OBJECTIVE: To estimate the rates of pregnancy-associated homicide and suicide in a multistate sample from the National Violent Death Reporting System, to compare these rates with other causes of maternal mortality, and to describe victims' demographic characteristics.
METHODS: We analyzed data from female victims of reproductive age from 2003 to 2007. We identified pregnancy-associated violent deaths as deaths attributable to homicide or suicide during pregnancy or within the first year postpartum, and we calculated the rates of pregnancy-associated homicide and suicide as the number of deaths per 100,000 live births in the sample population. We used descriptive statistics to report victims' demographic characteristics and prevalence of intimate-partner violence.
RESULTS: There were 94 counts of pregnancy-associated suicide and 139 counts of pregnancy-associated homicide, yielding pregnancy-associated suicide and homicide rates of 2.0 and 2.9 deaths per 100,000 live births, respectively. Victims of pregnancy-associated suicide were significantly more likely to be older and white or Native American as compared with all live births in National Violent Death Reporting System states. Pregnancy-associated homicide victims were significantly more likely to be at the extremes of the age range and African American. In our study, 54.3% of pregnancy-associated suicides involved intimate partner conflict that appeared to contribute to the suicide, and 45.3% of pregnancy-associated homicides were associated with intimate-partner violence.
CONCLUSION: Our results indicate that pregnancy-associated homicide and suicide are important contributors to maternal mortality and confirm the need to evaluate the relationships between sociodemographic disparities and intimate-partner violence with pregnancy-associated violent death.
LEVEL OF EVIDENCE: II
Pregnancy-associated homicide and suicide each account for more deaths than several other obstetric complications, including hemorrhage, obstetric embolism, or preeclampsia and eclampsia.
From the Department of Obstetrics and Gynecology, Education Discovery Institute, Georgia Health Sciences University, Augusta, Georgia; the Department of Emergency Medicine, Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; the Department of Community-Public Health, School of Nursing, Johns Hopkins University, Baltimore, Maryland; and the Departments of Psychiatry and Family Medicine, University of Michigan, Ann Arbor, Michigan.
Data analysis for this project funded under the primary author's fellowship in the Robert Wood Johnson Clinical Scholars Program. Manuscript preparation supported through the primary author's appointment in the Georgia Health Sciences University Education Discovery Institute. This work was awarded the Steiner Young Investigator Award at the 36th Annual Meeting of the North American Society for Psychosocial Obstetrics and Gynecology (NASPOG), February 1, 2010, Richmond, Virginia. This research uses data from the National Violent Death Reporting System, a surveillance system designed by the Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control. The findings are based, in part, on the contributions of 16 of the 17 funded states that collected violent death data and the contributions of the states' partners, including personnel from law enforcement, vital records, medical examiner and coroner records, and crime laboratories. The analyses, results, and conclusions presented here represent those of the authors and are not necessarily those of CDC. Persons interested in obtaining data files from National Violent Death Reporting System should contact CDC's National Center for Injury Prevention and Control, 4770 Buford Hwy, NE, MS F-63, Atlanta, GA 30341-3717 or call 800-CDC-INFO (232-4636).
The authors thank the Centers for Disease Control and Prevention National Violent Death Reporting System and Deborah Karch, PhD, for providing the data for this study; Matthew Davis, MD, MAPP, for research mentorship and study design assistance; and the Education Discovery Institute Statistical Support Team (B. Bodie, R. Whitaker, M. Villarosa) for statistical support.
Corresponding author: Christie Palladino, MD, MSc, 1120 15th Street, CJ 1025, Augusta, GA 30912; e-mail: firstname.lastname@example.org.
Financial Disclosure The authors did not report any potential conflicts of interest.