MedicalResearch.com Interview with:
Pauline Mendola, PhD
Investigator, Epidemiology Branch
Division of Intramural Population Health Research
Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH
Bethesda, MD 20892
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Efforts to monitor and reduce maternal mortality during and around the time of pregnancy largely focus on causes physiologically related to the pregnancy, despite the fact that increasing evidence suggests violent death – including homicide and suicide – are leading causes.
In this study, we analyzed US death certificates from 2005-2010 from states that include pregnancy information on the death record in order to estimate rates of pregnancy-associated homicide and suicide, and to determine if risk of violent death was increased for women during pregnancy and postpartum. Given the large proportion of death records with unknown pregnancy status, we adjusted for a range of possible misclassification and found that pregnancy-associated homicide risk ranged from 2.2-6.2 per 100,000 live births, while pregnancy-associated suicide risk ranged from 1.6-4.5 per 100,000 live births. Overall, homicide risk was 1.8 times higher among pregnant/postpartum women compared to non-pregnant women in the population. The risk of suicide was 38% lower among pregnant/postpartum women than the general population.
MedicalResearch.com: What should readers take away from your report?
Response: Suicide and homicide are the fourth and fifth leading causes of death among reproductive-aged women and these data suggest that pregnancy may be a time of heightened homicide risk particularly for younger Black women. It is impossible to determine if pregnancy-associated violent deaths would not have occurred in the absence of pregnancy; however, the significant role intimate partner violence and conflict plays in many cases of pregnancy-associated homicide and suicide, suggests that pregnancy may be an additional stressor in already vulnerable circumstances, or that these deaths may be the conclusion of a cycle of physical and sexual abuse that ends during pregnancy.
While suicide rates are low at this time, they appear to increase in the post-partum period where risks are higher for older White mothers. What is clear is 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.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: As implementation of records with pregnancy information is complete across all states, national estimates of pregnancy-associated homicide and suicide risk will continue to shed light on the magnitude of this problem and bring visibility to victims of violent death. Future research should aim to identify aspects of the social environment underlying increased risk of violent death and disparities in maternal mortality during and after pregnancy that may be addressed through policy and intervention efforts to reduce incidence.
MedicalResearch.com: Is there anything else you would like to add?
Response: Failure to consider non-obstetric causes of death including violent deaths underestimates both the magnitude of mortality and the racial inequality in risk of death among pregnant and recently pregnant women. It is important to note that these tragic deaths are all potentially preventable. Pregnancy is a time when nearly all women have contact with the medical care system and screening for risk factors such as depression and intimate partner violence may help to identify women at risk and target interventions.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Am J Obstet Gynecol. 2016 Sep;215(3):364.e1-364.e10. doi: 10.1016/j.ajog.2016.03.040. Epub 2016 Mar 26.
Pregnancy-associated homicide and suicide in 37 US states with enhanced pregnancy surveillance.
Wallace ME1, Hoyert D2, Williams C3, Mendola P4.
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