Introduction of pregnancy checkbox associated with increase in reported maternal mortality of 6.78 deaths per 100,000 livebirths
By Elana Gotkine HealthDay Reporter
WEDNESDAY, May 7, 2025 (HealthDay News) — Maternal deaths increased between 2000 and 2019, with much of the increase attributable to introduction of the pregnancy checkbox on death certificates, and another sharp increase was recorded in 2021 during the COVID-19 pandemic, according to a study published online April 28 in JAMA Pediatrics.
Robin Y. Park, from the University of Oxford in the United Kingdom, and colleagues examined trends in maternal, fetal, and infant death since 2000 in a cross-sectional analysis, as well as a staggered difference-in-differences analysis based on the introduction of the pregnancy checkbox on death certificates. The study population was limited to mothers aged 15 to 44 years.
The researchers found that introduction of the pregnancy checkbox was associated with an increase of 6.78 deaths per 100,000 livebirths in reported maternal mortality, which represented 66 percent of the total increase from 2000 to 2019. From 2000 until 2021, adjusted maternal death rates remained consistently between 6.75 and 10.24 per 100,000 live births, with a peak of 18.86 in 2021; the rate decreased to 10.23 in 2022. During the COVID-19 period, death rates increased most for Native American or Alaska Native women, increasing from 10.70 per 100,000 live births in 2011 to 2019 to 27.47 in 2000 to 2022. From 2000 to 2020, there was a decrease in infant death rates per 1,000 live births, from 6.93 to 5.44, followed by a slight increase to 2018 levels in 2021 to 2023. Per 1,000 live births, fetal death rates decreased from 6.28 to 5.53 from 2005 to 2022.
“Using difference-in-differences analyses, results of this study reveal that the pregnancy checkbox explained much of the observed increase in maternal mortality before the COVID-19 pandemic,” the authors write. “Nevertheless, results of this cross-sectional study suggest that, even adjusting for pregnancy checkbox effects, most groups saw increases from 2011 to 2019 to the 2020 to 2022 period, indicating that the COVID-19 pandemic led to worse outcomes. The findings demonstrate the relevance of public health emergencies to maternal health outcomes.”
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