Hooman Azad, MD, MPH, explains new leading causes of maternal death in the US

The traditional clinical focus on hemorrhage and hypertension as the primary drivers of maternal death may not be as clear cut as originally thought. A study published in The New England Journal of Medicine (NEJM) revealed that unintentional drug overdose and violence—homicide and suicide—now account for more than one-fourth of maternal deaths in the United States. Hooman Azad, MD, MPH, Clinical fellow, Maternal-Fetal Medicine, Columbia University, New York, and study author, discussed how these findings broaden the definition of maternal risk.^1,2

“We wanted to look at national mortality data to better understand how often overdose, homicide, and suicide contribute to maternal deaths,” Azad told Contemporary OB/GYN in the video above. “To be clear, the goal of this study was simply descriptive. It was to clearly define the pattern at a national level and not to explain why it is happening or to evaluate specific policies. I hope that it will create an impetus to do studies that answer those questions, because I think they are important; they were just not the focus of our study.”

Redefining the leading causes of death

Analyzing 7901 deaths among pregnant and postpartum women from 2018 through 2023, the Columbia University research team found that unintentional drug overdose was the single most frequent cause, accounting for 1152 deaths (5.2 per 100,000 live births). Violence followed as the second most frequent cause with 866 deaths (3.9 per 100,000 live births). Together, these 2 categories accounted for 2,018 deaths, nearly equaling the combined toll of cardiovascular disease, hypertension, infection, and hemorrhage (2,141 deaths).

“The fact that overdose was the single most frequent cause of maternal death was absolutely striking,” Azad stated. He noted that while medical complications remain critical, these findings demonstrate that a "meaningful proportion" of deaths fall outside traditional obstetric definitions.

The study also highlighted stark disparities: homicide occurred most frequently among non-Hispanic Black women across all age groups, but particularly among those aged 15 to 24 (14.3 deaths per 100,000 live births). Suicide and overdose were more common among non-Hispanic White women.

Clinical screening and systemic linkage

Azad emphasized that the frequency of these deaths during pregnancy and the first 42 postpartum days necessitates early and repeated screening. He suggested adopting strategies proven effective in pediatrics, such as inquiring about the presence of firearms—which were involved in 77% of maternal homicides and 39% of suicides.

However, Azad warned that identifying risk is only the first step.

“It is not enough just to ask and identify; you have to have a way of connecting people to resources,” he explained. “It is easy to implement asking as part of a clinical history, asking about intimate partner violence, firearms in the home, or mental health. Many of these are already incorporated in prenatal care. But more important than identifying the issue is the linkage to resources afterward. That is where larger-scale interventions and the structuring of our care systems are important.”

Future directions for postpartum research

While overall maternal mortality remained stable at approximately 34 deaths per 100,000 live births during the study period, Azad views this data as an impetus for deeper investigation.

“This is an identification and prioritization of an issue, with a call for clinicians and researchers to look into these topics in much greater detail,” Azad concluded.

References:

1. Azad HA, Goin D, Nathan LM, et al. Overdose, homicide, and suicide as causes of maternal death in the United States. N Engl J Med. 2026;394(7):722-723. doi:10.1056/NEJMc2512078
2. The most common causes of maternal death may surprise you. Press release. Columbia University. Published February 11, 2026. Accessed April 1, 2026. https://www.eurekalert.org/news-releases/1115897?