Oral Concurrent Session 1 - Equity, Public Health, and Policy
Oral Concurrent Sessions
Hooman A. Azad, MD, MPH (he/him/his)
OB/Gyn Resident Physician
Columbia University Medical Center
New York, New York, United States
Dana Goin, PhD
Columbia University Mailman School of Public Health
New York, New York, United States
Lisa Nathan, MD
Chief of Obstetrics, Sloane Hospital for Women
Columbia University Irving Medical Center
New York, New York, United States
Dena Goffman, MD (she/her/hers)
Professor, Women's Health in Obstetrics & Gynecology; Vice Chair, Quality & Patient Safety
Columbia University Medical Center
New York, New York, United States
Uma M. Reddy, MD, MPH (she/her/hers)
Professor and Vice Chair of Research, Department of Obstetrics and Gynecology
Columbia University
New York, New York, United States
Danielle Laraque-Arena, MD
Professor of Clinical Epidemiology and Pediatrics
Columbia University Mailman School of Public Health
New York, New York, United States
Mary E. D'Alton, MD
Obstetrician and Gynecologist-in-Chief
Willard C. Rappleye Professor and Chair
Columbia University Medical Center
New York, New York, United States
In medical training, the dogma is this: the leading causes of maternal mortality are bleeding, infection, hypertension, and cardiovascular disease.
This is only true when violence against women is excluded.
We present the leading causes of death in pregnancy, compare violent death rates in pregnant and non-pregnant people, and investigate firearm legislation’s association with these deaths.
Study Design:
Case-level data on deaths in US women ages 15-44 (2005-2022) were collected using CDC’s Limited Mortality File. Cause of death and pregnancy status were identified by ICD-10 codes. A “pregnancy checkbox” identified additional deaths in pregnancy. We include the first 42 postpartum days in defining “pregnancy,” consistent with national definitions.
We present the leading causes of death in pregnancy. We compare violent death rates among pregnant women and non-pregnant controls. A state-level, cross-sectional, ecologic panel study using negative binomial regressions is used to identify associations between domestic violence (DV) firearm laws and violent deaths in pregnancy.
Results:
In 18 years, 20,421 pregnant women died. 2,293 were violent deaths (11%); of these, 1,407 (61%) were homicides and 886 (39%) were suicides. 1,261 violent deaths involved firearms (55%). Violence was the most common cause of death in pregnancy (Figure 1A); the incidence doubled from 2005-2022. Violent death was more frequent in pregnant women than non-pregnant controls (3.2 v 1.2 deaths per 100,000 population) (Figure 1B).
DV laws were associated with reductions in homicide and firearm death in pregnancy (range, 17-32%). Laws requiring relinquishment of firearms among DV perpetrators showed the strongest associations with reduced death rates (Table 1).
Conclusion:
More pregnant women die from violence than any medical cause in the US, at higher rates than their non-pregnant counterparts. Firearm legislation is associated with fewer deaths, suggesting lethal means restriction may help curb this alarming trend. As maternal mortality rates rise, addressing violence should be a focus of clinicians and policymakers alike.
