Fetal Death Certificates as a Source of Surveillance Data for Stillbirths with Birth Defects

Abstract

Objective.

We assessed fetal death certificates (FDCs) as a source of surveillance for stillbirths with birth defects by linkage with data from the Metropolitan Atlanta Congenital Defects Program (MACDP), a population-based birth defects surveillance system.

Methods.

Stillbirths with defects in MACDP were identified from 1994 through 2002 and linked to FDCs. Sensitivity of FDCs for capturing stillbirths with defects was estimated, and predictors for a case being reported were assessed. Concordance for selected variables from each data source was evaluated.

Results.

Two hundred twenty-four of 257 stillbirths with birth defects in MACDP were linked to an FDC (linkage rate 5 87.2%; 95% confidence interval [CI] 82.4, 91.0). Stillbirths of non-Hispanic black and Hispanic/other mothers were more likely to be issued an FDC (odds ratio [OR] 5 5.6 [95% CI 1.9, 17.0] and 14.0 [95% CI 1.7, 114.0], respectively). Cases undergoing autopsy were more likely to be issued an FDC (OR53.2; 95% CI 1.1, 8.7). Performance of an amniocentesis was poorly recorded on FDCs. The sensitivity and positive predictive value of FDCs for selected classes of defects ranged from 10% to 70% and 25% to 93%, respectively.

Conclusions.

Compared to FDCs, MACDP's active case identification improves the ascertainment of stillbirths with birth defects and the quality of certain recorded data.

References

Fretts

. Etiology and prevention of stillbirth. Am J Obstet Gynecol 2005; 193:1923–35.

Goldenberg

Kirby

Culhane

. Stillbirth: a review. J Matern Fetal Neonatal Med 2004; 16:79–94.

Pauli

Reiser

Lebovitz

Kirkpatrick

. Wisconsin Stillbirth Service Program: I. Establishment and assessment of a community-based program for etiologic investigation of intrauterine deaths. Am J Med Genet 1994; 50:116–34.

Yuan

Platt

Morin

Joseph

Kramer

. Fetal deaths in the United States, 1997 vs. 1991 Am J Obstet Gynecol 2005;193:489–95.

Pauli

Reiser

. Wisconsin Stillbirth Service Program: II. Analysis of diagnoses and diagnostic categories in the first 1,000 referrals. Am J Med Genet 1994; 50:135–53.

Rodriguez

Mallonee

Archer

Gofton

. Evaluation of death certificate-based surveillance for traumatic brain injury—Oklahoma 2002. Public Health Rep 2006;121:282–9.

Watkins

Edmonds

McClearn

Mullins

Mulinare

Khoury

. The surveillance of birth defects: the usefulness of the revised U.S. standard birth certificate. Am J Public Health 1996; 86: 731–4.

Northam

Knapp

. The reliability and validity of birth certificates. J Obstet Gynecol Neonatal Nurs 2006; 35:3–12.

Hoyert

Martin

. Vital statistics as a data source. Semin Perinatol 2002; 26:12–6.

10.

Honein

Paulozzi

. Birth defects surveillance: assessing the “gold standard.” Am J Public Health 1999; 89:1238–40.

11.

Martin

Hoyert

. The national fetal death file. Semin Perinatol 2002; 26:3–11.

12.

Pauli

Reiser

. The Wisconsin Stillbirth Service Project: the “Wisconsin idea” in practice. Wisconsin Acad Rev 1984; 31:62–4.

13.

Buck

Johnson

. Methodologic considerations for population-based research on fetal deaths: overcoming data gaps. Semin Perinatol 2002; 26:31–5.

14.

Goldhaber

. Fetal death ratios in a prospective study compared to state fetal death certificate reporting. Am J Public Health 1989; 79:1268–70.

15.

Greb

Pauli

Kirby

. Accuracy of fetal death reports: comparison with data from an independent stillbirth assessment program. Am J Public Health 1987; 77:1202–6.

16.

Lydon-Rochelle

Cardenas

Nelson

Tomashek

Mueller

Easterling

. Validity of maternal and perinatal risk factors reported on fetal death certificates. Am J Public Health 2005; 95:1948–51.

17.

Correa-Villasenor

Cragan

Kucik

O'Leary

Siffel

Williams

. The Metropolitan Atlanta Congenital Defects Program: 35 years of birth defects surveillance at the Centers for Disease Control and Prevention. Birth Defects Res A Clin Mol Teratol 2003; 67:617–24.

18.

National Center for Health Statistics (US). Model State Vital Statistics Act and Regulations, 1992 Revision. In: DHHS Publication No. (PHS) 94-1115; 1995.

19.

Fleiss

. Statistical methods for rates and proportions. 2nd ed. New York: John Wiley and Sons; 1981.

20.

SAS Institute. SAS: Version 9.1. Cary (NC): SAS Institute; 2004.

21.

Siffel

Correa-Villasenor

Cragan

Alverson

. Prenatal diagnosis, pregnancy terminations and prevalence of Down's syndrome in Atlanta. Birth Defects Res A Clin Mol Teratol 2004; 70:565–71.

22.

Magee

. Investigation of stillbirth. Pediatr Dev Pathol 2001; 4:1–22.

23.

Michalski

Porter

Pauli

. Costs and consequences of comprehensive stillbirth assessment. Am J Obstet Gynecol 2002; 186:1027–34.