Pregnancy-Associated Homicide & Suicide in 37 US States with Enhanced Pregnancy Surveillance

BACKGROUND:

Pregnant and postpartum women may be at increased risk of violent death including homicide and suicide relative to non-pregnant women, but US national data have not been reported since implementation of enhanced mortality surveillance.

OBJECTIVE:

To estimate homicide and suicide ratios among women who are pregnant or postpartum and to compare their risk of violent death to non-pregnant/non-postpartum women.

STUDY DESIGN:

Death certificates (n=465,097) from US states with enhanced pregnancy mortality surveillance from 2005-2010 were used to compare mortality among four groups of women age 10-54: pregnant, early postpartum (pregnant within 42 days of death), late postpartum (pregnant within 43 days to 1 year of death) and non-pregnant/non-postpartum. We estimated pregnancy-associated mortality ratios and compared to non-pregnant/non-postpartum mortality ratios in order to identify differences in risk after adjusting for potential levels of pregnancy misclassification as reported in the literature.

RESULTS:

Pregnancy-associated homicide victims were most frequently young, Black, and undereducated while pregnancy-associated suicide occurred most frequently among older White women. 

After adjustments, pregnancy-associated homicide risk ranged from 2.2-6.2 per 100,000 live births, depending on the degree of misclassification estimated, compared to 2.5-2.6 per 100,000 non-pregnant/non-postpartum women aged 10-54. 

Pregnancy-associated suicide risk ranged from 1.6-4.5 per 100,000 live births after adjustments compared to 5.3-5.5 per 100,000 women aged 10-54 among non-pregnant/non-postpartum women. 

Assuming the most conservative published estimate of misclassification, risk of homicide among pregnant/postpartum women was 1.84 times that of non-pregnant/non-postpartum women while risk of suicide was decreased.

CONCLUSION:

Pregnancy and postpartum appear to be times of increased risk for homicide and decreased risk for suicide among women in the US.

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By:  Wallace ME1, Hoyert D2, Williams C3, Mendola P4.

• 1Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd Rockville, MD 20852.
• 2Mortality Statistics Branch, Division of Vital Statistics, National Center for Health Statistics, 3311 Toledo Road, Room 7318, Hyattsville, Maryland 20782.
• 3Department of Health Behavior, University of Kentucky, 151 Washington Ave, 342 Bowman Hall, Lexington, KY 40508.
• 4Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd Rockville, MD 20852. Electronic address: pauline.mendola@nih.gov. 
• Am J Obstet Gynecol. 2016 Mar 26. pii: S0002-9378(16)00532-9. doi: 10.1016/j.ajog.2016.03.040.

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