IntroductionThis study analyzed the contribution of firearms to pregnancy-associated mortality from homicide and suicide. MethodsThis was a retrospective cohort study using the CDC's National Violent Death Reporting System from 2008 – 2019. Women aged 15-44 years who died by suicide (intentional self-harm) and homicide where a firearm was involved were included. Persons without known pregnancy status were excluded. Pregnancy-associated deaths were defined as those that occurred during pregnancy or within 1 year of pregnancy (early and late postpartum). Sociodemographic characteristics, social, and circumstantial differences were compared in pregnancy-associated and non-pregnant deaths. Data analysis was conducted in 2022 – 2023. ResultsA total of 1,803 homicide and 1,929 suicide deaths from firearms were included. Twenty-two percent (n=388) and 11% (n=212) of firearm homicides and suicides respectively, were pregnancy-associated. Victims of pregnancy associated homicide were predominantly Black (54.8%), single (76%), and had high school diploma or equivalent degree (41.2%). Victims of pregnancy-associated suicide were predominantly White (80.5%). Among pregnancy-associated homicides and suicides, deaths occurred more frequently during pregnancy (63.4% and 40.3%). Compared to non-pregnancy associated homicides, pregnancy-associated homicides more frequently occurred in the victim's home (51.5% vs 46.7%, p=0.02) and was related to ongoing conflict or violence between a current or former partner (61.6% vs 51.9%, p < 0.001). Compared to non-pregnancy-associated suicide, pregnancy-associated suicides more frequently occurred in those who experienced intimate partner violence within a month of death (4.2% vs 1.3%, p=0.005). ConclusionsWhile there are differences in demographic characteristics between victims, interpersonal violence is associated with both pregnancy-associated homicides and suicides where a firearm was involved.