Pregnancy checkbox classification and place of death among late maternal deaths in the United States in 2024

Late maternal deaths occur more than 42 days but less than 1 year after pregnancy. Their classification may depend on pregnancy-checkbox information recorded on death certificates. This cross-sectional descriptive study used 2024 National Center for Health Statistics mortality records and resident live-birth denominators. Late maternal deaths were classified as direct, indirect, or unspecified. Checkbox-classification marker status, late maternal mortality ratios (MMRs), and place of death were described. Exact Poisson (Garwood) 95% confidence intervals were calculated. The 971 records comprised 649 maternal and 322 late maternal deaths. Of the late deaths, 75 (23.3%) were classified as direct and 247 (76.7%) as indirect; none were unspecified. Overall, 285 (88.5%) carried the checkbox-classification marker, including 245 of 247 indirect deaths. The late MMR was 21.1 per 100,000 live births among non-Hispanic Black women, 14.8 among women aged 35 years or older, and 13.8 among women with high school graduation or less. Inpatient locations accounted for 55.6% of maternal deaths and 48.4% of late maternal deaths; home locations accounted for 15.7% and 25.5%, respectively. Because 88.5% of records carried the marker, excluding them lowered the late MMR from 8.9 to 1.0 per 100,000. Late maternal mortality in 2024 showed demographic disparities, a larger share of deaths at home than among maternal deaths, and substantial dependence on the checkbox-classification marker. Marker exclusion describes that dependence and does not identify confirmed pregnancy-related deaths.