Using multiple-cause mortality database to estimate number of reported pregnancy-associated injury deaths

OBJECTIVE: To use multiple-cause mortality database to estimate the number of reported pregnancy-associated injury deaths in the US from 1981 through 2010; and to assess changes in number of reported deaths following implementation of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) in 1999, and the introduction of a pregnancy checkbox in 2003 revision of the U.S. standard death certificate.

METHODS: We defined pregnancy-associated injury deaths as deaths with mention pregnancy-related conditions (ICD-9 codes 630-676 or ICD-10 codes O00-O99) on the death certificate and assigning injury (ICD-9 codes E800-E869, E880-E929, E950-E999 or ICD-10 codes V01-Y36, Y85-Y98) as the underlying cause of death.   

RESULTS: The number of reported pregnancy-associated injury deaths was 7 in 1981-1982, 9 in 1997-1998 and increased to 33 in 1999-2000. The increase was more prominent since 2003, rising from 51 in 2001-2002 to 306 in 2003-2004 and to 714 in 2009-2010. The number of deaths for three mechanisms of injury (unintentional poisoning, suicide, and homicide) showed notable increases from 1999-2002 to 2003-2006. Unintentional poisoning and suicide had more prominent increasing trends than motor vehicle traffic crashes and homicide from 2007-2008 to 2009-2010.

CONCLUSION: Ascertainment of pregnancy-associated injury deaths using multiple-case mortality database improved prominently after the introduction of pregnancy checkbox in 2003. Additionally, unintentional poisoning and suicide deaths increased in even greater numbers than motor vehicle traffic crashes and homicide; this suggests a real increase in number of injury deaths.