The latest revision of the birth certificate features a new checkbox format designed to collect more effectively information for public health research. One of the new checkbox items, medical risk factors for this pregnancy, is designed to collect information on risk factors which result in adverse pregnancy outcomes. Data from 308,573 birth certificates filed in Alabama between 1988 and 1992 were analyzed. Although problems exist with the data collected for this item, useful information can be obtained to investigate important public health issues. First, the data can be used to determine the prevalence of medical risk factors in the population. Second, differences between subpopulations with these conditions can be examined. For example, some differences between racial groups in adverse pregnancy outcomes may be explained by the fact that black mothers are more likely to have a medical risk factor than whites. Third, some medical factors are associated with elevated risks for low birth weight, while others are associated with reduced probability of low birth weight. Although useful data can be obtained from the medical risk factor item, it and other checkbox items would be more useful if efforts were made to improve reporting. Improvements in training persons who complete the birth certificate are especially needed. Reporting of checkbox items also needs to be validated by comparing results with other sources. In future revisions of the birth certificate, new items need to be examined carefully to determine if that instrument is the appropriate medium for collecting the information.