Study: Murder, suicide exceed medical deaths in pregnancy

From Reuters:

Oct 27 (Reuters) - Expectant mothers are more likely to die from murder or suicide than from several of the most common pregnancy-related medical problems, a U.S. study said.

Roughly half of those women who died violently had had some kind of conflict with their current or former partners, according to findings published in the journal Obstetrics and Gynecology, causing experts to call for more thorough screening for domestic problems during pregnancy check-ups.

"We've seen improvements in the more traditional causes of death, likely due to advances in medical care and public health practices," said Christie Palladino, an obstetrician-gynecologist at Georgia Health Sciences University in Augusta and lead author of the study.

This finding is especially troubling because violent deaths can be stopped, she added.

The study, which used data from the U.S. Centers for Disease Control and Prevention's National Violent Death Reporting System, examined the years from 2003 to 2007.

About three out of every 100,000 women who are pregnant or have a child less than a year old are murdered, and two out of every 100,000 kill themselves -- numbers that remained fairly constant in the years the researchers looked at.

But fewer than two out of every 100,000 women died from either pregnancy-related bleeding, improper development of the placenta, or preeclampsia, a complication of high blood pressure that can occur during pregnancy, according to a different set of data.

Women who died by suicide were more likely to be white or Native American, unmarried and over 40. Older women and those under 24 were at greater risk of being murdered, as were African Americans and unmarried women.

"I think that there's still an under-appreciation of the risk and probably less screening than should be done," said Linda Chambliss, director of maternal fetal medicine at St. Joseph's Hospital and Medical Center in Phoenix, who did not participate in the study.

"Even if the numbers are relatively small, you're talking about something that's preventable."

The National Violent Death Reporting System includes all records of violent deaths in the participating U.S. states, but in some case the pregnancy status of the victim was not known. Palladino and her colleagues excluded those records from the study.

Pregnancy is a prime opportunity for working to prevent suicides and murders, particularly those related to domestic violence, because women regularly see health care providers, Palladino said.

"We want to make sure we intervene before we get to these really disastrous consequences," she added. SOURCE: bit.ly/u2Dgjy (Reporting from New York by Kerry Grens at Reuters Health; Editing by Elaine Lies and Robert Birsel)

Homicide and Suicide During the Perinatal Period: Findings From the National Violent Death Reporting System [fee]
Palladino, Christie Lancaster; Singh, Vijay; Campbell, Jacquelyn; Flynn, Heather; Gold, Katherine J.
Obstetrics & Gynecology. 118(5):1056-1063, November 2011.
doi: 10.1097/AOG.0b013e31823294da

Abstract

OBJECTIVE: To estimate the rates of pregnancy-associated homicide and suicide in a multistate sample from the National Violent Death Reporting System, to compare these rates with other causes of maternal mortality, and to describe victims' demographic characteristics.

METHODS: We analyzed data from female victims of reproductive age from 2003 to 2007. We identified pregnancy-associated violent deaths as deaths attributable to homicide or suicide during pregnancy or within the first year postpartum, and we calculated the rates of pregnancy-associated homicide and suicide as the number of deaths per 100,000 live births in the sample population. We used descriptive statistics to report victims' demographic characteristics and prevalence of intimate-partner violence.

RESULTS: There were 94 counts of pregnancy-associated suicide and 139 counts of pregnancy-associated homicide, yielding pregnancy-associated suicide and homicide rates of 2.0 and 2.9 deaths per 100,000 live births, respectively. Victims of pregnancy-associated suicide were significantly more likely to be older and white or Native American as compared with all live births in National Violent Death Reporting System states. Pregnancy-associated homicide victims were significantly more likely to be at the extremes of the age range and African American. In our study, 54.3% of pregnancy-associated suicides involved intimate partner conflict that appeared to contribute to the suicide, and 45.3% of pregnancy-associated homicides were associated with intimate-partner violence.

CONCLUSION: Our results indicate that pregnancy-associated homicide and suicide are important contributors to maternal mortality and confirm the need to evaluate the relationships between sociodemographic disparities and intimate-partner violence with pregnancy-associated violent death.

LEVEL OF EVIDENCE: II