TY - JOUR TI - Pitfalls of national routine death statistics for maternal mortality study AU - Saucedo, Monica AU - Bouvier-Colle, Marie-Hélène AU - Chantry, Anne A. AU - Lamarche-Vadel, Agathe AU - Rey, Grégoire AU - Deneux-Tharaux, Catherine T2 - Paediatric and Perinatal Epidemiology AB - BACKGROUND: The lessons learned from the study of maternal deaths depend on the accuracy of data. Our objective was to assess time trends in the underestimation of maternal mortality (MM) in the national routine death statistics in France and to evaluate their current accuracy for the selection and causes of maternal deaths. METHODS: National data obtained by enhanced methods in 1989, 1999, and 2007-09 were used as the gold standard to assess time trends in the underestimation of MM ratios (MMRs) in death statistics. Enhanced data and death statistics for 2007-09 were further compared by characterising false negatives (FNs) and false positives (FPs). The distribution of cause-specific MMRs, as assessed by each system, was described. RESULTS: Underestimation of MM in death statistics decreased from 55.6% in 1989 to 11.4% in 2007-09 (P