Optimizing an algorithm for the identification and classification of pregnancy outcomes in German claims data

Wentzell, Nadine; Schink, Tania; Haug, Ulrike; Ulrich, S.; Niemeyer, Marieke; Mikolajczyk, Rafael

doi:10.1002/pds.4588

Cited by 23 publications

(37 citation statements)

References 9 publications

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“…Pregnancy outcomes were determined adopting an algorithm specifically developed to identify pregnancy outcomes in German health insurance data. 6 Maternal and infant outcomes in pregnancy Information on maternal outcomes included live birth, stillbirth, elective termination, ectopic pregnancy, spontaneous abortion, gestational week of delivery, delivery by CS, pre-eclampsia and gestational diabetes. A live birth was defined as preterm if it occurred before gestational week 37 and further defined as extremely preterm if it occurred before week 32.…”

Section: Methodsmentioning

confidence: 99%

Maternal and infant outcomes in pregnancies of women with axial spondyloarthritis compared with matched controls: results from nationwide health insurance data

et al. 2022

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ObjectivesTo investigate pregnancy outcomes in women with axial spondyloarthritis (axSpA) under different pharmacological treatments in comparison with matched controls.MethodsUsing health insurance data from 2006 to 2019, pregnancy outcomes of women with axSpA were compared with those of age-matched and calendar year-matched controls without axSpA. Women with axSpA were further stratified by treatment prior to delivery and pregnancy outcomes compared. Adjusted ORs (aORs) with 95% CIs were calculated using generalised estimating equation analyses.ResultsA total of 1021 pregnancy outcomes in patients with axSpA were identified (928 deliveries, 80 abortions, 13 ectopic pregnancies) and compared with 10 210 pregnancy outcomes in controls (9488 deliveries, 615 abortions, 147 ectopic pregnancies). Compared with controls, women with axSpA showed higher odds of elective caesarean section (aOR 1.52; 1.25 to 1.85).Among women with axSpA, the risk of preterm birth was higher under non-steroidal anti-inflammatory drugs (NSAIDs) treatment (aOR 2.22; 1.09 to 4.52) than without any anti-inflammatory treatment. The risks of preterm birth (aOR 4.01; 1.93 to 8.34) and small-for-gestational-age (aOR 3.22; 1.34 to 7.73) were increased under NSAIDs treatment in combination with conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs), steroids or analgesics. Non-significant increased risks of small-for-gestational-age (aOR 1.68; 0.43 to 6.57) and preterm birth (aOR 1.56; 0.51 to 4.83) were found under biological DMARDs.ConclusionsWomen with axSpA have significantly increased odds of caesarean section compared with matched controls. Risks of preterm birth and small-for-gestational-age vary by type of anti-inflammatory treatment.

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Section: Methodsmentioning

confidence: 99%

Maternal and infant outcomes in pregnancies of women with axial spondyloarthritis compared with matched controls: results from nationwide health insurance data

et al. 2022

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“…The estimation of the beginning of pregnancy is the last step in establishing GePaRD as a data source for studies on the utilization and safety of drugs during pregnancy. We already developed procedures to reliably identify pregnancies and classify their outcomes ( 4 , 11 ) and to link mothers to the newborns ( 12 ). With this algorithm, we are now, for example, able to examine, in how many pregnancies the unborn child is exposed to a potentially teratogenic drug during the time window that is critical regarding exposure to the respective drug, to assess the outcome of these pregnancies, and to study the (long-term) effect of the exposure in the children.…”

Section: Discussionmentioning

confidence: 99%

“…Each entry contains two parts of information (i) the expected date of delivery and (ii) the quarter and year in which the EDD was coded. The database also contains the actual date of birth and specific codes with which to identify preterm births and births occurring after the due date ( 4 ). Prenatal examinations, which are typically conducted by gynecologists in Germany, may be identified based on the respective codes of the Doctors' Fee Scale within the Statutory Health Insurance Scheme (Einheitlicher Bewertungsmaßstab, EBM), and the exact dates of examinations are available as well.…”

Section: Methodsmentioning

confidence: 99%

“…The latter inclusion criterion ensured a sufficiently long observation period to obtain all available information over the full course of pregnancy. Pregnancies ending in live births were identified based on a previously developed algorithm ( 4 ) and the respective births were classified as “preterm birth,” “birth after due date,” and “term birth” (i.e., a birth not coded as preterm or after due date).…”

Section: Methodsmentioning

confidence: 99%

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Estimating the Beginning of Pregnancy in German Claims Data: Development of an Algorithm With a Focus on the Expected Delivery Date

