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Lanning J, Magallon SM, Bukowinski AT, Gumbs GR, Conlin AMS, Hall C. Investigation of a transient increase in omphalocele prevalence in a birth cohort of TRICARE beneficiaries. Birth Defects Res 2024; 116:e2305. [PMID: 38411336 DOI: 10.1002/bdr2.2305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/27/2023] [Accepted: 01/05/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND The Department of Defense Birth and Infant Health Research (BIHR) program leverages medical encounter data to conduct birth defect surveillance among infants born to military families. Omphalocele is a major abdominal wall defect with an annual prevalence of ~2 per 10,000 births in BIHR data, but an unexpected increase was observed during 2017-2019, reaching 6.4 per 10,000 births in 2018. To investigate this transient increase in prevalence, this study aimed to validate the omphalocele case algorithm among infants born 2016-2021. METHODS Omphalocele cases were identified by ICD-10 code Q79.2 (exomphalos) on one inpatient or two outpatient infant encounter records and validated using parental and infant electronic health records. Characteristics of true and false positive cases were assessed using bivariate analyses and compared over time. RESULTS Of 638,905 live births from 2016 to 2021, 230 met the ICD-10 case definition for omphalocele; 138 (60.0%) cases were eligible for validation, of which 68 (49.3%) were true positives. The geometric mean time from birth to first ICD-10 omphalocele diagnosis was 1.1 (standard error [SE] 0.1) days for true positives and 11.9 (SE 3.1) days for false positives. Among the 70 false positives, 36 (51.4%) were cases of confirmed umbilical hernia; rates of umbilical hernia and delayed omphalocele diagnoses (>30 days after birth) were elevated among false positives during 2017-2019. CONCLUSIONS Higher misuse of ICD-10 code Q79.2 during 2017-2019 likely influenced the associated increase in omphalocele prevalence. Timing of diagnosis should be considered for omphalocele case definitions using medical encounter data.
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Affiliation(s)
- Jackielyn Lanning
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc, San Diego, California, USA
| | - Sandra Michelle Magallon
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc, San Diego, California, USA
| | - Anna T Bukowinski
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc, San Diego, California, USA
| | - Gia R Gumbs
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc, San Diego, California, USA
| | - Ava Marie S Conlin
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Clinton Hall
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc, San Diego, California, USA
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2
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Romano CJ, Magallon SM, Hall C, Bukowinski AT, Gumbs GR, Conlin AMS. Validation of ICD-9-CM codes for major genitourinary birth defects in Military Health System administrative data, 2006-2014. Birth Defects Res 2024; 116:e2265. [PMID: 37933714 DOI: 10.1002/bdr2.2265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/28/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The Department of Defense Birth and Infant Health Research program is dedicated to birth defects research and surveillance among military families. Here, we assess and refine the validity of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for selected genitourinary birth defects in the Military Health System (MHS). We additionally outline methods for the calculation of positive predictive value (PPV) and negative predictive value (NPV), sensitivity, and specificity using a stratified sampling design. METHODS Among military infants born from 2006 through 2014, a random sample of ICD-9-CM screen-positive cases (for six genitourinary birth defects) and screen-negative cases were selected for chart review. PPV, NPV, sensitivity, and specificity were calculated for individual defects and any included defect (i.e., overall); measures were weighted by the inverse probability of being sampled. RESULTS Of 461,557 infants, 686 were sampled for chart review. Bladder exstrophy was accurately reported (PPV: >90%), while the accuracy of renal dysplasia, renal agenesis/hypoplasia, and hypospadias was moderate (PPVs: 66%-68%) and congenital hydronephrosis was low (PPV: 20%). Specificity and NPVs always exceeded 98%. The overall PPV was 50%; however, excluding congenital hydronephrosis screen-positive cases and requiring at least two inpatient or outpatient diagnostic codes resulted in a PPV of 85%. CONCLUSIONS The validity of major genitourinary birth defect codes varied in MHS administrative data. The accuracy of an overall defect measure improved by omitting congenital hydronephrosis and requiring at least two diagnostic codes. Although PPV is generally useful for research, additional calculation of NPV, sensitivity, and specificity better informs the identification of appropriate selection criteria across surveillance and research settings.
