In recent years, as deaths from medical complications during pregnancy have declined, injuries-specifically those sustained in motor vehicle crashes-represent a growing proportion of all pregnancy-associated deaths. To investigate pregnancy-associated deaths in motor vehicle crashes in New Mexico, we scrutinized the database of the New Mexico Office of the Medical Investigator for all deaths during pregnancy and up to 6 weeks postpartum from 1986 through 1995. A total of 97 deaths were identified, 47 of which were injury-related. Motor vehicle crashes accounted for 33 (approximately 70%) of the injury-related deaths. We analyzed the data on motor vehicle crashes for decedent's age and ethnicity, fetal gestational age, time of crash, rural vs urban location of crash, seat belt use, and drug and alcohol use. Compared with non-Hispanic white women, proportionately higher numbers of Hispanic and American Indian pregnant women were killed in motor vehicle crashes. In searching for modifiable risk factors, we noted that 45% of the crashes involved alcohol and that the majority of pregnant women killed (77%) were not wearing seat belts at the time of the crash. We conclude that education about seat belt use during pregnancy (as well as the dangers of alcohol use and riding with intoxicated drivers while pregnant) is a promising strategy to reduce motor vehicle fatalities.