, Joseph NT. Pregnancy-associated homicide and suicide: an analysis of the National Violent Death Reporting System, 2008–2019. Obstetrics & Gynecology. 2022;140(4):565–573.

Physicians can help prevent pregnancy-associated deaths through extensive screening and intervention.

Drivers of homicides and suicides

As a result, researchers have prioritized understanding the mechanisms behind pregnancy-related deaths—those deaths caused by a pregnancy complication, by events linked to pregnancy, or by the pregnancy’s physiologic impact on an underlying condition.

The Obstetrics & Gynecology study stated that nearly 20% of all deaths during pregnancy and the postpartum period can be attributed to homicide, suicide, and drug overdose.

The study, which used data from the CDC’s National Violent Death Reporting System from 2008–2019, pointed to two primary drivers of these outcomes:

Mental health issues. The study found that for individuals who died by suicide, a sizable proportion were being treated for mental health issues at the time: 31.2% of pregnant individuals, 44.9% of early postpartum individuals, and 41.1% of late postpartum individuals. Further data showed that those who struggled with mental health problems—including substance use disorders (SUD)—were more likely to die by suicide (77.4%) than homicide (7.2%).

Intimate partner violence (IPV). Pregnant patients who died by suicide and homicide commonly experienced IPV. The rates of IPV were significantly higher for individuals who died by homicide, however, than for those who died by suicide (57.3% vs 37.1%, respectively). Also, the homicide group had higher rates of other violent crimes compared with those who died by suicide (24.8% vs 1.7%, respectively).

Other factors such as age, race, and education level also played a part in the likelihood of a pregnant individual dying by suicide or homicide.

The Obstetrics & Gynecology study authors urged clinicians to consider the deaths resulting from these causes as avoidable.

Every pregnancy-associated violent death should be considered preventable. There is an urgent need for scientific evidence informing actionable strategies to eliminate these maternal deaths.

Prevention methods

According to an article published by the Journal of Women’s Health, providers can implement universal screening and referral for pregnant patients who may experience SUD, IPV, and mental illnesses like anxiety and depression.

Campbell J, Matoff-Stepp S, Velez ML, et al. Pregnancy-associated deaths from homicide, suicide, and drug overdose: review of research and the intersection with intimate partner violence. Journal of Women’s Health. 2021;30(2):236–244.

Pregnant and postpartum patients who’ve made trips to the ED or hospital during the first year or more after delivery may be at higher risk of homicide, suicide, and drug overdose, so clinicians who take steps to identify these patients may help to avert these unfortunate outcomes.

For patients with SUD, one way you can mitigate risk is to propose alternatives to opioids. This would allow the patient to manage chronic pain without the possibility of developing an addiction.

Another option is to build programs that train patients to use naloxone and inform them about other aspects of comprehensive treatments for SUD.

Finally, consider referring your patients to trauma-informed community services.