Agreement Between Maternal Report and Medical Records During Pregnancy: Medications for Rheumatoid Arthritis and Asthma

Abstract

Background: There are limited data regarding the comparability of medication exposure information during pregnancy from maternal report and medical records, including for rheumatoid arthritis and asthma-related medications.Methods: This study included pregnant women with rheumatoid arthritis (n = 216) and asthma (n = 172) enrolled in the MothertoBaby Pregnancy Studies (2009Studies ( -2014. Women reported types and dates of medications used through semi-structured telephone interviews up to three times during pregnancy and once after delivery, and medical records were obtained. We calculated Cohen's kappa coefficients and 95% confidence intervals (CIs) and per cent agreement for agreement between report and records. Results: For rheumatoid arthritis, prednisone was reported most frequently (53%). During pregnancy, kappa coefficients for rheumatoid arthritis medications ranged from 0.32 (95% CI 0.15, 0.50) for ibuprofen, with 84.3% agreement, to 0.90 (95% CI 0.84, 0.96) for etanercept with 95.4% agreement, and was 0.44 (95% CI 0.33, 0.55) for prednisone, with 71.3% agreement. For asthma, albuterol was reported most frequently (77.9%). During pregnancy, kappa coefficients for asthma medications ranged from 0.21 (95% CI 0.08, 0.35), with 64.5% agreement for albuterol to 0.84 (95% CI 0.71, 0.96) for budesonide/formoterol, with 96.5% agreement. Where kappas for any use during pregnancy were less than excellent (i.e. ≤0.80), medication use was more frequently captured by report than record. Conclusions: Agreement was higher for medications typically used continuously than sporadically. Information on medication use from medical records alone may not be adequate when studying the impact of intermittently used medications during pregnancy on perinatal outcomes.

Patterns of prednisone use during pregnancy in women with rheumatoid arthritis: Daily and cumulative dose

“…This study used data collected by the MotherToBaby Autoimmune Diseases in Pregnancy Study, an ongoing prospective cohort study that aims to evaluate the effects of select medications and autoimmune diseases during pregnancy . Participants were from the United States and Canada and were self‐referred, referred by their health care providers, or referred by MotherToBaby, a free counseling service of the Organization of Teratology Information Specialists that provides evidence‐based information regarding medications and other exposures during pregnancy and lactation.…”

Acetaminophen use in pregnancy: Examining prevalence, timing, and indication of use in a prospective birth cohort

“…Details of study design and subject recruitment have been previously described. [18][19][20][21][22] Briefly, subjects residing in the United States or Canada who speak English or Spanish are recruited through three primary mechanisms:…”

“…The MotherToBaby pregnancy study has a long history of prospectively enrolling women in pregnancy and collecting self-reported prescription and over-the-counter medications. 18,19,22,31 Our practice of collecting detailed information on each exposure, including start and stop date, dose and changes in dose, frequency, and indication, all lent to this project.…”

How to Improve Information on Medication Exposure during Pregnancy

“…2,4,5,7,8 However, agreement between maternal report and medical records has been less studied. 9 In this issue of Paediatric and Perinatal Epidemiology, Palmsten and colleagues 10 report on the comparability of information on medication exposures for rheuma toid arthritis and asthma during pregnancy collected in prospective cohorts from maternal report and medical records. The study included pregnant women with rheumatoid arthritis (n = 216) or asthma (n = 172) from the USA and Canada enrolled in the MotherToBaby or Autoimmune Diseases in Pregnancy studies.…”

“…The study by Palmsten and colleagues raises this question and an alternative to relying on maternal report would be to use other data collection methods like daily journals or mobile apps, especially for outcomes that refer to specific time windows during pregnancy. 10 The optimal capture of data on medication use during pregnancy is specific to each setting, country and health provider but also to the disease under study. Advances in electronic medical record systems and information technology apps developed in collaboration with pregnant women, clinicians and researchers would be a promising future for improvement in studies on medication use in pregnancy.…”