In the United States, more than 20 percent of deaths during pregnancy and the first year after childbirth are due to drug use, suicide, or homicide, suggests a study funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The number of pregnancy-associated deaths from these causes increased between 2010 and 2019, with drug-related deaths nearly tripling.
The work, led by Claire Margerison, Ph.D., of Michigan State University, also highlights considerable racial and ethnic inequities in these deaths. The findings appear in Obstetrics & Gynecology.
Maternal mortality statistics typically encompass deaths from causes directly related to or aggravated by pregnancy or pregnancy care. There have been few national estimates of the burden of deaths due to drug use, suicide, or homicide that occur during pregnancy or the first year postpartum. In the current study, researchers examined death certificate records from 33 states and Washington, DC, to estimate the prevalence of such pregnancy-associated deaths in the United States from 2010 to 2019.
Of the 11,782 pregnancy-associated deaths that the researchers identified, 11.4 percent were due to use of illicit or prescription drugs, 5.4 percent were due to suicide, and 5.4 percent were due to homicide. The prevalence of pregnancy-associated deaths because of drug use increased 190 percent between 2010 and 2019. Deaths from homicide rose 63 percent, and those due to suicide increased 30 percent.
“These data also demonstrate unacceptable racial and ethnic inequities in pregnancy-associated deaths,” the authors write. For example, they observed much higher rates of pregnancy-associated deaths due to suicide among American Indians and Alaska Natives, compared to other racial and ethnic groups. Non-Hispanic Black people had a disproportionately high risk of death from homicide.
Overall, homicide accounted for 8 percent of deaths during pregnancy, compared to only 3.4 percent of all deaths among females of reproductive age. Almost 60 percent of pregnancy-associated homicides occurred during pregnancy, while approximately half of drug-related deaths and suicides took place between six weeks and one year postpartum. The researchers speculate that the higher risk of drug-related and suicide deaths in the postpartum period may be attributable to lack of specialized mental health and substance use services, the stress of caring for a newborn, hormonal changes, and other factors.
The findings indicate that deaths due to drug use, suicide, and homicide are substantial and growing contributors to pregnancy-associated mortality. The authors estimate that preventing such deaths would have saved more than 2,600 pregnant and postpartum people between 2010 and 2019. The data also underscore the need to address racial and ethnic disparities in these deaths.
The findings suggest the need for research to identify risk factors and prevention approaches for pregnancy-associated deaths due to drug use, suicide, and homicide. Such prevention approaches may include screening for substance use, mental health issues, and intimate partner violence and coordinating obstetric care with addiction medicine, behavioral health, and social services. The authors also call for attention to barriers to accessing care and support, including issues with housing, transportation, childcare, and domestic abuse.
Margerison CE et al. Pregnancy-associated deaths due to drugs, suicide, and homicide in the United States, 2010–2019. Obstetrics & Gynecology DOI: 10.1097/AOG.0000000000004649 (2022)