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

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.