Homicide and other injuries as causes of maternal death in New York City, 1987 through 1991

Abstract

Objectives: We attempted to document the role of homicide and other injuries as causes of maternal death and to compare the risk of fatal injury among pregnant women with that in the general population.

Study design: We reviewed New York City medical examiner records of 2331 women aged 15 to 44 years who died of injury in 1987 through 1991. Pregnancies were identified from autopsy information.

Results: A total of 115 (39%) of 293 deaths in currently or recently pregnant women were attributable to injury. These 115 deaths included homicide (63%), suicide (13%), motor vehicle crashes (12%), and drug overdoses (7%). Minority women were overrepresented among the injury deaths (black 53%, Hispanic 24%, white 19%). Recent substance use was documented in 48% of the injury deaths. Pregnancy was documented on only 35% of the 115 death certificates. The risk of fatal injury is similar for currently pregnant women and for women in the general population, except for an increased risk of homicide among pregnant black women.

Conclusions: Homicide and other injuries are major contributors to maternal mortality and should be (but rarely are) included routinely in maternal mortality surveillance systems. Prenatal and postpartum clinic visits represent an ideal time to implement interventions to prevent injuries among pregnant women.

PIP: The contribution of homicide and other injuries to maternal mortality was assessed through a review of New York City, New York (US) medical examiner records of 2331 women 15-44 years of age who died of injuries during 1987-91. Pregnant women were identified through autopsy information. A total of 115 (39%) of 293 deaths in currently or recently pregnant women were attributed to injury. Only 22 (35%) of these injury-related deaths were recorded in the New York City Department of Health's maternal mortality surveillance system, and the box on the death certificate indicating current or recent pregnancy was not checked in 65% of these cases. The mean age of pregnant women dying of injury was 25.5 years. The largest proportion of injury-related deaths were homicides (63%); other causes were suicide (13%), motor vehicle accidents (12%), and drug overdoses (7%). Minority women were over-represented in injury deaths; 53% were Black, 24% were Hispanic, and 19% were White. Significantly more homicides were observed (n = 44) than expected (n = 28.8) among currently pregnant Black women. Recent substance use was documented in 48% of injury deaths. The contribution of homicide and other injuries to maternal mortality requires more attention in both surveillance systems and prenatal and postpartum care programs.