Ayesha Dholakia, MD, discusses firearms as leading cause of US maternal death

Recent data show that homicide is now the leading cause of death during pregnancy in the United States, surpassing well-known obstetric causes such as hemorrhage, hypertension, and sepsis.

According to Ayesha Dholakia, MD, fellow in pediatric emergency medicine at Boston Children’s Hospital, nearly 80% of these maternal homicides involve firearms. Pregnant and postpartum individuals are 37% more likely to be killed with a gun compared with their nonpregnant peers, yet violence remains underrecognized as a maternal health threat. Against the backdrop of a maternal mortality rate already 2 to 3 times higher than that of comparable nations, firearm-related deaths represent an especially urgent and preventable source of mortality.

Dholakia’s research demonstrates a strong link between state-level firearm ownership and pregnancy-associated homicide. For every 1% increase in estimated firearm ownership, pregnancy-associated homicide rates rise by 6%, and firearm-specific homicide rates increase by 8%, even after adjusting for socioeconomic factors such as poverty, unemployment, insurance coverage, and population density.

Geographic differences were striking: some states reported no maternal homicides during the study period, while others recorded rates as high as 100 per 1 million live births. These findings indicate that the surrounding firearm environment, not chance, significantly shapes maternal survival.

The impact of maternal homicide is also unevenly distributed across demographic groups. Young women, particularly those aged 20 to 24 years, faced the highest risk. Non-Hispanic Black women accounted for over half of pregnancy-associated homicides despite representing a much smaller share of all pregnancies. These disparities mirror longstanding structural inequities—differences in neighborhood safety, exposure to intimate partner violence (IPV), and access to protections and resources—that disproportionately affect young Black women.

To reduce firearm-related homicides during pregnancy, Dholakia outlined several key strategies. Clinically, prenatal and postpartum visits offer crucial opportunities for screening for IPV and discussing firearm presence and safe storage. Professional organizations such as ACOG already recommend including firearm safety counseling within IPV screening, and resources such as the AMA–Ad Council “Agree to Agree” campaign provide guidance for initiating these conversations.

Systemic support for patients following screening is equally essential, ensuring they can access referrals, safety resources, and follow-up care. Finally, policy interventions—including domestic violence firearm relinquishment laws, extreme risk protection orders, and safe storage requirements—have already been shown to reduce violent deaths and represent critical tools for protecting pregnant people.

Dholakia emphasized that existing data likely undercount these deaths, given limitations in determining pregnancy status at the time of death and the many nonfatal firearm injuries not captured in mortality statistics. Even so, the pattern is unmistakable: maternal homicides are predictable, preventable, and driven by broader structural inequities. Addressing firearm-related violence as a maternal health emergency is essential to safeguarding pregnant and postpartum individuals.

No relevant disclosures.

Reference

Dholakia A, Monuteaux MC, D’Ambrosi G, McLone SG, Fleegler E, Lee LK. Firearm homicide in pregnant women and state-level firearm ownership. JAMA Netw Open. 2025;8(11):e2542447. doi:10.1001/jamanetworkopen.2025.42447