Original Research Higher Risk of Homicide Among Pregnant and Postpartum Females Aged 10–29 Years in Illinois, 2002–2011 Abigail R. Koch, MA, Deborah Rosenberg, PhD, and Stacie E. Geller, PhD, for the Illinois Department of Public Health Maternal Mortality Review Committee Working Group OBJECTIVE: To examine whether being pregnant or postpartum was associated with excess risk for homicide among females in Illinois and to describe the association between pregnancy status and homicide by race, eth- nicity, and age group. METHODS: This is a retrospective, multicohort, ecologic study of females of reproductive age in Illinois between 2002 and 2011 using Illinois Department of Public Health maternal mortality data and vital records data. We compared pregnancy-associated homicides with live births using x 2 tests. Among maternal deaths in the state, we calculated mortality rates per 100,000 live births for homicide and other violent causes and the leading direct obstetric causes. We calculated aggregate, pregnancy- associated, and nonpregnancy associated homicide rates stratified by race or ethnicity and age group. RESULTS: There were 636 pregnancy-associated deaths in Illinois from 2002 to 2011. Of these, 82 (13%) were the result of homicide (5.0 [95% confidence interval (CI) 4.0– 6.2]/100,000 live births). There were 931 homicides among females of reproductive age not associated with pregnancy (2.88 [95% CI 2.70–3.07]/100,000 population). More than half of the homicides were women aged 20–29 years (n553 [64.6%]), non-Hispanic black women (n543 [52.4%]), women residing in Cook County (n547 [57.3%]), and unmarried women (n557 [69.5%]). Pregnant and postpartum females aged 10–29 years were at twice the risk of homicide compared with their nonpregnant or postpartum counterparts (relative risk 2.20 [95% CI 1.70– 2.85]). Non-Hispanic black and Hispanic females experi- enced higher rates of homicide than non-Hispanic white females irrespective of pregnancy or age. CONCLUSION: Although all violence against women must be addressed, we recommend that state maternal mortality review committees, in addition to reviewing deaths resulting from obstetric and clinical causes, should conduct in-depth reviews of pregnancy- associated homicides and other violent deaths. (Obstet Gynecol 2016;128:440–6) DOI: 10.1097/AOG.0000000000001559 P regnancy-associated homicide (homicide occurring during or within 1 year of pregnancy) has been estimated as ranging from 8.4% to 43.3% of all pregnancy-associated mortality. 1–6 The Centers for Dis- ease Control and Prevention reported an overall pregnancy-associated homicide rate of 1.7 per 100,000 live births for 1991–1999. 6 Among 16 states reporting to the National Violent Death Reporting System from 2003 to 2007, the pregnancy-associated homicide rate was 2.9 per 100,000 live births, a higher rate than for specific direct obstetric causes (hemorrhage, hyperten- sive disorders, or amniotic fluid embolism). 7 Scant research has addressed whether women who are pregnant or within 1 year of pregnancy are at increased risk for homicide. In New York and Washington, DC, in the 1980s and 1990s, no associ- ation was observed between pregnancy status and homicide risk. 1,5 In North Carolina, pregnancy and postpartum status were strongly protective against homicide among women 30 years and older (rate ratio 0.17 [95% confidence interval (CI) 0.04–0.68]). See related editorial on page 427. From the Center for Research on Women and Gender, the School of Public Health, Division of Epidemiology and Biostatistics, and the College of Medicine, Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois. Corresponding author: Abigail R. Koch, MA, 1640 W Roosevelt Road, Chicago, IL 60608; e-mail: abbykoch@uic.edu. Financial Disclosure The authors did not report any potential conflicts of interest. © 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0029-7844/16 440 VOL. 128, NO. 3, SEPTEMBER 2016 OBSTETRICS & GYNECOLOGY Copyright ª by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.