Pregnancy-Associated Deaths Due to Drugs, Suicide, and Homicide in the United States, 2010-2019

Abstract

Objective: To estimate the prevalence of pregnancy-associated deaths due to drugs, suicide, and homicide nationwide from 2010 to 2019.

Methods: Using U.S. death certificate records from 2010 to 2019 for 33 states plus the District of Columbia, we identified pregnancy-associated deaths using the pregnancy checkbox and International Classification of Diseases, Tenth Revision codes, calculated pregnancy-associated death ratios, and categorized deaths by cause, timing relative to pregnancy, race or ethnicity, and age.

Results: Of 11,782 pregnancy-associated deaths identified between 2010 and 2019, 11.4% were due to drugs, 5.4% were due to suicide, and 5.4% were due to homicide, whereas 59.3% were due to obstetric causes and the remaining 18.5% were due to other causes. Drug-related deaths, suicide, and homicide accounted for 22.2% of pregnancy-associated deaths. All three causes of death increased over the study period, with drug-related pregnancy-associated deaths increasing 190%. Homicide during pregnancy and drug-related deaths, suicides, and homicide in the late postpartum period (43-365 days) accounted for a larger proportion of all deaths in these time periods than the contribution of these causes to all deaths among females of reproductive age. Pregnant and postpartum people identified as non-Hispanic American Indian or Alaska Native were at highest risk of drug-related and suicide death, and people identified as non-Hispanic Black were at highest risk of homicide.

Conclusion: Deaths due to drug use, suicide, and homicide constitute more than one fifth of all deaths during pregnancy and the first year postpartum. Drug-related deaths and homicides have increased over the past decade. Substantial racial and ethnic inequities in these deaths exist.

Figure 1.

Pregnancy-associated death ratios and 95% CIs for drug-related deaths, suicide, and homicide in 33 U.S. states and the District of Columbia, 2010 to 2019. The pregnancy-associated death ratio due to drug-related causes rose 190% from 2.7/100,000 in 2010 to 7.8/100,000 in 2019 (RR: 2.9, 95% CI: 2.2–3.8). The pregnancy-associated death ratio due to suicide increased approximately 30% from 2010–2019 from 1.9/100,000 to 2.5/100,000, but this increase was not statistically significant (RR: 1.3, 95% CI: 0.9–1.9). The homicide pregnancy-associated death ratio increased 63% (RR: 1.6, 95% CI: 1.1–2.3) from 1.8/100,000 to 3.0/100,000 in 2019.

Figure 2.

Percentage of cause-specific pregnancy-associated deaths by timing relative to pregnancy in 32 U.S. states* and the District of Columbia, 2010 to 2019. *California data not included in this figure due to lack of specificity of timing relative to pregnancy.