Homicide a leading cause of death in pregnant women. (Continuing Education).

According to a study published in the Journal of Midwifery and Family Medicine Women's Health, the leading cause of death among pregnant women is homicide.

The study's authors reviewed 651 autopsy charts from the District of Columbia's Chief Medical Examiner's Office for cases from 1988 until 1996. The researchers discovered thirteen homicides of pregnant women that had not been reported with the twenty-one maternal deaths from medical causes (for example, hemorrhage and infection). These thirteen unreported deaths account for 38 percent of pregnancy-associated deaths.

"Few studies have evaluated the prevalence of homicide in women of childbearing age," explains the study's lead author and researcher, Cara Krulewitch, CNM, PHD, of the University of Maryland, Baltimore. "We need to turn our attention to these women and develop a clearer understanding of the magnitude of the problem, especially among pregnant women."

Other findings include:

* Pregnant homicide victims are more likely to have been killed early in the pregnancy; which can make it difficult to identify the pregnancy and relate it to the homicide.

* Pregnant homicide victims are more likely to be killed with a gun.

* Pregnant teenagers (aged 15-19 years) are most at risk.

Similar results have been found in other areas of the country. However, it is difficult to collect data on homicide as a cause of maternal mortality, due to cause-of-death coding standards. Moreover, the Federal Bureau of Investigation statistics do not note if a woman was pregnant at the time of the homicide. This study highlights these shortcomings in identifying and reporting maternal mortality across the nation, which allows this epidemic of violent death to escape scrutiny.

"What pregnant women do not know," said American College of Nurse-Midwives Executive Director Deanne Williams, "is that instead of facing joyful celebration at the announcement of pregnancy, too many face violence and death. We have got to do a better job of identifying this problem and helping the women and their partners not end up with such a horrific outcome."

The authors note that the deaths in the study, although not officially reported within maternal mortality ratios, may truly be pregnancy-related in that the violence might not have escalated to result in death if the women were not pregnant.

--Journal of Midwifery and Women's Health, February 20, 2001