Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Maternal Deaths From Suicide & Overdose

Obstet Gynecol; 2016 Dec; Metz, Rovner, et al

Most maternal deaths occur in the postpartum period, with self-harm (suicide and overdose) the most common cause of pregnancy-associated mortality, according to a recent study that examined maternal deaths from suicide and overdose in Colorado from 2004 to 2012. Researchers found:

  • 30% of the 211 total maternal deaths in Colorado during the study period resulted from self-harm.
  • Pregnancy-associated death ratio from overdose was 5.0 per 100,000 live births; 4.6% for suicide.
  • Deaths were equally distributed throughout the first postpartum year with only 6 maternal deaths during pregnancy.
  • Prior psychiatric diagnoses were documented in 54% and prior suicide attempts in 10% of women.
  • 48% of women discontinued medications during pregnancy.
  • Pharmaceutical opioids were the most common drug identified.


Metz TD, Rovner P, Hoffman CM, et al. Maternal deaths from suicide and overdose in Colorado, 2004-2012. Obstet Gynecol. 2016;128(6):1233-1240. doi:10.1097/AOG.0000000000001695.


Reductions in maternal mortality are an identified national priority with plans for addressing common causes of bad-outcomes like hemorrhage, hypertension, venous thromboembolism, and infection.1 This study is a collection of data that begins to address an underappreciated cause of maternal morbidity and mortality: self-harm. The startling results of this study show that there are almost 10-fold more maternal deaths from self–harm than there are from maternal hemorrhage. Postpartum depression, which can lead to self-harm, has been recognized as far more common than previously believed.1 The first step in addressing a problem is recognizing that the problem exists, and this study represents an important first step in this direction. —Neil Skolnik, MD

  1. Vesga-López O, Blanco C, Keyes K, Olfson M, Grant BF, Hasi DS. Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry. 2008;65(7):805-815. doi:10.1001/archpsyc.65.7.805