Dr. Corrine Williams, associate professor in the department of health, behavior & society at the University of Kentucky College of Public Health, published the paper “Pregnancy-associated homicide and suicide in 37 US states with enhanced pregnancy surveillance” in the September issue of The American Journal of Obstetrics and Gynecology.
[Photo: Dr. Corrine Williams]
Pregnant and postpartum women may be at increased risk of violent death including homicide and suicide relative to nonpregnant women, but U.S. national data have not been reported since the implementation of enhanced mortality surveillance. The objective of the study was to estimate homicide and suicide ratios among women who are pregnant or postpartum, and to compare their risk of violent death with nonpregnant/nonpostpartum women.
Death certificates from U.S. states with enhanced pregnancy mortality surveillance from 2005 through 2010 were used to compare mortality among four groups of women aged 10–54 years: pregnant, early postpartum (pregnant within 42 days of death), late postpartum (pregnant within 43 days to 1 year of death), and nonpregnant/nonpostpartum. The researchers estimated pregnancy-associated mortality ratios and compared with nonpregnant/nonpostpartum mortality ratios to identify differences in risk after adjusting for potential levels of pregnancy misclassification as reported in the literature.
Pregnancy-associated homicide victims were most frequently young, black, and undereducated, whereas pregnancy-associated suicide occurred most frequently among older white women. After adjustments, pregnancy-associated homicide risk ranged from 2.2 to 6.2 per 100,000 live births, depending on the degree of misclassification estimated, compared with 2.5–2.6 per 100,000 nonpregnant/nonpostpartum women aged 10–54 years. Pregnancy-associated suicide risk ranged from 1.6–4.5 per 100,000 live births after adjustments compared with 5.3–5.5 per 100,000 women aged 10–54 years among nonpregnant/nonpostpartum women. Assuming the most conservative published estimate of misclassification, the risk of homicide among pregnant/postpartum women was 1.84 times that of nonpregnant/nonpostpartum women, whereas risk of suicide was decreased.
Dr. Williams et al. conclude that pregnancy and postpartum appear to be times of increased risk for homicide and decreased risk for suicide among women in the United States. They further argue that pregnancy may be a potentially important window of opportunity to identify women who are at risk for homicide and suicide, especially those who might not otherwise be in contact with health care and social services.