Are Pregnant and Postpartum Women: At Increased Risk for Violent Death? Suicide and Homicide Findings from North Carolina

Samandari, Ghazaleh; Martin, Sandra L.; Kupper, Lawrence L.; Schiro, Sharon; Norwood, Tammy; Avery, Matt

doi:10.1007/s10995-010-0623-6

Cited by 36 publications

(35 citation statements)

References 40 publications

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“…Women in pregnancy and in the postpartum may have a high prevalence of depression and are at risk of suicide, however, the risk to die from injuries and suicide is still reported to be higher among women who are not pregnant and not in the postpartum period. 13,63 This finding is even found in settings with very good cause of death ascertainment, such as in the UK confidential enquiries, and has been attributed in part to the fact that women who become pregnant are healthier than the general population of non-pregnant women. 64 Similarly, in a demographic surveillance site in Bangladesh, violent deaths were not more common in pregnant women compared to women who were not pregnant, except for pregnant adolescents in which a higher rate to die from suicide and injuries has been observed(the higher number of injuries among pregnant adolescents has largely been explained by the high number of unwanted pregnancies in unmarried young girls).…”

Section: Discussionmentioning

confidence: 99%

Contribution of suicide and injuries to pregnancy-related mortality in low-income and middle-income countries: a systematic review and meta-analysis

Fuhr

Calvert

Ronsmans

et al. 2014

The Lancet Psychiatry

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Summary Background Although suicide is one of the leading causes of deaths among young women in low and middle-income countries (LMIC), the contribution of suicide and injuries to pregnancy-related mortality remains unknown. Methods We conducted a systematic review to identify studies reporting the proportion of pregnancy-related deaths attributable to suicide and/or injuries in LMIC. Random-effects meta-analysis was used to calculate the pooled prevalence of pregnancy-related deaths attributable to suicide, stratified by WHO region. To account for the possible misclassification of suicide deaths as injuries, we calculated the pooled prevalence of deaths attributable to injuries, and undertook a sensitivity analysis reclassifying the leading methods of suicides among women in LMIC (burns, poisoning, falling or drowning) as suicide. Findings 36 studies from 21 countries were identified. The pooled total prevalence across the regions was 1·00% for suicide (95% confidence interval (CI): 0·54–1·57) and 5·06% for injuries (95% CI: 3·72–6·58). Reclassifying the leading suicide methods from injuries to suicide increased the pooled prevalence of pregnancy-related deaths attributed to suicide to 1·68% (95% CI: 1·09–2·37). Americas (3·03%, 95% CI: 1·20–5·49),the Eastern-Mediterranean region (3·55%, 95% CI: 0·37–9·37), and the South-East Asia region (2·19%, 95% CI: 1·04–3·68) had the highest prevalence for suicide, with the Western-Pacific region (1·16%, 95% CI: 0·00–4·67) and the Africa region (0·65%, 95% CI: 0·45–0·88) having the lowest. Interpretation The available data suggest a modest contribution of injuries and suicide to pregnancy-related mortality in LMIC with wide regional variations. However, this study may have underestimated suicide deaths due to lack of recognition and inclusion of these causes in eligible studies. We recommend that injury-related and other co-incidental causes of death are included in the WHO definition of maternal mortality to promote measurement and effective intervention for reduction of maternal mortality in LMIC.

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Section: Discussionmentioning

confidence: 99%

Contribution of suicide and injuries to pregnancy-related mortality in low-income and middle-income countries: a systematic review and meta-analysis

Fuhr

Calvert

Ronsmans

et al. 2014

The Lancet Psychiatry

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“…29 This discrepancy may be due to enhanced case ascertainment since the 1990s (the PMSS data were based on death records and, in some but not all cases, linked live birth or fetal death records). Other studies on pregnancy-associated homicide have reported rates per 100,000 ranging from 8.6 in Tennessee from 1989 to 1991 (postpartum only), 6 9.3 in Maryland 1993–2008, 4 2.9 in North Carolina from 2004–2006, 30 and 2.9 in 17 states participating in the National Violent Death Reporting System (NVDRS) from 2003–2007 (SC, GA, NC, VA, NJ, MD, AK, MA, OR, CO, OK, RI, WI, CA, KT, NM, UT). 31 Although we find similar rates of pregnancy-associated homicide, Samandari et al 30 concluded that the risk of homicide was decreased among pregnant/postpartum women in North Carolina based on a homicide rate of 4.9 per 100,000 in the referent non-pregnant/non-postpartum population.…”

Section: Commentmentioning

confidence: 98%

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

Wallace

Hoyert

Williams

et al. 2016

American Journal of Obstetrics and Gynecology

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Background 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. Objective 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. Study 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. Results 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). Conclusion Pregnancy and postpartum appear to be times of increased risk for homicide and decreased risk for suicide among women in the US.

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“…[30][31][32][33][34][35][36][37][38][39][40][41] The unique physiology of pregnancy renders the patient vulnerable to hypoxemia and hemodynamic disadvantage, given the rapid development of desaturation with apnea and the presence of aortocaval compression when the patient is unconscious and supine. Therefore, all BLS interventions are essential and should be initiated rapidly and simultaneously once the rescuers arrive.…”

Section: First Respondersmentioning

confidence: 99%

“…[34][35][36][37][38] In the developed world, trauma is the leading cause of maternal mortality. Unintentional injury (primarily motor vehicle accidents), homicide, and suicide are the 3 leading components of fatal trauma.…”

Section: Trauma/suicide In Pregnancymentioning

confidence: 99%

Cardiac Arrest in Pregnancy

Jeejeebhoy¹,

Zelop²,

Lipman³

et al. 2015

Circulation

324

111

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Abstract-This is the first scientific statement from the American Heart Association on maternal resuscitation. This document will provide readers with up-to-date and comprehensive information, guidelines, and recommendations for all aspects of maternal resuscitation. Maternal resuscitation is an acute event that involves many subspecialties and allied health providers; this document will be relevant to all healthcare providers who are involved in resuscitation and specifically maternal resuscitation. Key Words: AHA Scientific Statements ■ cardiopulmonary resuscitation ■ heart arrest ■ pregnancy © 2015 American Heart Association, Inc.Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIR.0000000000000300The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on July 6, 2015, and the American Heart Association Executive Committee on August 24, 2015. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIR.0000000000000300/-/DC1. The American Heart Association requests that this document be cited as follows: Jeejeebhoy FM, Zelop CM, Lipman S, Carvalho B, Joglar J, Mhyre JM, Katz VL, Lapinsky SE, Einav S, Warnes CA, Page RL, Griffin RE, Jain A, Dainty KN, Arafeh J, Windrim R, Koren G, Callaway CW; on behalf of the American Heart Association Emergency Cardiovascular Care Committee, Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Cardiovascular Diseases in the Young, and Council on Clinical Cardiology. Cardiac arrest in pregnancy: a scientific statement from the American Heart Association. Circulation. 2015;132:1747-1773 Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://my.americanheart.org/statements and select the "Policies and Development" link.Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/CopyrightPermission-Guidelines_UCM_300404_Article.jsp. A link to the "Copyright Permissions Request Form" appears on the right ...

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Are Pregnant and Postpartum Women: At Increased Risk for Violent Death? Suicide and Homicide Findings from North Carolina

Cited by 36 publications

References 40 publications

Contribution of suicide and injuries to pregnancy-related mortality in low-income and middle-income countries: a systematic review and meta-analysis

Contribution of suicide and injuries to pregnancy-related mortality in low-income and middle-income countries: a systematic review and meta-analysis

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

Cardiac Arrest in Pregnancy

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