By Linda Carroll

(Reuters Health) – Some women in the United States may be most at risk of being murdered during pregnancy or shortly after giving birth, a new study suggests.

An analysis of Louisiana mortality data found that women were twice as likely to be murdered when they were pregnant or had recently given birth than at any other time in their lives, the study team reports in JAMA Pediatrics.

Homicide was a more common cause of death than any other single pregnancy-related cause.

“The point of this study is to shed light on this issue,” said lead author Maeve Wallace of the Tulane University School of Public Health and Tropical Medicine in New Orleans. “What we found is not unique to Louisiana. It’s been documented in lots of other states around the country.”

Wallace hopes studies like hers will spur action by healthcare providers and community organizations to find ways to protect pregnant and postpartum women at risk for homicide.

Other research has shown that these kinds of homicides often involve an intimate partner, Wallace said. So, when women come in to see their obstetricians, it can be an opportunity to ask questions and try to intervene, she added.

To look at rates of homicide among pregnant and postpartum women in their state, Wallace and her colleagues turned to data from the Louisiana Department of Health. The researchers reviewed all verified causes of deaths occurring in 2016 and 2017.

Among the 119 pregnancy-associated deaths in Louisiana during that period, 13.4% were homicides. That translates to a rate of deaths by homicide among pregnant women and new mothers of 12.9 per 100,000 – which far exceeds mortality from any single pregnancy complication, including artery blockages, at 4.8 per 100,000, and blood pressure disorders, at 3.2 per 100,000 deaths.

Even motor vehicle crashes (10.5 per 100,000) and other accidents (11.3 per 100,000) killed fewer pregnant women and new mothers than homicide.

The rate of deaths by homicide among pregnant and postpartum women was also twice as high as that of other females, whose overall murder rate was 6.3 per 100,000, according to data from the Centers for Disease Control and Prevention. The greatest risk was among females aged 10 to 29. In that age group, the rate of homicide among pregnant and postpartum women was 16.2 per 100,000 as compared to 6.8 per 100,000 for those who were neither pregnant nor postpartum.

The new study adds to the growing body of evidence showing that pregnant and postpartum women are at risk for being murdered by their intimate partners, said Phyllis Sharps, the Elsie Lawler Endowed Chair and a professor at the Johns Hopkins School of Nursing in Baltimore.

“Most often what you find is that these women are in a relationship where the partner is violent,” Sharps said. “Intimate partner violence is about power and control. When a woman is pregnant, she is very much preoccupied by the pregnancy and her baby – which is what she should be doing.”

As the woman becomes more distracted by her pregnancy, the partner feels threatened, Sharps said. “He feels he maybe doesn’t have as much control because she is not paying as much attention to him and he resorts to violence,” she explained. “And generally that violence gets worse and it can escalate to homicide.”

That’s why all pregnant women should be screened, Sharps said. “You want to find out what is going on in the relationship,” she added. “Is she concerned or afraid? Does she have a partner who is hurting her?”

Many professional organizations, such as those that serve obstetricians and gynecologists and emergency medicine doctors, have guidelines on screening, Sharps said.

Doctors shouldn’t have preconceived notions about their patients, Sharps said. “Any woman at any time can be a victim of partner violence,” she added. “So they should just ask all women.”

SOURCE: JAMA Pediatrics, online February 3, 2020.