Development of algorithms to determine the onset of pregnancy and delivery date using health care administrative data in a university hospital in Japan

Pharmacoepidemiology and Drug

Jin

et al. 2019

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Purpose: To evaluate the prevalence and patterns of prescriptions of antiepileptic drugs (AEDs) to prenatal and postpartum women in Japan using a large administrative database.Methods: The dates of pregnancy onset and delivery were estimated using published algorithms and infant birth months. The prevalence of prescribed AEDs, the maximum dose of some AEDs, and the frequency of potential combination therapy with AEDs were evaluated for the 180 days before pregnancy onset, during pregnancy, and at 180-day postpartum.Results: In total, 33 941 pregnant women were eligible for analysis. At least one AED was prescribed to 225 women (66 per 10 000 deliveries) between 180 days before pregnancy and 180-day postpartum and for 135 women (40 per 10 000 deliveries) during pregnancy. The prevalence of AED prescription declined during the first and second trimesters and increased in the third trimester and postpartum. Valproate was the most frequently prescribed drug, followed by clonazepam, lamotrigine, and carbamazepine. Nine (18.4%) of the 49 women with at least one prescription record of valproate in the first trimester were prescribed more than 600 mg/day of valproate.Concerning potential combination therapy, 40 (12 per 10 000 deliveries) concurrently received two or more AEDs between 180 days before pregnancy and 180-day postpartum, respectively, 31 (9 per 10 000 deliveries) women received these drugs during pregnancy.Conclusions: Various AEDs were prescribed to pregnant Japanese women. Women of reproductive age should select the appropriate AED before becoming pregnant, depending on the risk benefit profile.

Section: Methodsmentioning

confidence: 99%

Examination of the prescription of antiepileptic drugs to prenatal and postpartum women in Japan from a health administrative database

Pharmacoepidemiology and Drug

Jin

et al. 2019

Self Cite

“…Dates of pregnancy onset were estimated from all gestational ages extracted from any diagnosis, except entries related to pregnancies with abortive outcomes (ICD‐10 code O00‐O08). We previously reported that 92.8% of the identified dates of pregnancy onset were within ±7 days of the gold standard date of pregnancy onset …”

Section: Methodsmentioning

confidence: 99%

“…Delivery dates were identified based on delivery‐related entries listed in Supplementary Table 1 and the birth months of infants. We found in our previous study that the following delivery‐related diagnoses and surgical procedures were on or within ±7 days from the gold standard delivery date: (1) diagnoses with the ICD‐10 codes O60, O622, O629, O640, O655, O669, O683, O690, O709, O711, O717, O721, O723, O730, O800, O814, and O821, vacuum extractions, cesarean sections, elective cesarean sections, and cesarean sections due to placenta previa or delivery before week 32, and obstetric hysterectomy . We developed an algorithm based on these findings in which the earliest dates of “selected” diagnoses and surgical procedures were primarily considered as delivery dates.…”

Section: Methodsmentioning

confidence: 99%

“…For those without such diagnoses and procedures, the earliest dates of any other delivery‐related diagnoses, surgical and medical procedures, and injectable medications listed in Supplementary Table 1 were considered as delivery dates. This algorithm indicated that 96.4% of identified delivery dates were within ±7 days from the gold standard delivery date in our previous report . Given that neonatal birth months and years are available in the JMDC claims database, we used the dates of delivery‐related entries only when the date was within the birth month of an infant (Figure ).…”

Section: Methodsmentioning

confidence: 99%

“…We developed algorithms to identify dates of pregnancy onset and delivery from administrative data . The primary objective of the present study was to clarify trends in antihypertensive drugs prescribed for women during pregnancy by applying these algorithms to data from a large administrative database.…”

Section: Introductionmentioning

confidence: 99%

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Antihypertensives prescribed for pregnant women in Japan: Prevalence and timing determined from a database of health insurance claims

Pharmacoepidemiology and Drug

Nishigori

et al. 2018

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Purpose:The purpose of the study is to evaluate the status of prescribed antihypertensives primarily during pregnancy, but also before pregnancy and after delivery, using a large claims database in Japan. Methods:The dates of pregnancy onset and delivery were identified using reported algorithms and the birth months of infants. The prevalence and timing of prescribed antihypertensives during pregnancy were descriptively evaluated. Time trends in prescriptions were evaluated using multivariate logistic regression analyses. We also evaluated the prevalence of antihypertensives prescribed within 180 days before pregnancy and 180 days after delivery among women who were covered by health insurers during the entire period.Results: At least one antihypertensive agent was prescribed for 1144 (2.74%) of 41 693 pregnant women. The most frequently prescribed oral antihypertensive during pregnancy was nifedipine, followed by methyldopa, hydralazine, and furosemide.Drugs targeting the renin-angiotensin system were prescribed for 21 pregnant women (0.05%), including angiotensin II receptor blockers that were prescribed for 19 (0.05%) of them. Nicardipine was the most frequently prescribed injectable antihypertensive during pregnancy, followed by furosemide, hydralazine, and nitroglycerin.Annual prescription trends remained similar except for a significant decrease in those for oral and injectable furosemide and an annual increase in those for organic nitrate.Based on an evaluation of 33 941 pregnant women, the number of prescriptions for antihypertensives increased particularly during the third trimester, then decreased from 91 to 180 days after delivery.Conclusions: Various types of antihypertensives are prescribed for Japanese pregnant women. The effects of exposing pregnant Japanese women to these agents should be evaluated.

Folic acid prescribed to prenatal and postpartum women who are also prescribed antiepileptic drugs in Japan: Data from a health administrative database

Jin

et al. 2020

Birth Defects Research

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Background: The aim of this study was to evaluate the prevalence of folic acid (FA) prescription to prenatal and postpartum women who have also been prescribed antiepileptic drugs (AED) in Japan. Methods: The data set used in this study included women covered by health insurance between 2005 and 2016. The prevalence of FA prescriptions between 180 days before pregnancy and 180 days postpartum was determined from a large administrative database, with the FA prescription classified according to dose and timing. Results: For 33,941 women meeting our eligibility criteria, the mean maternal age at delivery was 32.3 years. At least one AED was prescribed to 225 of 33,941 women between 180 days before pregnancy and 180 days postpartum. FA was prescribed to 32 of 225 women (14.2%) during the same period. FA was prescribed to 8.8% of women with AED within 90 days before pregnancy and to 19.8% during the first trimester. FA was prescribed to 10.9% during the first 30 days after conception, all of whom were prescribed FA before the pregnancy. The maximum FA dose prescribed within 90 days before pregnancy was 5 mg/day for 5 of 12 women (41.7%) and >5 mg/day for 4 of 12 women (33.3%). The maximum FA dose prescribed during the first trimester was 5 mg/day for 14 of 22 women (63.6%) and >5 mg/day for 8 of 22 women (36.4%).