By Charnicia E. Huggins

NEW YORK, Mar 20 (Reuters Health) - When women who are pregnant or were recently pregnant die, the most likely cause is homicide, new study findings suggest.

"[This] was definitely an unexpected and extremely surprising finding," study author Dr. Isabelle L. Horon from the Maryland Department of Health and Mental Hygiene in Baltimore told Reuters Health in an interview.

About 20% of the 247 pregnancy-related deaths that occurred in Maryland from 1993 to 1998 were due to homicide, according to Horon and co-author Dr. Diana Cheng. The second-leading cause of death was cardiovascular disorders, which accounted for 19% of deaths, the authors report in the March 21st issue of The Journal of the American Medical Association.

In contrast, homicide was behind less than 12% of deaths among non-pregnant women in Maryland, even after the investigators took into consideration age and race. In general, younger females and African-American women face higher rates of homicide.

These findings suggest that health officials should investigate the relationship between homicides and the pregnancy and post-pregnancy time periods--such as whether a homicide resulting from domestic violence is related to the stress of pregnancy, the report indicates.

"Since the original focus of the paper was on enhanced surveillance of all pregnancy-associated deaths, we have not yet done a comprehensive review of all homicide deaths," Izard said.

Yet, the statistics, according to Horon and Cheng, show that "the number of pregnancy-associated deaths is substantially higher and the causes of death substantially broader than previously believed."

Better monitoring of such deaths "is therefore a critical step in the reduction of pregnancy-associated mortality," the report concludes.

In a related editorial, Victoria Frye of the Center for Health and Gender Equity in Takoma Park, Maryland, writes, "it is important to note that in the United States, homicide is a leading killer of young women, pregnant or not."

She also notes that although the current study could not address the issue, many female homicide victims are killed by their intimate partners.

A "first step" in addressing the problem, she concludes, would be for all doctors to follow the recommendations of the American College of Obstetricians and Gynecologists to screen women for signs of domestic violence.

Citing the importance of following such recommendations, Debbie Lee from the Family Violence Prevention Fund stated, "If we're going to promote safe motherhood, we have to really begin to screen, and until we do we're not going to be able to reduce this maternal mortality."

"It's a fairly simple intervention. It doesn't have to be overwhelming, but it is a very life-saving support for battered women," she said. Lee was not involved in the new study.

The Family Violence Prevention Fund is a non-profit organization dedicated to ending domestic violence.

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