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Affiliation(s)
- Celeste J Romano
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Sandra M Magallon
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Clinton Hall
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Anna T Bukowinski
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Gia R Gumbs
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Ava Marie S Conlin
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
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3
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Gozar H, Bara Z, Dicu E, Derzsi Z. Current perspectives in hypospadias research: A scoping review of articles published in 2021 (Review). Exp Ther Med 2023; 25:211. [PMID: 37090085 PMCID: PMC10119991 DOI: 10.3892/etm.2023.11910] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/09/2023] [Indexed: 04/25/2023] Open
Abstract
Hundreds of papers are written about hypospadias every year referring to all aspects of the pathology, being one of the most common congenital malformations. The present study conducted a scoping review of articles published in 2021 to present the main issues and summarize current perspectives and achievements in the field. It searched for the keyword 'hypospadias' in the three most popular databases (PubMed, Scopus and Web of Science). After the analysis of the publications, they were categorized into different domains. The present review was performed respecting the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR) guidelines. A total of 284 articles were included. These were published in 142 different journals. The most accessed was the Journal of Paediatric Urology with 54 articles. The main identified domains were related to surgical techniques, postoperative care, complications, anesthesia, anatomical factors, genetics, environmental factors, endocrinology, associated malformations, questionnaires and recommendations, management, biological materials, animal models, retrospective studies of centers, social media, bibliometrics, small gestational age, neoplasm, or fertility. Promising modifications of existing surgical techniques were presented with improved outcomes for both the proximal and distal types of hypospadias. Relevant anatomical and etiological, and also genetic factors were clarified. Aspects of the peri- and postoperative management referring to the antibiotherapy, analgesia, dressing techniques, and the future use of novel bioengineering agents to prevent, reduce or treat the occurring complications were discussed.
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Affiliation(s)
- Horea Gozar
- Clinic of Pediatric Surgery and Orthopedics, Târgu Mureș, County Emergency Clinical Hospital, Târgu Mureș 540136, Romania
- Department of Pediatric Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș 540142, Romania
| | - Zsolt Bara
- Clinic of Pediatric Surgery and Orthopedics, Târgu Mureș, County Emergency Clinical Hospital, Târgu Mureș 540136, Romania
| | - Emilia Dicu
- Clinic of Pediatric Surgery and Orthopedics, Târgu Mureș, County Emergency Clinical Hospital, Târgu Mureș 540136, Romania
| | - Zoltán Derzsi
- Clinic of Pediatric Surgery and Orthopedics, Târgu Mureș, County Emergency Clinical Hospital, Târgu Mureș 540136, Romania
- Department of Pediatric Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș 540142, Romania
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4
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Bakker MK, Loane M, Garne E, Ballardini E, Cavero-Carbonell C, García L, Gissler M, Given J, Heino A, Jamry-Dziurla A, Jordan S, Urhoj SK, Latos-Bieleńska A, Limb E, Lutke R, Neville AJ, Pierini A, Santoro M, Scanlon I, Tan J, Wellesley D, de Walle HEK, Morris JK. Accuracy of congenital anomaly coding in live birth children recorded in European health care databases, a EUROlinkCAT study. Eur J Epidemiol 2023; 38:325-334. [PMID: 36807730 PMCID: PMC10033551 DOI: 10.1007/s10654-023-00971-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/28/2023] [Indexed: 02/21/2023]
Abstract
Electronic health care databases are increasingly being used to investigate the epidemiology of congenital anomalies (CAs) although there are concerns about their accuracy. The EUROlinkCAT project linked data from eleven EUROCAT registries to electronic hospital databases. The coding of CAs in electronic hospital databases was compared to the (gold standard) codes in the EUROCAT registries. For birth years 2010-2014 all linked live birth CA cases and all children identified in the hospital databases with a CA code were analysed. Registries calculated sensitivity and Positive Predictive Value (PPV) for 17 selected CAs. Pooled estimates for sensitivity and PPV were then calculated for each anomaly using random effects meta-analyses. Most registries linked more than 85% of their cases to hospital data. Gastroschisis, cleft lip with or without cleft palate and Down syndrome were recorded in hospital databases with high accuracy (sensitivity and PPV ≥ 85%). Hypoplastic left heart syndrome, spina bifida, Hirschsprung's disease, omphalocele and cleft palate showed high sensitivity (≥ 85%), but low or heterogeneous PPV, indicating that hospital data was complete but may contain false positives. The remaining anomaly subgroups in our study, showed low or heterogeneous sensitivity and PPV, indicating that the information in the hospital database was incomplete and of variable validity. Electronic health care databases cannot replace CA registries, although they can be used as an additional ascertainment source for CA registries. CA registries are still the most appropriate data source to study the epidemiology of CAs.
