Observational study finds injuries and violence as primary causes of maternal death — Evidence Review

A new analysis finds that drug overdose, homicide, and suicide have become the leading causes of maternal death in the United States, surpassing traditional medical complications. Most related research supports these findings, showing that injuries and violence have long been significant contributors to maternal mortality. The study was conducted by Columbia University.

• Multiple related studies, including large observational analyses from the 1990s onward, consistently report that traumatic injuries—particularly from violence—are major or even leading causes of maternal death in the US and internationally 1 2 4 5.
• Research demonstrates racial disparities similar to those found in the new study, with Black women at higher risk for homicide-related maternal deaths and White women more affected by overdose and suicide 2 4.
• Consistent with the new findings, literature highlights that injury-related maternal deaths are often underreported and that expanding screening for substance use and intimate partner violence during pregnancy is recommended 2 4 11 12 14.

Study Overview and Key Findings

Efforts to reduce maternal mortality have typically focused on medical complications such as hemorrhage, infection, and cardiovascular disease. However, this new national analysis underscores a shift in the pattern of maternal deaths in the United States, with preventable injuries and violence now surpassing these medical causes. The study’s findings highlight the need for broader approaches to maternal health, including enhanced screening and prevention strategies for drug use and interpersonal violence during pregnancy.

Property	Value
Study Year	2026
Organization	Columbia University
Journal Name	New England Journal of Medicine
Authors	Hooman A. Azad, Dana Goin, Lisa M. Nathan, Dena Goffman, Sonali Rajan, Uma Reddy, Mary E. D’Alton, Danielle Laraque-Arena
Population	Pregnant and postpartum women
Methods	Observational Study
Outcome	Causes of maternal death
Results	Injuries and violence are primary causes of maternal death.

Literature Review: Related Studies

To contextualize these findings, we searched the Consensus paper database, containing over 200 million research papers, using the following queries:

1. maternal death causes injuries violence
2. maternal mortality risk factors
3. violence impact on maternal health

Below, we summarize the main themes that emerge from related studies:

Topic	Key Findings
Are injuries and violence leading causes of maternal death?	- Traumatic injury, including homicide and suicide, accounts for a substantial proportion of maternal deaths in the US, with some studies reporting trauma as the leading cause 1 2 4 5. - Violence and overdose are significant contributors to maternal mortality and are often underrecognized in maternal health surveillance 2 4 5.
What are the risk factors and disparities in maternal mortality?	- Black women experience higher rates of homicide-related maternal deaths, while White women are more affected by overdose and suicide 2 4. - Factors such as lack of education, inadequate antenatal care, and comorbidities increase maternal mortality risk in both high- and low-income settings 7 8 9 10.
How does violence during pregnancy impact maternal and neonatal outcomes?	- Physical violence and intimate partner violence (IPV) are linked to increased maternal morbidity, adverse birth outcomes, and higher maternal and neonatal mortality 11 12 14 15. - IPV reduces the likelihood of receiving adequate prenatal care and is associated with other health risk behaviors 12 14.
How has the focus on medical causes influenced maternal mortality trends?	- Improvements in managing medical complications have reduced hospital-based maternal deaths, but injury and violence now represent a greater share of maternal mortality 8. - Surveillance systems may undercount injury-related deaths due to inconsistent documentation of pregnancy status on death certificates 2 4.

Are injuries and violence leading causes of maternal death?

Multiple studies over several decades have identified trauma—including homicide, suicide, and drug overdose—as major or even leading contributors to maternal deaths. The new study’s finding that injuries now surpass medical causes aligns with this long-standing but sometimes underrecognized trend.

• Trauma accounted for 46.3% of maternal deaths in a large 1991 US study, with homicide and suicide being key contributors 1.
• In New York City, nearly 40% of maternal deaths were attributed to injury, predominantly homicide and suicide 2.
• North Carolina data identified injuries as the single most common cause of maternal death, emphasizing the need for injury prevention in perinatal care 4.
• International studies also note significant contributions from violence and accidents to maternal mortality 5.

What are the risk factors and disparities in maternal mortality?

The new study’s identification of racial disparities in maternal deaths from violence and overdose is supported by multiple related studies. Social determinants such as race, education, and access to health care continue to drive disparities.

• Black women are at higher risk for homicide-related maternal deaths, while White women are more affected by suicide and overdose 2 4.
• Lack of formal education, inadequate antenatal care, and comorbid conditions are significant risk factors for maternal mortality across diverse settings 7 8 9 10.
• Maternal mortality rates are higher in populations with less access to care and among those with additional social vulnerabilities 6 7 10.

How does violence during pregnancy impact maternal and neonatal outcomes?

The adverse effects of violence—particularly intimate partner violence—during pregnancy are well-documented. These effects extend beyond maternal mortality to include maternal morbidity, poor birth outcomes, and reduced access to care.

• Physical violence during pregnancy is common and associated with increased maternal complications, preterm birth, and low birth weight 11.
• Intimate partner violence reduces the likelihood of adequate prenatal care, which itself is protective against poor outcomes 12 14.
• Exposure to violence in utero has significant social and economic costs, as well as long-term intergenerational effects 15.
• Universal screening and targeted interventions for IPV during pregnancy are recommended as effective prevention strategies 12 14.

How has the focus on medical causes influenced maternal mortality trends?

While medical complications remain important, improved management has led to declines in hospital-based maternal deaths from these causes. As a result, deaths from injuries and violence now constitute a larger proportion of overall maternal mortality—a shift clearly reflected in the new study.

• Delivery-related hospital mortality has decreased, likely due to quality improvement strategies for medical complications 8.
• Surveillance systems may miss injury-related maternal deaths if pregnancy status is not consistently recorded on death certificates, leading to underestimation 2 4.
• Expanded efforts to manage medical complications have not been matched by equivalent attention to injury and violence prevention 4 8.

Future Research Questions

While the new study advances our understanding of shifting maternal mortality patterns, several questions remain unanswered. Future research should address the underlying causes of injury-related maternal deaths, effective prevention strategies, and the impact of broader social determinants.

Research Question	Relevance
What are the most effective interventions for preventing injury-related maternal deaths?	Identifying and evaluating targeted prevention strategies, such as screening for substance use and violence, could inform clinical and public health practice 4 11 12.
How do social determinants influence the risk of maternal death from violence and overdose?	Understanding how factors like race, socioeconomic status, and access to care shape these risks can help address disparities and inform policy 2 4 6 7.
What are the long-term impacts of maternal exposure to violence on child health and development?	Violence during pregnancy has documented short-term consequences, but further research is needed on long-term effects for both mothers and children 12 15.
How does improved reporting of pregnancy status on death certificates affect maternal mortality surveillance?	Inconsistent documentation leads to undercounting of injury-related maternal deaths; better data could improve surveillance accuracy and policy response 2 4.
To what extent can multidisciplinary care (including mental health and social services) reduce injury-related maternal mortality?	The potential for integrated care models to prevent overdose, suicide, and violence-related deaths among pregnant and postpartum women is promising but not fully understood 12 14.