Schink

Wentzell

Dathe

et al. 2020

Front. Public Health

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Background: Estimating the beginning of pregnancy is crucial when studying drug safety in pregnancy, but important information in this regard, such as the last menstrual period (LMP), is generally not recorded in claims databases. The beginning of pregnancy is therefore usually estimated by subtracting a median length of pregnancy from the date of birth. Due to the variability in pregnancy lengths, this might result in non-negligible errors. German claims data may offer the possibility to estimate the beginning of pregnancy more precisely based on the expected delivery date (EDD) which can be coded once or more often during a pregnancy. Purpose: To estimate the beginning of pregnancy in German claims data focusing on the potential of the expected delivery date (EDD). Methods: We included data of all pregnancies in women aged 12–50 years ending in a live birth between 2006 and 2015 identified in the German Pharmacoepidemiological Research Database (GePaRD). We assessed the number of coded EDDs per pregnancy and the concordance if ≥ 2 EDDs were coded. We estimated the beginning of pregnancy by subtracting 280 days from the EDD or the most frequent EDD (in case of discordant EDDs). To examine plausibility, we determined the distribution of pregnancy lengths and assessed whether the gestational age at which prenatal examinations were coded was plausible. For pregnancies without EDD, the beginning was estimated by subtracting the respective observed median lengths of pregnancy for preterm births, term births, and births after due date from the actual dates of birth. Results: In 82.4% of pregnancies, at least one EDD was available (thereof 6.1% with only one EDD and 80.9% with ≥ 2 EDDs that were all concordant). The maximal difference between discordant EDDs was in median 5 days (interquartile range: 3–7 days). Based on the EDD, the median length of pregnancy was 276 days for term births and in 84.7% of pregnancies the second antibody screening test was performed in the recommended interval ± 2 weeks. In pregnancies without EDD the respective proportion was 84.9%. Conclusions: By using the EDD, the beginning of pregnancy can plausibly be estimated in German claims data.

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“…17 While we used a similar approach to Hornbrook et al 2 to identify pregnancy outcomes and to estimate LMP when Z3A codes were absent, we did not replicate the Hornbrook algorithms exactly as we did not have the additional data sources available including gestational age from hospital discharge summaries and an EMR-based preterm birth prevention database. Like Wentzell et al 18 that ranked outcomes as more reliable if the outcome date was from an inpatient stay, we ranked outcomes as more reliable if both a procedure code and diagnosis code were observed on the same date.…”

Section: Resultsmentioning

confidence: 99%

Identification of pregnancies and infants within a US commercial healthcare administrative claims database

Bertoia

Phiri

Clifford

et al. 2022

Pharmacoepidemiology and Drug

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Purpose: Health care insurance claims databases are becoming a more common data source for studies of medication safety during pregnancy. While pregnancies have historically been identified in such databases by pregnancy outcomes, International Classification of Diseases, 10th revision Clinical Modification (ICD-10-CM) Z3A codes denoting weeks of gestation provide more granular information on pregnancies and pregnancy periods (i.e., start and end dates). The purpose of this study was to develop a process that uses Z3A codes to identify pregnancies, pregnancy periods, and links infants within a commercial health insurance claims database. Methods: We identified pregnancies, gestation periods, pregnancy outcomes, and linked infants within the US-based Optum Research Database between 2015 and 2020 via a series of algorithms utilizing diagnosis and procedure codes on claims. The diagnosis and procedure codes included ICD-10-CM codes, Current Procedural Terminology (CPT) codes, and Healthcare Common Procedure Coding System (HCPCS) codes. Results:We identified 1 030 874 pregnancies among 841 196 women of reproductive age. Of pregnancies with livebirth outcomes, 84% were successfully linked to infants. The prevalence of pregnancy outcomes (livebirth, stillbirth, ectopic, molar, and abortion) was similar to national estimates. Conclusions:This process provides an opportunity to study drug safety and care patterns during pregnancy and may be replicated in other claims databases containing ICD-10-CM, CPT, and HCPCS codes. Work is underway to validate and refine the various algorithms.

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Optimizing an algorithm for the identification and classification of pregnancy outcomes in German claims data

Abstract: Our algorithm led to plausible results regarding the identification and classification of pregnancy outcomes. It will be an important foundation for studies on drug utilization and drug safety during pregnancy based on GePaRD.

Cited by 23 publications

References 9 publications

Maternal and infant outcomes in pregnancies of women with axial spondyloarthritis compared with matched controls: results from nationwide health insurance data

Maternal and infant outcomes in pregnancies of women with axial spondyloarthritis compared with matched controls: results from nationwide health insurance data

Estimating the Beginning of Pregnancy in German Claims Data: Development of an Algorithm With a Focus on the Expected Delivery Date

Identification of pregnancies and infants within a US commercial healthcare administrative claims database

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