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Affiliation(s)
- Marian K Bakker
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Maria Loane
- Institute for Nursing and Health Research, Ulster University, Northern Ireland, Newtownabbey, UK
| | - Ester Garne
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Elisa Ballardini
- Neonatal Intensive Care Unit, Paediatric Section, IMER Registry (Emilia Romagna Registry of Birth Defects), Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Laura García
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Mika Gissler
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Joanne Given
- Institute for Nursing and Health Research, Ulster University, Northern Ireland, Newtownabbey, UK
| | - Anna Heino
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Anna Jamry-Dziurla
- Polish Registry of Congenital Malformations, Chair and Department of Medical Genetics, University of Medical Sciences, Poznan, Poland
| | - Sue Jordan
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | - Stine Kjaer Urhoj
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anna Latos-Bieleńska
- Polish Registry of Congenital Malformations, Chair and Department of Medical Genetics, University of Medical Sciences, Poznan, Poland
| | - Elisabeth Limb
- Population Health Research Institute, St George's University of London, London, UK
| | - Renee Lutke
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Amanda J Neville
- IMER Registry, Centre for Epidemiology and Clinical Research, University of Ferrara and Azienda, Ospedaliero Universitario Di Ferrara, Ferrara, Italy
| | - Anna Pierini
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Michele Santoro
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Ieuan Scanlon
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | - Joachim Tan
- Population Health Research Institute, St George's University of London, London, UK
| | - Diana Wellesley
- University of Southampton and Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, SO16 5YA, UK
| | - Hermien E K de Walle
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joan K Morris
- Population Health Research Institute, St George's University of London, London, UK
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5
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Chomistek AK, Phiri K, Doherty MC, Calderbank JF, Chiuve SE, McIlroy BH, Snabes MC, Enger C, Seeger JD. Development and Validation of ICD-10-CM-based Algorithms for Date of Last Menstrual Period, Pregnancy Outcomes, and Infant Outcomes. Drug Saf 2023; 46:209-222. [PMID: 36656445 PMCID: PMC9981491 DOI: 10.1007/s40264-022-01261-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION AND OBJECTIVE Validation studies of algorithms for pregnancy outcomes based on International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes are important for conducting drug safety research using administrative claims databases. To facilitate the conduct of pregnancy safety studies, this exploratory study aimed to develop and validate ICD-10-CM-based claims algorithms for date of last menstrual period (LMP) and pregnancy outcomes using medical records. METHODS Using a mother-infant-linked claims database, the study included women with a pregnancy between 2016-2017 and their infants. Claims-based algorithms for LMP date utilized codes for gestational age (Z3A codes). The primary outcomes were major congenital malformations (MCMs) and spontaneous abortion; additional secondary outcomes were also evaluated. Each pregnancy outcome was identified using a claims-based simple algorithm, defined as presence of ≥ 1 claim for the outcome. Positive predictive values (PPV) and 95% confidence intervals (CI) were calculated. RESULTS Overall, 586 medical records were sought and 365 (62.3%) were adjudicated, including 125 records each for MCMs and spontaneous abortion. Last menstrual period date was validated among maternal charts procured for pregnancy outcomes and fewer charts were adjudicated for the secondary outcomes. The median difference in days between LMP date based on Z3A codes and adjudicated LMP date was 4.0 (interquartile range: 2.0-10.0). The PPV of the simple algorithm for spontaneous abortion was 84.7% (95% CI 78.3, 91.2). The PPV for the MCM algorithm was < 70%. The algorithms for the secondary outcomes pre-eclampsia, premature delivery, and low birthweight performed well, with PPVs > 70%. CONCLUSIONS The ICD-10-CM claims-based algorithm for spontaneous abortion performed well and may be used in pregnancy studies. Further algorithm refinement for MCMs is needed. The algorithms for LMP date and the secondary outcomes would benefit from additional validation in a larger sample.
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Affiliation(s)
| | - Kelesitse Phiri
- Optum, 1325 Boylston Street, 11th Floor, Boston, MA, 02215, USA
| | | | | | | | | | | | - Cheryl Enger
- Optum, 1325 Boylston Street, 11th Floor, Boston, MA, 02215, USA
| | - John D Seeger
- Optum, 1325 Boylston Street, 11th Floor, Boston, MA, 02215, USA
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6
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Margulis AV, Huybrechts K. Identification of pregnancies in healthcare data: A changing landscape. Pharmacoepidemiol Drug Saf 2023; 32:84-86. [PMID: 35976191 DOI: 10.1002/pds.5526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Andrea V Margulis
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
| | - Krista Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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7
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Bhatt P, Poku FA, Umscheid J, Ayensu M, Parmar N, Vasudeva R, Donda K, Doshi H, Dapaah-Siakwan F. Trends in prevalence and mortality of gastroschisis and omphalocele in the United States from 2010 to 2018. World J Pediatr 2022; 18:511-514. [PMID: 35294711 DOI: 10.1007/s12519-022-00544-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Jacob Umscheid
- University of Kansas School of Medicine, Wichita, KS, USA
| | | | | | | | | | - Harshit Doshi
- Golisano Children's Hospital of Southwest Florida, Fort Myers, FL, USA
| | - Fredrick Dapaah-Siakwan
- Neonatal Intensive Care Unit, Valley Children's Hospital, 9300 Valley Children's Place, SE 20, Madera, CA, 93636, USA.
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8
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Dolk H, Damase‐Michel C, Morris JK, Loane M. COVID-19 in pregnancy-what study designs can we use to assess the risk of congenital anomalies in relation to COVID-19 disease, treatment and vaccination? Paediatr Perinat Epidemiol 2022; 36:493-507. [PMID: 35234297 PMCID: PMC9115419 DOI: 10.1111/ppe.12840] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/07/2021] [Accepted: 11/08/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The COVID-19 pandemic has accelerated pregnancy outcome research, but little attention has been given specifically to the risk of congenital anomalies (CA) and first trimester exposures. OBJECTIVES We reviewed the main data sources and study designs used internationally, particularly in Europe, for CA research, and their strengths and limitations for investigating COVID-19 disease, medications and vaccines. POPULATION We classify research designs based on four data sources: a) spontaneous adverse event reporting, where study subjects are positive for both exposure and outcome, b) pregnancy exposure registries, where study subjects are positive for exposure, c) congenital anomaly registries, where study subjects are positive for outcome and d) population healthcare data where the entire population of births is included, irrespective of exposure and outcome. STUDY DESIGN Each data source allows different study designs, including case series, exposed pregnancy cohorts (with external comparator), ecological studies, case-control studies and population cohort studies (with internal comparator). METHODS The quality of data sources for CA studies is reviewed in relation to criteria including diagnostic accuracy of CA data, size of study population, inclusion of terminations of pregnancy for foetal anomaly, inclusion of first trimester COVID-19-related exposures and use of an internal comparator group. Multinational collaboration models are reviewed. RESULTS Pregnancy exposure registries have been the main design for COVID-19 pregnancy studies, but lack detail regarding first trimester exposures relevant to CA, or a suitable comparator group. CA registries present opportunities for improving diagnostic accuracy in COVID-19 research, especially when linked to other data sources. Availability of inpatient hospital medication use in population healthcare data is limited. More use of ongoing mother-baby linkage systems would improve research efficiency. Multinational collaboration delivers statistical power. CONCLUSIONS Challenges and opportunities exist to improve research on CA in relation to the COVID-19 pandemic and future pandemics.
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Sumner KM, Ehlinger A, Georgiou ME, Wurst KE. Development and evaluation of standardized pregnancy identification and trimester distribution algorithms in U.S. IBM MarketScan® Commercial and Medicaid data. Birth Defects Res 2021; 113:1357-1367. [PMID: 34523818 DOI: 10.1002/bdr2.1954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/07/2021] [Accepted: 09/01/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Creation of new algorithms to identify pregnancies in automated health care claims databases is of public health importance, as it allows us to learn more about medication use and safety in a vulnerable population. Previous algorithms were largely created using international classification of disease codes, but despite the U.S. code transition in 2015, few algorithms are available with the latest ICD-10-CM codes. METHODS Using U.S. IBM MarketScan® Commercial Claims and Encounters and Multi-State Medicaid databases for women aged 10-64 years during 2014 and 2016, two pregnancy algorithms (ICD-9-CM and ICD-10-CM) were created using expert clinical review. The algorithms were evaluated by assessing the distribution of pregnancy outcomes (live birth and pregnancy losses) within each time-based cohort and the ability of the algorithms to identify select medication use during pregnancy. Medication exposure, demographics, comorbidities, and pregnancy outcomes were compared to published literature estimates for the two time periods. RESULTS For the IBM MarketScan® Commercial database, the algorithms identified 687,228 pregnancies in 2014 and 444,293 in 2016. In the IBM MarketScan® Medicaid database, 389,132 pregnancies in 2014 and 406,418 in 2016 were identified. Percentages of most pregnancy outcomes identified using the algorithms were similar to national data sources; however, percentages of preterm births and pregnancy losses were not comparable. Most medication use estimates from the algorithms were similar to or higher than published estimates. CONCLUSIONS By incorporating the latest ICD-10-CM codes, the new algorithms provide more complete estimates of medication use during pregnancy than algorithms using the outdated codes.
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Affiliation(s)
- Kelsey M Sumner
- Value Evidence Outcomes Epidemiology, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Anna Ehlinger
- Access and Customer Engagement Strategy Pricing, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Mary E Georgiou
- Value Evidence Outcomes Epidemiology, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Keele E Wurst
- Value Evidence Outcomes Epidemiology, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
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10
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Moro PL, Panagiotakopoulos L, Oduyebo T, Olson CK, Myers T. Monitoring the safety of COVID-19 vaccines in pregnancy in the US. Hum Vaccin Immunother 2021; 17:4705-4713. [PMID: 34756131 DOI: 10.1080/21645515.2021.1984132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Pregnant persons are at increased risk of severe illness from COVID-19. The first COVID-19 vaccines in the U.S. were authorized for emergency use in December 2020 and pregnant persons were eligible and could get vaccinated despite scarce safety data in this population. To monitor the safety of COVID-19 vaccination during pregnancy, four surveillance systems are used by the Centers for Disease Control and Prevention (CDC). The Vaccine Adverse Event Reporting System is a national, passive system that captures reports of potential adverse events. V-safe is a novel, active system that uses text messaging and web-based surveys to provide health check-ins after vaccination; and enrolls eligible v-safe participants in the v-safe pregnancy registry. The Vaccine Safety Datalink is a collaboration between the CDC and nine integrated health care organizations which performs near-real time surveillance and traditional epidemiologic studies on pregnant vaccine recipients. The CDC is committed to timely and comprehensive monitoring of COVID-19 vaccine safety in pregnancy.
