Drugs, homicide and suicide outweigh several medical complications traditionally associated with maternal mortality. And there are differences by ethnicity.
The main causes of death among pregnant women and those in the recent postpartum period are no longer, above all, classic clinical complications of pregnancy, but rather preventable injuries and violence — especially accidental overdose of drugs, homicide and suicide.
The analysis was recently conducted by researchers at Columbia University and in The New England Journal of Medicine, which reads that accidental overdose appears as the most frequent cause in the USA, with a rate of 5.2 deaths per 100,000 births.
Homicide and suicide, considered together, total 3.9 deaths per 100,000 births.
These are numbers that, according to him, place violence and preventable injuries ahead of various medical complications traditionally associated with maternal mortality.
The team, led by Hooman Azadanalyzed death certificate records between 2018 and 2023. All women who died during pregnancy or up to 42 days after giving birth were included.
The data also show differences by ethnicity: overdose and suicide were more frequent among white women, while homicides occurred more frequently among black women. Firearms were involved in more than three-quarters of violence-related deaths.
Maternal mortality remained practically stable over the six years analyzed, with the exception of an increase during the COVID-19 pandemic. The study also suggests that the timing of deaths varies depending on the cause: more than half of deaths from overdose and violence occurred during pregnancywhile other causes such as cardiovascular disease, infection, hypertension and hemorrhage tended to occur more in the immediate postpartum period.
The researchers emphasize that, in the last two decades, strengthening protocols to manage medical complications has improved obstetric care. And simultaneously, overdose and violence have represented a growing portion of deaths.
Monitoring this change has not always been straightforward, as pregnancy status is not always recorded consistently on death certificates, which can limit the accuracy of national statistics. For Azad, health services may not be identifying substance use and intimate partner violence with the same effectiveness when compared to tracking medical complications.
The study advocates a multidisciplinary response, with referral to mental health care and social services throughout the pregnancy, as a way to prevent overdoses and violence and reduce maternal mortality.
