Examining interpregnancy intervals and maternal and perinatal health outcomes using US vital records: Important considerations for analysis and interpretation

Background Numerous studies use birth certificate data to examine the association between interpregnancy interval (IPI) and maternal and perinatal health outcomes. Substantive changes from the latest birth certificate revision have implications for examining this relationship. Methods We provide an overview of the National Vital Statistics System and recent changes to the national birth certificate data file, which have implications for assessing IPI and perinatal health outcomes. We describe the calculation of IPI using birth certificate information and related measurement issues. Missing IPI values by maternal age, race and education using 2016 birth certificate data were also compared. Finally, we review and summarise data quality studies of select covariate and outcome variables (sociodemographic, maternal health and health behaviours, and infant health) conducted after the most recent 2003 birth certificate revision. Results Substantive changes to data collection, dissemination and quality have occurred since the 2003 revision. These changes impact IPI measurement, trends and associations with perinatal health outcomes. Missing values of IPI were highest for older ages, lower education and non-Hispanic black women. Minimal differences were found when comparing IPI using different gestational age measures. Recent data quality studies pointed to substantial variation in data quality by item and across states. Conclusion Future studies examining the association of IPI with maternal and perinatal data using vital records should consider these aspects of the data in their research plan, sensitivity analyses and interpretation of findings.