Pregnancy-associated homicide and suicide in 37 US states with enhanced pregnancy surveillance

Résumé

textbfBACKGROUND: Pregnant and postpartum women may be at increased risk of violent death including homicide and suicide relative to non-pregnant women, but US national data have not been reported since implementation of enhanced mortality surveillance. textbfOBJECTIVE: To estimate homicide and suicide ratios among women who are pregnant or postpartum and to compare their risk of violent death to non-pregnant/non-postpartum women. textbfSTUDY DESIGN: Death certificates (n=465,097) from US states with enhanced pregnancy mortality surveillance from 2005-2010 were used to compare mortality among four groups of women age 10-54: pregnant, early postpartum (pregnant within 42 days of death), late postpartum (pregnant within 43 days to 1 year of death) and non-pregnant/non-postpartum. We estimated pregnancy-associated mortality ratios and compared to non-pregnant/non-postpartum mortality ratios in order to identify differences in risk after adjusting for potential levels of pregnancy misclassification as reported in the literature. textbfRESULTS: Pregnancy-associated homicide victims were most frequently young, Black, and undereducated while pregnancy-associated suicide occurred most frequently among older White women. After adjustments, pregnancy-associated homicide risk ranged from 2.2-6.2 per 100,000 live births, depending on the degree of misclassification estimated, compared to 2.5-2.6 per 100,000 non-pregnant/non-postpartum women aged 10-54. Pregnancy-associated suicide risk ranged from 1.6-4.5 per 100,000 live births after adjustments compared to 5.3-5.5 per 100,000 women aged 10-54 among non-pregnant/non-postpartum women. Assuming the most conservative published estimate of misclassification, risk of homicide among pregnant/postpartum women was 1.84 times that of non-pregnant/non-postpartum women (95% confidence interval: 1.71, 1.98) while risk of suicide was decreased (relative risk=0.62, 95% confidence interval: 0.57, 0.68). textbfCONCLUSION: Pregnancy and postpartum appear to be times of increased risk for homicide and decreased risk for suicide among women in the US. ÉTATS-UNIS FEMME SUICIDE-COMPLÉTÉ POST-PARTUM GROSSESSE HOMICIDE VIOLENCE