In the United States, the leading cause of death among pregnant and postpartum women is unintentional drug overdose. Between 2018 and 2023, overdose killed 1,152 pregnant or recently pregnant women, a rate of 5.2 deaths per 100,000 live births. That finding, published in the New England Journal of Medicine, challenges the common assumption that obstetric emergencies like hemorrhage or infection pose the greatest threat. In fact, overdose, homicide, and suicide together accounted for more than one quarter of all maternal deaths during that period, nearly equaling the combined toll of cardiovascular disease, infection, hypertension, and hemorrhage.
Overdose, Homicide, and Suicide
Drug overdose is now the single most common cause of death for pregnant and postpartum women in the U.S. Violence, defined as homicide or suicide, is the second most frequent cause, responsible for 866 deaths over the same six-year window (3.9 per 100,000 live births). Of those violent deaths, homicides made up 68 percent and suicides 32 percent.
These numbers reflect a broader shift in how maternal death is understood. Traditional tracking focused on medical complications directly caused by pregnancy. But when researchers widened the lens to include all deaths during pregnancy and the first 42 postpartum days, nonmedical causes surged into view. A study in Philadelphia found that over a four-year period, 49 percent of maternal deaths were nonmedical, including overdoses, car crashes, homicides, and suicides. Overdose alone composed 40 percent of those nonmedical deaths.
Mental health conditions are a significant driver. Among non-Hispanic white women specifically, mental health conditions were identified as the leading underlying cause of pregnancy-related death. The postpartum period carries particular risk: 63 percent of all maternal deaths occur in the first year after birth, a window when mood disorders, substance use relapse, and intimate partner violence can intensify while medical attention drops off.
Cardiovascular Disease
When looking strictly at medical causes, cardiovascular disease is the biggest killer. Heart-related conditions account for more than 33 percent of pregnancy-related deaths. That category includes several distinct problems: heart failure, coronary artery disease, stroke, and a condition called peripartum cardiomyopathy, where the heart muscle weakens near the end of pregnancy or in the months after delivery.
Heart failure is the most common complication among pregnant women with any form of heart disease. Coronary artery disease alone is responsible for over 20 percent of maternal cardiac deaths, often presenting as a sudden heart attack. Pregnancy places enormous strain on the cardiovascular system. Blood volume increases by roughly 50 percent, heart rate rises, and blood pressure fluctuates. For women with undiagnosed heart conditions or risk factors like obesity, chronic high blood pressure, or diabetes, these changes can be dangerous.
Hemorrhage, Hypertension, and Infection
The obstetric emergencies most people associate with childbirth still claim lives, though at lower rates than cardiovascular disease. A 2018 report from nine state Maternal Mortality Review Committees found that about 50 percent of all pregnancy-related deaths were caused by hemorrhage, cardiovascular or coronary conditions, cardiomyopathy, or infection combined. Hemorrhage specifically caused 11.5 percent of pregnancy-related deaths from 2011 to 2014.
Preeclampsia and related hypertensive disorders are a major threat globally, responsible for more than 70,000 maternal deaths per year worldwide. The World Health Organization estimated that in 2020, preeclampsia-related deaths accounted for roughly 24 percent of all maternal deaths globally. For Black women in the U.S., preeclampsia, eclampsia, and blood clots (embolism) are the most common underlying causes of death, a pattern that differs from the overall population.
Racial Disparities
The risk of dying during or after pregnancy is not distributed evenly. In 2023, Black women died at a rate of 50.3 per 100,000 live births. White women died at 14.5 per 100,000, Hispanic women at 12.4, and Asian women at 10.7. That means Black women face roughly 3.5 times the risk of white women and nearly five times the risk of Asian women.
The causes of death also differ by race. Black women are disproportionately affected by hypertensive disorders and blood clots, while white women are more likely to die from mental health-related causes including overdose and suicide. These patterns point to different failures in care: delayed diagnosis of preeclampsia in Black patients, inadequate screening for substance use and depression in white patients, and systemic gaps in postpartum follow-up across the board.
How the U.S. Compares Globally
Worldwide, the leading cause of maternal death is hemorrhage, followed by hypertensive disorders. These are conditions most closely tied to the physical act of pregnancy and childbirth, and they dominate in low-income countries where access to emergency obstetric care is limited. In high-income countries, the picture shifts. Complications from abortion and miscarriage, ectopic pregnancy, and cardiovascular conditions carry more relative weight.
The U.S. stands out among wealthy nations for the prominence of overdose, homicide, and suicide in its maternal death statistics. This reflects both the country’s opioid crisis and high rates of gun violence, problems that intersect with pregnancy in ways the healthcare system has been slow to address.
Most Deaths Are Preventable
More than 80 percent of pregnancy-related deaths in the U.S. are considered preventable. That assessment comes from the CDC and state-level Maternal Mortality Review Committees, which examine each case and determine whether reasonable changes by patients, families, providers, hospitals, or community systems could have altered the outcome. Preventable does not mean the fix was simple. It means there was at least some chance the death could have been avoided.
Only 11 percent of maternal deaths happen on the day of delivery. The vast majority occur before or, more commonly, after leaving the hospital. That timing gap highlights a core problem: the highest-risk window for new mothers extends months past the point where most medical attention ends. Many women have a single postpartum checkup at six weeks and then no routine contact with a provider for the rest of the year, precisely when overdose, cardiac events, and violence are most likely to occur.