Fetal death certificates as a source of surveillance data for stillbirths with birth defects

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 = 87.2%; 95% confidence interval [CII 82.4, 91.0). Stillbirths of non-Hispanic black and Hispanic/other mothers were more likely to be issued an FDC (odds ratio [OR] = 5.6 [95% Cl 1.9, 17.0] and 14.0 [95% Cl 1.7, 114.0], respectively). Cases undergoing autopsy were more likely to be issued an FDC (OR=3.2; 95% Cl 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, MACDPs active case identification improves the ascertainment of stillbirths with birth defects and the quality of certain recorded data.