A new national analysis reveals that the most common causes of death among pregnant and postpartum women are not traditional medical complications, but preventable injuries and violence.
Columbia University researchers report that injuries and violence are now the primary causes of death among pregnant and recently postpartum women. Specifically, accidental drug overdose, homicide, and suicide account for more deaths in this group than traditional medical complications.
The study appears 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, who led the study and is a maternal-fetal medicine fellow in the Department of Obstetrics and Gynecology at Columbia University Vagelos College of Physicians and Surgeons.
Analyzing National Death Records
To better understand the causes of pregnancy-related deaths, the team reviewed U.S. death certificate data from 2018 through 2023. They identified all women who died while pregnant or within 42 days of giving birth (within 42 days of delivery).
Accidental drug overdose ranked first, occurring at a rate of 5.2 deaths per 100,000 births. Homicide and suicide were next, together accounting for 3.9 deaths per 100,000 births. The data also revealed differences by race. Overdose and suicide were more frequent among white women, while homicide occurred more often among Black women. Firearms were involved in more than three-quarters of deaths caused by violence.
Maternal mortality overall remained largely unchanged during the six-year study window, aside from a rise during the COVID-19 pandemic.
Gaps in Screening and Prevention
More than half of deaths linked to overdose and violence took place during pregnancy itself. In contrast, other leading causes, including cardiovascular disease, infection, hypertension, and hemorrhage, were more likely to occur shortly after delivery in the immediate postpartum period.
Over the past 20 years, expanded efforts to manage medical complications during pregnancy and postpartum have improved care. At the same time, research has shown that overdose and violence represent a growing share of maternal deaths. Tracking this shift has been challenging, however, because pregnancy status has not always been recorded consistently on death certificates, limiting the accuracy of national data.
“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.”
Reference: “Overdose, Homicide, and Suicide as Causes of Maternal Death in the United States” by Hooman A. Azad, Dana Goin, Lisa M. Nathan, Dena Goffman, Sonali Rajan, Uma Reddy, Mary E. D’Alton and Danielle Laraque-Arena, 11 February 2026, New England Journal of Medicine.
DOI: 10.1056/NEJMc2512078
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1 Comment
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