In the American Journal of Public Health, Pooja Mehta and colleagues seek to understand the effect of unintentional injuries, suicide, and homicide on pregnancy-associated death. The authors find that about half of of pregnancy-associated deaths - occurring during or within one year of pregnancy - in Philadelphia between 2010 and 2014 were due to unintentional injuries, homicide, or suicide. Of these deaths, more than 50% were directly or indirectly associated with substance use, more than 40% were associated with serious mental illness, and more than 20% were associated with intimate partner violence. These figures are comparable to those reported previously in other U.S. cities, and reflect a higher prevalence of these conditions in pregnant women compared with all women of reproductive age. Approximately half of all those who died had an unscheduled hospital visit within a month of death, suggesting significant missed opportunities for prevention. Health systems and providers need to build a community-engaged system for referral, treatment, communication, and support to address complex issues such as substance use disorder, mental illness, and intimate partner violence during pregnancy.