title: Improved Ascertainment of Pregnancy-Associated Suicides and Homicides in North Carolina.
abstract: Injuries, including those resulting from violence, are a leading cause of death during pregnancy and the postpartum period. North Carolina, along with other states, has implemented surveillance systems to improve reporting of maternal deaths, but their ability to capture violent deaths is unknown. The purpose of this study was to quantify the improvement in ascertainment of pregnancy-associated suicides and homicides by linking data from the North Carolina Violent Death Reporting System (NC-VDRS) to traditional maternal mortality surveillance files.
  
  
  
  Enhanced case ascertainment was used to identify suicides and homicides that occurred during or up to 1 year after pregnancy from 2005 to 2011 in North Carolina. NC-VDRS data were linked to traditional maternal mortality surveillance files (i.e., death certificates with any mention of pregnancy or matched to a live birth or fetal death record and hospital discharge records for women who died in the hospital with a pregnancy-related diagnosis). Mortality ratios were calculated by case ascertainment method. Analyses were conducted in 2015.
  
  
  
  A total of 29 suicides and 55 homicides were identified among pregnant and postpartum women through enhanced case ascertainment as compared with 20 and 34, respectively, from traditional case ascertainment. Linkage to NC-VDRS captured 55.6% more pregnancy-associated violent deaths than traditional surveillance alone, resulting in higher mortality ratios for suicide (2.3 vs 3.3 deaths per 100,000 live births) and homicide (3.9 vs 6.2 deaths per 100,000 live births).
  
  
  
  Linking traditional maternal mortality files to NC-VDRS provided a notable improvement in ascertainment of pregnancy-associated violent deaths.
authors.affiliation: Centers for Disease Control and Prevention/CSTE Applied Epidemiology Fellowship, Atlanta, Georgia; North Carolina Department of Health and Human Services, Injury and Violence Prevention Branch, Division of Public Health, Raleigh, North Carolina.
authors.forename: Anna E
authors.initials: AE
authors.lastname: Austin
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland. Electronic address: cvladutiu@hrsa.gov.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Vladutiu
authors.affiliation: North Carolina State Center for Health Statistics, Division of Public Health, Raleigh, North Carolina.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Jones-Vessey
authors.affiliation: North Carolina Department of Health and Human Services, Injury and Violence Prevention Branch, Division of Public Health, Raleigh, North Carolina.
authors.forename: Tammy S
authors.initials: TS
authors.lastname: Norwood
authors.affiliation: North Carolina Department of Health and Human Services, Injury and Violence Prevention Branch, Division of Public Health, Raleigh, North Carolina.
authors.forename: Scott K
authors.initials: SK
authors.lastname: Proescholdbell
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: M Kathryn
authors.initials: MK
authors.lastname: Menard
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006708:Homicide / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009657:North Carolina; D011247:Pregnancy / Q000523:psychology*; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult