Validation of an algorithm to estimate gestational age in electronic health plan databases

Li, Qian; Andrade, Susan E.; Cooper, William O.; Davis, Robert L.; Dublin, Sascha; Hammad, Tarek A.; Pawloski, Pamala A.; Pinheiro, Simone P.; Raebel, Marsha A.; Scott, Pamela E.; Smith, David H.; Dashevsky, Inna; Haffenreffer, Katherine; Johnson, Karin; Toh, Sengwee

doi:10.1002/pds.3407

Cited by 90 publications

(91 citation statements)

References 31 publications

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“…Using the birth certificate data to calculate the LMP has been validated previously by one of the participating health plans, which found a concordance of +/- 2 weeks in the LMP between the birth certificate and the medical records in 94% of the records reviewed(12). In addition, another recent validation study(13) found that LMP-based gestational age and obstetric estimate-based gestational age were identical in more than half of all deliveries and within ±1 week in approximately 85% of all deliveries; the difference in means was 1 day.…”

Section: Methodsmentioning

confidence: 98%

The Prevalence and Trends of Antiviral Medication Use During Pregnancy in the US: A Population-Based Study of 664,297 Deliveries in 2001–2007

Avalos

Chen

Yang

et al. 2014

Matern Child Health J

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Objectives To evaluate the prevalence, trends, timing and duration of exposure to antiviral medications during pregnancy within a US cohort of pregnant women and to evaluate the proportion of deliveries with a viral infection diagnosis among women given antiviral medication during pregnancy. Methods Live-born deliveries between 2001 and 2007, to women aged 15 to 45 years, were included from the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP), a collaborative research program between the U.S. Food and Drug Administration and eleven health plans. They were evaluated for prevalence, timing, duration, and temporal trends of exposure to antiviral medications during pregnancy. We also calculated the proportion of deliveries with a viral infection diagnosis among those exposed to antiviral medications. Results Among 664,297 live births, the overall prevalence of antiviral exposure during pregnancy was 4% (n=25,155). Between 2001 and 2007, antiviral medication exposure during pregnancy doubled from 2.5% to 5%. The most commonly used antiviral medication was acyclovir, with 3% of the deliveries being exposed and most of the exposure occurring after the 1st trimester. Most deliveries exposed to antiviral medications were exposed for less than 30 days (2% of all live births). Forty percent of the women delivering an infant exposed to antiviral medications had a herpes diagnosis. Conclusions Our findings highlight the increased prevalence of women delivering an infant exposed to antiviral medications over time. These findings support the need for large, well-designed studies to assess the safety and effectiveness of these medications during pregnancy.

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Section: Methodsmentioning

confidence: 98%

The Prevalence and Trends of Antiviral Medication Use During Pregnancy in the US: A Population-Based Study of 664,297 Deliveries in 2001–2007

Avalos

Chen

Yang

et al. 2014

Matern Child Health J

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“…We estimated gestational age at delivery by imputing standard ages based on delivery prematurity or post-term delivery diagnoses codes from the mother and linked child. [22–24] To capture complete prenatal and postpartum immunization and clinical information, we required continuous health plan enrollment from the estimated onset of pregnancy to seven days post-delivery (Figure 1). …”

