The Most Common Causes of Maternal Death May Surprise You

Researchers at Columbia University have found that accidental drug overdose, homicide, and suicide are the leading causes of death among pregnant and postpartum women. 

The findings were published in the New England Journal of Medicine. 

“Overdose and violence are not typically on our radar when it comes to thinking about approaches to reducing maternal morbidity and mortality, but these events are far more common among pregnant and postpartum women than we think,” says Hooman Azad, a maternal-fetal medicine fellow in the Department of Obstetrics and Gynecology at Columbia University Vagelos College of Physicians and Surgeons and study leader.  

The researchers used information on death certificates to identify all pregnant and postpartum women (within 42 days of delivery) who died in the United States between 2018 and 2023.  

Their analysis revealed that accidental overdose was the leading cause of death among pregnant or postpartum women (5.2 deaths per 100,000 births), followed by homicide and suicide (combined for 3.9 deaths per 100,000 births). Accidental overdose and suicide were more common among white women; homicide was more frequent among Black women. Over three-quarters of violent deaths involved firearms.  

Except for an increase during the COVID-19 pandemic, the overall maternal death rate remained steady over the six-year period.  

Over half of deaths due to accidental overdose and violence occurred during pregnancy, whereas the next four most common causes of death—cardiovascular disease, infection, hypertension, and hemorrhage—occurred more often in the immediate postpartum period. 

As interventions to prevent and treat medical complications during pregnancy and postpartum have become more widespread over the past two decades, multiple studies have shown that accidental overdose and violence have accounted for increasing numbers of maternal deaths. But until recently, a lack of standardized data—due to different methods for documenting pregnancy in death records—has made it difficult to track these trends. 

“The take-home message is that we may not do as good a job in screening for drug use and intimate partner violence among our pregnant patients as we do for medical complications,” Azad says. “We have an opportunity to refocus our efforts on preventing drug overdose and violence with multidisciplinary care that includes referrals to mental health care and social services throughout pregnancy—which could save hundreds of lives.”