The Impact of the pregnancy checkbox and misclassification on maternal mortality trends in the United States, 1999–2017

Maternal mortality is a critical indicator of population health in both the United States and internationally (1-3). Monitoring maternal mortality over time is important to evaluate progress in improving maternal health in the United States, to make international comparisons, and to examine differences and inequities by demographic subgroup (3). Substantial disparities in maternal mortality exist by race and Hispanic origin and age in the United States (4-6). Maternal and pregnancy-related mortality rates for non-Hispanic black women are approximately three times the rates for non-Hispanic white women, while women aged 40 and over have the highest maternal mortality rates compared with other age groups (4,6,7).