By Donna St. George
Washington Post Staff Writer
Wednesday, February 23, 2005; Page A05

The U.S. Centers for Disease Control and Prevention has reported that homicide is a leading cause of traumatic death among new and expectant mothers, with higher risks for women who are younger than 20 or black. It was the CDC's first national look at pregnancy and homicide.

The study, which was released yesterday and appears in the March issue of the American Journal of Public Health, documents 617 slayings from 1991 to 1999. That number significantly understates the actual toll because many states do not have reliable methods for tracking such deaths, researchers said.

The CDC study was lauded by several public health experts for recognizing an overlooked phenomenon. Using data from more than 30 states, the CDC found that homicide ranked second, after auto accidents, among trauma deaths of pregnant women and new mothers. The study looked only at "injury deaths" and drew no comparison to deaths from medical causes.

"I think it's a very important first step," said Jacquelyn Campbell, who studies domestic homicide at the Johns Hopkins University School of Nursing. She said more research is needed "to really understand how widespread it is and . . . how to best intervene to prevent these deaths."

In the CDC report, researchers recommended that state and local health officials take ambitious steps to improve the way they identify maternal homicides, linking information from autopsy records, police reports and birth and death records, for example, to develop a clearer portrait of victims and offenders. Few states do this.

"Homicide is an important cause of death for women during pregnancy or within one year of pregnancy," said Jeani Chang, lead author of the CDC study.

Many of the CDC's findings were comparable to those produced by The Washington Post in a year-long examination of homicide and pregnancy, published in December. After culling cases from death certificate data, medical examiner records, news reports and interviews, the paper identified 1,367 maternal homicides since 1990, a total that also falls short because so many cases are missed.

The CDC study found that homicide accounted for 31 percent of maternal injury deaths. Auto accidents accounted for 44 percent, other unintentional injuries for 13 percent and suicide for 10 percent.

The analysis showed black women had a maternal homicide risk about seven times that of white women. The disparity was even more striking at ages 25 to 29, with black women in that age group about 11 times as likely as white women to be killed.

The authors reported that age stood out more than race, with the highest homicide risk for women younger than 20 when all races were combined.

Among other differences noted, married women were found at less risk than unmarried women. Women who received no prenatal care had a higher risk of homicide than those who did.

The study found that 57 percent of maternal homicides were caused by gunfire; stabbings ranked second, with nearly 18 percent.

The CDC study said it was "important but difficult to assess" whether women in general are at an increased risk of homicide during pregnancy and the postpartum period, which covers 12 months under the public health definition of "pregnancy-associated" deaths. It noted that homicide is a leading cause of death among black and young women, regardless of maternal status.

Using its 617 cases, the CDC calculated a ratio of 1.7 homicides per 100,000 live births, but Chang, the lead author, acknowledged the ratio is understated because homicides are so poorly tracked.

In Maryland, researchers found 11.5 homicides per 100,000 live births. In two other state studies, the figures were much higher than the CDC number, said Isabelle Horon, co-author of a Maryland study published in the Journal of the American Medical Association in 2001.

Horon said the CDC study "may call attention to the problem, but I think that it also does a disservice to the problem because it suggests the magnitude of the problem is less than what it is."

The CDC report pointed out that several studies, including Horon's, showed pregnant and postpartum women faced an increased risk of homicide. In Maryland, researchers found that new and expectant mothers were nearly twice as likely as other women to be victims of homicide, even after adjusting for race and age.

Cara Krulewitch, a researcher at the University of Maryland at Baltimore School of Nursing, called the CDC findings significant.

"Homicide was second on the list of injuries," she said. "It wasn't falls. It wasn't suicides. It wasn't anything else." This does not mean that most pregnant women are in peril, she said, "but that there is a phenomenon going on out there and we don't understand it yet."