Pregnancy-associated deaths due to drugs, suicide, and homicide in the U.S. 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 iden- tified 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 reproduc- tive 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 peo- ple 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.