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This Article Extract Full Text (PDF) All Versions of this Article: AJPH.2005.072041v1 95/11/1879-a    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Chang, J. Articles by Berg, C. J. Search for Related Content PubMed Articles by Chang, J. Articles by Berg, C. J.

Jeani Chang, MPH and Cynthia J. Berg, MD, MPH

The authors are with the Division of Reproductive Health, Coordinating Center for Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.

Correspondence: Requests for reprints should be sent to Jeani Chang, 4770 Buford Hwy NE, MS, K-21, Atlanta, GA 30341-3724 (e-mail: jchang{at}cdc.gov).

We appreciate Horon’s interest in pregnancy-associated mortality and her work in this important area of women’s health. For the years of our study, we requested reporting areas (health departments in the 50 states, the District of Columbia, and New York City) to send us deidentified death certificates and, for those deaths after a live birth or stillbirth, matching birth or fetal death certificates. We also asked for certificates for deaths that occurred during pregnancy or within 1 year after pregnancy.

We have no choice but to rely on the methods used by each reporting area to determine whether a death (including a death because of homicide) is pregnancy-associated. As stated in our discussion, the cause of death on death certificates is the most common way of ascertaining pregnancy-associated deaths. Next is computerized linking of deaths among women of reproductive age with birth certificates and fetal death certificates; we believe this system is used in about half the reporting areas. Maryland is fortunate to be able to also use medical examiners reports to ascertain additional cases.

We know our numbers underestimate the overall magnitude of pregnancy-associated mortality. However, to produce a national picture of the risk factors associated with death during or shortly after pregnancy, we used the only sources of information available on pregnancy-associated deaths. We hope that our article and Horon’s letter will encourage states to use multiple methods to identify pregnancy-associated deaths and to use the information to develop appropriate interventions for the period around pregnancy to prevent mortality from all causes.

This Article Extract Full Text (PDF) All Versions of this Article: AJPH.2005.072041v1 95/11/1879-a    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Chang, J. Articles by Berg, C. J. Search for Related Content PubMed Articles by Chang, J. Articles by Berg, C. J.