The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data
ABSTRACT The purpose of this study was to determine the accuracy of live-birth certificates and hospital discharge data that reported of pre-existing maternal medical conditions and complications of pregnancy.
We conducted a population-based validation study in 19 non-federal short-stay hospitals in Washington state with a stratified random sample of 4541 women who had live births between January 1, 2000, and December 31, 2000. True- and false-positive fractions were calculated.
Birth certificate and hospital discharge data combined had substantially higher true-positive fractions than did birth certificate data alone for cardiac disease (54% vs 29%), acute or chronic lung disease (24% vs 10%), gestational diabetes mellitus (93% vs 64%), established diabetes mellitus (97% vs 52%), active genital herpes (77% vs 38%), chronic hypertension (70% vs 47%), pregnancy-induced hypertension (74% vs 49%), renal disease (13% vs 2%), and placenta previa (70% vs 33%). For the 2 medical risk factors that are available only on birth certificates, true-positive fractions were 37% for established genital herpes and 68% for being seropositive for hepatitis B surface antigen.
In Washington, most medical conditions and complications of pregnancy that affect mothers are substantially underreported on birth certificates, but hospital discharge data are accurate in the reporting of gestational and established diabetes mellitus and placenta previa. Together, birth certificate and hospital discharge data are much superior to birth certificates alone in the reporting of gestational diabetes mellitus, active genital herpes, and chronic hypertension.
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ABSTRACT: To develop and validate a software algorithm to detect pregnancy episodes and maternal morbidities using automated data. Data SOURCES/STUDY SETTING: Automated records from a large integrated health care delivery system (IHDS), 1998-2001. Through complex linkages of multiple automated information sources, the algorithm estimated pregnancy histories. We evaluated the algorithm's accuracy by comparing selected elements of the pregnancy history obtained by the algorithm with the same elements manually abstracted from medical records by trained research staff. The algorithm searched for potential pregnancy indicators within diagnosis and procedure codes, as well as laboratory tests, pharmacy dispensings, and imaging procedures associated with pregnancy. Among 32,847 women with potential pregnancy indicators, we identified 24,680 pregnancies occuring to 21,001 women. Percent agreement between the algorithm and medical records review on pregnancy outcome, gestational age, and pregnancy outcome date ranged from 91 percent to 98 percent. The validation results were used to refine the algorithm. This pregnancy episode grouper algorithm takes advantage of databases readily available in IHDS, and has important applications for health system management and clinical care. It can be used in other settings for ongoing surveillance and research on pregnancy outcomes, pregnancy-related morbidities, costs, and care patterns.Health Services Research 05/2007; 42(2):908-27. DOI:10.1111/j.1475-6773.2006.00635.x · 2.49 Impact Factor
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ABSTRACT: To identify the risk factors for placenta previa in an Asian population. This retrospective cohort study involved Taiwanese women delivered between July 1990 and December 2003 at Chang Gung Memorial Hospital, Taipei, Taiwan. Pregnancies complicated by multiple gestation and fetal anomalies were excluded. There were 457 cases of placenta previa (1.2%) among the 37,702 pregnancies analyzed. Risk factors for placenta previa included a prior preterm birth (OR, 6.6; 95% confidence interval [CI], 4.1-10.6); technology-assisted conception (OR, 4.8; 95% CI, 2.9-7.8); smoking (OR, 3.3; 95% CI, 1.2-9.1) or working (OR, 3.8; 95% CI, 2.8-5.3) during pregnancy; maternal age of, or greater than 35 years (OR, 2.0 to 2.2; 95% CI, 1.3-3.7); and previous induced abortions (OR, 1.3-3.0; 95% CI, 1.1-7.1). The risk factors for placenta previa were found to be the same for Asian women as those previously recorded for American and European women, but additional factors were detected.International Journal of Gynecology & Obstetrics 05/2007; 97(1):26-30. DOI:10.1016/j.ijgo.2006.12.006 · 1.56 Impact Factor
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ABSTRACT: Prior research suggests that women diagnosed and treated for gestational diabetes mellitus (GDM) gain less total gestational weight than normoglycemic women. Our study finds that race/ethnicity modifies this association. Relative to normoglycemic women, non-Hispanic white women with GDM gain less weight but non-Hispanic black and Hispanic women gain more weight.Diabetes Research and Clinical Practice 01/2015; 108(1). DOI:10.1016/j.diabres.2015.01.020 · 2.54 Impact Factor