Variations reported in state-level maternal death causes

Variations reported in state-level maternal death causes | Image Credit: © Igor Borodin - © Igor Borodin - stock.adobe.com.

State-specific intervention strategies may be needed to ensure a safe and healthy pregnancy, according to a recent study published in JAMA Network Open.¹

Frequent mortality rates during pregnancy and through the first year postpartum have been reported in the United States. These include pregnancy-related deaths and unintentional or incidental causes of death, with key factors including homicide, suicide, and drug overdose during this period.¹

According to investigators, while pregnancy-associated deaths caused by violence and drug overdose have been measured, “a more comprehensive description of state-level prevalences has previously not been possible.” A study was conducted to evaluate state-level pregnancy mortalities from homicide, suicide, and drug overdose.¹

Mortality files were assessed to determine pregnancy-related deaths up through 1 year postpartum between 2018 and 2022. Female patients aged 10 to 44 years were included in the analysis, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes were used to determine suicide, homicide, and drug overdose cases.¹

Between 2018 and 2022, 10,715 mortalities among pregnant or first year postpartum patients were reported, 837 of which were homicides, 579 were suicides, and 2083 were drug overdoses. Firearms were involved in 851 mortalities. Of included homicides, 51.4% occurred during pregnancy, vs 31.8% of suicides and 34.4% of drug overdoses.¹

Texas reported the highest count of homicides at 72, with a rate of 3.82 per 100,000 live births. However, the highest prevalence of 12.86 per 100,000 live births was reported in Mississippi. Texas also reported the highest number of suicides at 49, but Montana had the highest rate of 21.5 per 100,000 live births.¹

Ohio had the highest number of drug overdose deaths at 173, with a rate of 26.38 per 100,000 live births. However, the rate was highest in Delaware at 36.03 per 100,000 live births. ¹

At the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting, data highlighting suicide and homicide as the leading causes of US maternal death was presented.² The data was collected by the Centers for Disease Control and Prevention and was from 2005 to 2022.

Of maternal deaths, 11% were linked to homicide or suicide. Significant racial disparities were also reported, with a nearly 4-fold increase in homicide-related deaths among Black birthing individuals aged 18 to 24 years. The rate among these patients was nearly 8 deaths per 100,000.²

The current study found firearms were involved in 76% of homicides and 37% of suicides.¹ They were the most common and second most common method of injury in these cases, respectively, with hanging or strangulation being the most common for suicides at 40%.

The highest rate of pregnancy-related homicides caused by a firearm was 13.42 per 100,000 live births in Mississippi. Maine, Rhode, Island, and Vermont all recorded no pregnancy-related deaths involving a firearm. No pregnancy-related homicides were also reported in these states, alongside New Hampshire.¹

These results indicated variations in causes of death and their magnitude among pregnant and first year postpartum patients in the United States. Investigators recommended future work “attend to the structural and policy-level causes of differences in rates across states.”¹

References

1. Wallace ME, Jahn JL. Pregnancy-associated mortality due to homicide, suicide, and drug overdose. JAMA Netw Open. 2025;8(2):e2459342. doi:10.1001/jamanetworkopen.2024.59342
2. Ebert M. Study: Homicide and suicide are leading causes of maternal death in the United States. Contemporary OB/GYN. January 30, 2025. Accessed February 11, 2025. https://www.contemporaryobgyn.net/view/study-homicide-and-suicide-are-leading-causes-of-maternal-death-in-the-united-states