Evaluation of the Pregnancy Status Checkbox on the Identification of Maternal Deaths

Objectives-This report quantifies the impact of the inclusion of a pregnancy status checkbox item on the U.S. Standard Certificate of Death on the number of deaths classified as maternal. Maternal mortality rates calculated with and without using the checkbox information for deaths in 2015 and 2016 are presented. Methods-This report is based on cause-of-death information from 2015 and 2016 death certificates collected through the National Vital Statistics System. Records originally assigned to a specified range of ICD-10 codes (i.e., A34, O00-O99) when using information from the checkbox item were recoded without using the checkbox item. Ratios of deaths assigned as maternal deaths using checkbox item information to deaths assigned without checkbox item information were calculated to quantify the impact of the pregnancy status checkbox item on the classification of maternal deaths for 47 states and the District of Columbia. Maternal mortality rates for all jurisdictions calculated using cause-of-death information entered on the certificate with and without the checkbox were compared overall and by characteristics of the decedent. Results-Use of information from the checkbox, along with information from the cause-of-death section of the certificate, identified 1,527 deaths as maternal compared with 498 without the checkbox in 2015 and 2016 (ratio = 3.07), with the impact varying by characteristics of the decedent such as age at death. The ratio for women under age 25 was 2.15 (204 compared with 95 deaths) but was 14.14 (523 compared with 37 deaths) for women aged 40-54. Without the adoption of the checkbox item, maternal mortality rates in both 2015 and 2016 would have been reported as 8.7 deaths per 100,000 live births compared with 8.9 in 2002. With the checkbox, the maternal mortality rate would be reported as 20.9 and 21.8 deaths per 100,000 live births in 2015 and 2016.