Over the years, researchers and clinicians have made great strides in reducing the number of maternal deaths associated with cardiac disease, infection, and hemorrhage. However, the rate of maternal morbidity from injury has not changed, and researchers now suspect injury is a leading cause of maternal mortality as well as an important, preventable cause of death among pregnant women.
To estimate the rates of homicide and suicide, Dr Christie Lancaster Palladino, educational researcher and assistant professor of obstetrics and gynecology at Georgia Health Sciences University, and colleagues conducted a secondary data analysis of maternal violent death from National Violent Death Reporting System, a multistate active surveillance system activated by the Centers for Disease Control and Prevention. In this analysis, the researchers included women who were pregnant or had been pregnant within one year’s time. This was based on comments from the CDC/American College of Obstetricians and Gynecologists Maternal Mortality Study Group, which defined the term pregnancy-associated mortality as “any death of a woman while pregnant or within 1 year of the termination of pregnancy, regardless of cause.” Women were included in the analysis if they were between the ages of 15 and 54. Palladino et al. found 233 pregnancy-associated violent deaths and an overall pregnancy-associated violent death mortality rate of 4.9 per 100,000 live births. Of the violent-deaths, 35.2% occurred during the postpartum period while 64.8% of the deaths occurred while the woman was pregnant. The rate of violent deaths associated with pregnancy remained relatively stable over time (range=4.3% to 5.4%). The researchers also noted that both homicide and suicide rates were higher than the rates of death from common obstetric causes.
Specifically, Palladino et al. found an overall pregnancy-associated suicide rate of 2.0 per 100,000 live births. Older women (>40 years old) were at greater risk for suicide than their younger counterparts. While the rates of suicide did not appear to differ among the states, Palladino and colleagues noted that women who committed suicide were more likely to be white or Native American and were most often not married.
For violent deaths attributed to homicides, Palladino et al. found a rate of 2.90 per 100,000 live births. More than three-quarters (77.7%) of the homicides occurred in women who were pregnant. Women who were victims of pregnancy-associated homicide were most likely at the ends of the age spectrum; they mostly fell in the group who were 24 years of age and younger or 40 years old or older. Almost half of the women were African American.
Palladino and colleagues found a common thread through the suicides and homicides: intimate partners seemed to play a negative role in both types of violent deaths. In fact, about half of the deaths from both homicide and suicide were somehow tied to intimate partner. The study authors found that 54.3% of the women who committed suicide had experienced problems with a current or former intimate partner and that this had played a role in the suicide. Moreover, 42.2% of the suspects in the homicide cases were a current or former intimate partner of the victim.
“Our results indicate that pregnancy-associated homicide and suicide each account for more deaths than many other obstetric complications, which may be thought of as more ‘traditional’ causes of maternal mortality, and confirm the need to focus on the relationships between sociodemographic disparities and intimate-partner violence with pregnancy-associated violent death,” the researchers concluded. “These findings suggest that effective prevention methods aimed at perinatal psychosocial health are imperative.”
Palladino CL, Singh V, Campbell J, et al. Homicide and suicide during the perinatal period: findings from the national violent death reporting system. Obstet Gynecol. 2011 Nov;118(5):1056-63.