Section: Methodsmentioning

confidence: 99%

Prenatal Tdap immunization and risk of maternal and newborn adverse events

Layton¹,

Butler

Li³

et al. 2017

Vaccine

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Many countries recommend combined tetanus toxoid, reduced diphtheria toxoid and acellular pertussis immunization (Tdap) during pregnancy to stimulate transplacental transmission of pertussis antibodies to newborns. The immune system can be altered during pregnancy, potentially resulting in differing immunization risks in pregnant women. The safety of widespread Tdap immunization during pregnancy needs to be established. Our objective was to assess whether prenatal Tdap immunization was associated with adverse birth outcomes, and to evaluate the effect of timing of Tdap administration on these outcomes. We identified pregnancies at delivery in a large insurance claims database (2010–2014). Tdap immunization was categorized as optimal prenatal (27+ weeks), early prenatal (<27 weeks), postpartum (≤7 days post-delivery), or none. Medical claims were searched to identify maternal adverse immunization reactions (e.g. anaphylaxis, fever, Guillian-Barre syndrome [GBS]), adverse birth outcomes (e.g. preeclampsia/eclampsia, premature rupture or membranes, chorioamnionitis) and newborn outcomes (e.g. respiratory distress, pulmonary hypertension, neonatal jaundice). Women with optimal or early prenatal Tdap were compared to those not immunized in pregnancy, using propensity score-weighted log-binomial regression and Cox proportional hazards models to estimate risk ratios (RR) and hazard ratios (HR). We identified 1,079,034 deliveries and 677,075 linked newborns; 11.5% were immunized optimally and 2.3% immunized early. There were 1 case of post-immunization anaphylaxis, and 12 cases of maternal encephalopathy (all post-delivery); there were no cases of GBS. Optimally-timed immunization was associated with small increased relative risks of: chorioamnionitis [RR=1.11, (95% CI: 1.07–1.15), overall risk=2.8%], and postpartum hemorrhage [RR=1.23 (95% DI: 1.18–1.28), overall risk=2.4%]; however, these relative increases corresponded to low absolute risk increases. Tdap was not associated with increased risk of any adverse newborn outcome. Overall, prenatal Tdap immunization was not associated with newborn adverse events, but potential associations with chorioamnionitis consistent with one previous study and postpartum hemorrhage require further investigation.

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“…11, 12 However, the sensitivity is much lower (between 45% and 80%) and is particularly low for infants born at 35 or 36 weeks’ gestation. 12, 13 Consequently, only a subset of infants born preterm are coded as preterm.…”

Section: Methodsmentioning

confidence: 99%

Employer-Sponsored Plan Expenditures for Infants Born Preterm

et al. 2017

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BACKGROUND Care for infants born preterm or with major birth defects is costly. Specific estimates of financial burden for different payers are lacking, in part because use of administrative data to identify preterm infants and costs is challenging. METHODS We used private health insurance claims data and billing codes to identify live births during 2013 and calculated first-year expenditures for employer-sponsored health plans for infants born preterm, both overall and stratified by major birth defects. RESULTS We conservatively estimated that 7.7% of insured infants born preterm accounted for 37% of $2.0 billion spent by participating plans on the care of infants born during 2013. With a mean difference in plan expenditures of ~$47 100 per infant, preterm births cost the included plans an extra $600 million during the first year of life. Extrapolating to the national level, we projected aggregate employer-sponsored plan expenditures of $6 billion for infants born preterm during 2013. Infants with major birth defects accounted for 5.8% of preterm births but 24.5% of expenditures during infancy. By using an alternative algorithm to identify preterm infants, it was revealed that incremental expenditures were higher: $78 000 per preterm infant and $14 billion nationally. CONCLUSION Preterm births (especially in conjunction with major birth defects) represent a substantial burden on payers, and efforts to mitigate this burden are needed. In addition, researchers need to conduct studies using linked vital records, birth defects surveillance, and administrative data to accurately and longitudinally assess per-infant costs attributable to preterm birth and the interaction of preterm birth with major birth defects.

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Validation of an algorithm to estimate gestational age in electronic health plan databases

Cited by 90 publications

References 31 publications

The Prevalence and Trends of Antiviral Medication Use During Pregnancy in the US: A Population-Based Study of 664,297 Deliveries in 2001–2007

The Prevalence and Trends of Antiviral Medication Use During Pregnancy in the US: A Population-Based Study of 664,297 Deliveries in 2001–2007

Prenatal Tdap immunization and risk of maternal and newborn adverse events

Employer-Sponsored Plan Expenditures for Infants Born Preterm

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