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Affiliation(s)
- Pedro L Moro
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, National Center for Zoonotic and Emerging Infectious Diseases, United States
| | - Lakshmi Panagiotakopoulos
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, National Center for Zoonotic and Emerging Infectious Diseases, United States
| | - Titilope Oduyebo
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, National Center for Zoonotic and Emerging Infectious Diseases, United States
| | - Christine K Olson
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, National Center for Zoonotic and Emerging Infectious Diseases, United States
| | - Tanya Myers
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, National Center for Zoonotic and Emerging Infectious Diseases, United States
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Kharbanda EO, Vazquez-Benitez G, DeSilva MB, Naleway AL, Klein NP, Hechter RC, Glanz JM, Donahue JG, Jackson LA, Sheth SS, Greenberg V, Panagiotakopoulos L, Mba-Jonas A, Lipkind HS. Association of Inadvertent 9-Valent Human Papillomavirus Vaccine in Pregnancy With Spontaneous Abortion and Adverse Birth Outcomes. JAMA Netw Open 2021; 4:e214340. [PMID: 33818618 PMCID: PMC8022219 DOI: 10.1001/jamanetworkopen.2021.4340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE The 9-valent human papillomavirus (9vHPV) vaccine is recommended for individuals through age 26 years and may be administered to women up to age 45 years. Data on 9vHPV vaccine exposures during pregnancy are limited. OBJECTIVE To evaluate the associations between 9vHPV vaccine exposures during pregnancy or peripregnancy and selected pregnancy and birth outcomes (spontaneous abortion [SAB], preterm birth, small-for-gestational age [SGA] birth, and major structural birth defect). DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data from 7 participating health systems in the Vaccine Safety Datalink. The cohort comprised pregnancies among girls and women aged 12 to 28 years that ended between October 26, 2015, and November 15, 2018. Singleton pregnancies that ended in a live birth, stillbirth, or SAB were included. EXPOSURES Vaccine exposure windows were distal (9vHPV or 4vHPV vaccine administered from 22 to 16 weeks before last menstrual period [LMP]), peripregnancy (9vHPV vaccine administered from 42 days before LMP until LMP), and during pregnancy (9vHPV vaccine administered from LMP to 19 completed weeks' gestation). Primary comparisons were (1) girls and women with 9vHPV vaccine exposures during pregnancy vs those with 4vHPV or 9vHPV distal vaccine exposures, (2) girls and women with vaccine exposures peripregnancy vs those with 4vHPV or 9vHPV distal vaccine exposures, and (3) girls and women with 9vHPV vaccine exposures during pregnancy or peripregnancy vs those with 4vHPV or 9vHPV distal vaccine exposure. MAIN OUTCOMES AND MEASURES Spontaneous abortions were confirmed based on medical record review and adjudication. Preterm and SGA births were identified from electronic health record and birth data. Major structural birth defects were based on diagnostic codes using a validated algorithm. Inverse probability weighting was used to balance the covariates. Time-dependent covariate Cox proportional hazards regression models and Poisson regression were used to estimate the associations between 9vHPV vaccine exposures and pregnancy and birth outcomes. RESULTS The final cohort included 1493 pregnancies among girls and women with a mean (SD) maternal age of 23.9 (2.9) years. Of these pregnancies, 445 (29.8%) had exposures to the 9vHPV vaccine during pregnancy, 496 (33.2%) had exposures to the 9vHPV vaccine peripregnancy, and 552 (37.0%) had 4vHPV or 9vHPV distal vaccine exposures. The 9vHPV vaccine administered during pregnancy was not associated with increased risk for SAB (hazard ratio, 1.12; 95% CI, 0.66-1.93) compared with distal vaccine exposures. Findings were similar for 9vHPV vaccine exposures peripregnancy (relative risk [RR], 0.72; 95% CI, 0.42-1.24). Among live births (n = 1409), 9vHPV vaccine exposures during pregnancy were not associated with increased risks for preterm birth (RR, 0.73; 95% CI, 0.44-1.20) or SGA birth (RR, 1.31; 95% CI, 0.78-2.20). Results were similar regarding the association between 9vHPV vaccine exposures peripregnancy and preterm birth (RR, 0.72; 95% CI, 0.45-1.17) and SGA birth (RR, 1.10; 95% CI, 0.65-1.88). Birth defects were rare in all exposure groups, occurring in about 1% of live births with available infant data. CONCLUSIONS AND RELEVANCE This study found that 9vHPV vaccine exposures during or around the time of pregnancy were uncommon and not associated with SABs or selected adverse birth outcomes. These findings can inform counseling for inadvertent 9vHPV vaccine exposures.
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Affiliation(s)
- Elyse O. Kharbanda
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota
| | | | - Malini B. DeSilva
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota
| | - Allison L. Naleway
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Nicola P. Klein
- The Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | - Rulin C. Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | | | - Lisa A. Jackson
- Kaiser Permanente Washington, Health Research Institute, Seattle, Washington
| | - Sangini S. Sheth
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Victoria Greenberg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | | | - Adamma Mba-Jonas
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Division of Epidemiology, US Food and Drug Administration, Silver Spring, Maryland
| | - Heather S. Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
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