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Accidental drug overdose has emerged as the leading cause of death among pregnant and postpartum women in the United States, a new study has revealed.
Researchers from Columbia University found that overdoses, homicides and suicides together account for a substantial share of deaths during pregnancy and shortly after birth—often exceeding medical causes that dominate the public discussion around maternal health.
In their study, the team analyzed U.S. death certificate data to identify all deaths among pregnant and postpartum women within 42 days of delivery between 2018 and 2023.
“Overdose and violence are not typically on our radar when it comes to thinking about approaches to reducing maternal morbidity and mortality, but these events are far more common among pregnant and postpartum women than we think,” paper author Dr Hooman Azad said in a statement.
The analysis found that accidental overdose led mortality causes with 5.2 deaths per 100,000 births. Homicide and suicide followed, with a combined rate of 3.9 deaths per 100,000 births.
The research also highlighted disparities. Accidental overdose and suicide were more common among white women, while deaths via homicide was seen more frequent among Black women.
More than three-quarters of violent deaths involved firearms, underscoring the role of gun violence in maternal mortality.
Timing mattered as well. Over half of overdose and violence-related deaths occurred during pregnancy itself.
By contrast, the next four most common causes—cardiovascular disease, infection, hypertension and hemorrhage—were more likely to occur in the immediate postpartum period.
Despite fluctuations during the COVID-19 pandemic, the overall maternal death rate remained relatively steady across the six-year period studied. However, the composition of those deaths has shifted.
As medical care to prevent and manage obstetric complications has improved over the past two decades, a growing body of research shows that non-medical causes such as overdose and violence make up an increasing share of maternal deaths.
Tracking these trends has historically been difficult because of inconsistent methods for documenting pregnancy status on death records. Improved standardization in recent years has allowed researchers to see the patterns more clearly.
For Azad, the findings point to missed opportunities in care.
“The take-home message is that we may not do as good a job in screening for drug use and intimate partner violence among our pregnant patients as we do for medical complications,” he said.
Azad argues that maternal health efforts must broaden beyond clinical complications to include social and behavioral risks.
He concluded: “We have an opportunity to refocus our efforts on preventing drug overdose and violence with multidisciplinary care that includes referrals to mental health care and social services throughout pregnancy—which could save hundreds of lives.”
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Reference
Azad, H. A., Goin, D., Nathan, L. M., Goffman, D., Rajan, S., Reddy, U., D’Alton, M. E., & Laraque-Arena, D. (2026). Overdose, Homicide, and Suicide as Causes of Maternal Death in the United States. New England Journal of Medicine, 394(7), 722–723. https://doi.org/10.1056/NEJMc2512078
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