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Hwang YM, Roper RT, Piekos SN, Enquobahrie DA, Hebert MF, Paquette AG, Baloni P, Price ND, Hood L, Hadlock JJ. Timing of selective serotonin reuptake inhibitor use and risk for preterm birth and related adverse events: with a consideration of the COVID-19 pandemic period. J Matern Fetal Neonatal Med 2024; 37:2313364. [PMID: 38342572 PMCID: PMC11033706 DOI: 10.1080/14767058.2024.2313364] [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: 08/30/2023] [Accepted: 01/29/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE There is uncertainty around the safety of SSRIs for treating depression during pregnancy. Nevertheless, the use of SSRIs has been gradually increasing, especially during the COVID-19 pandemic period. We aimed to (1) characterize maternal depression rate and use of SSRIs in a recent 10-year period, (2) address confounding by indication, as well as socioeconomic and environmental factors, and (3) evaluate associations of the timing of SSRI exposure in pregnancy with risk for preterm birth (PTB), low birthweight (LBW), and small for gestational age (SGA) infants among women with depression before pregnancy. METHODS We conducted propensity score-adjusted regression to calculate odds ratios (ORs) of PTB, LBW, and SGA. We accounted for maternal/pregnancy characteristics, comorbidity, depression severity, time of delivery, social vulnerability, and rural residence. RESULTS There were 50.3% and 40.3% increases in the prevalence rate of prenatal depression and prenatal SSRI prescription rate during the pandemic. We identified women with depression ≤180 days before pregnancy (n = 8406). Women with no SSRI order during pregnancy (n = 3760) constituted the unexposed group. The late SSRI exposure group consisted of women with an SSRI order after the first trimester (n = 3759). The early-only SSRI exposure group consisted of women with SSRI orders only in the first trimester (n = 887). The late SSRI exposure group had an increased risk of PTB of OR = 1.5 ([1.2,1.8]) and LBW of OR = 1.5 ([1.2,2.0]), relative to the unexposed group. Associations between late SSRI exposure and risk of PTB/LBW were similar among a subsample of patients who delivered during the pandemic. CONCLUSIONS These findings suggest an association between PTB/LBW and SSRI exposure is dependent on exposure timing during pregnancy. Small for gestational age is not associated with SSRI exposure.
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Affiliation(s)
- Yeon Mi Hwang
- Institute for Systems Biology; 401 Terry Ave N, Seattle, Washington, USA 98109
- Molecular Engineering and Sciences Institute, University of Washington; Seattle, Washington, USA
| | - Ryan T. Roper
- Institute for Systems Biology; 401 Terry Ave N, Seattle, Washington, USA 98109
| | - Samantha N. Piekos
- Institute for Systems Biology; 401 Terry Ave N, Seattle, Washington, USA 98109
| | - Daniel A. Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington; Seattle, Washington, USA
| | - Mary F. Hebert
- Department of Pharmacy, School of Pharmacy, University of Washington; Seattle, Washington, USA
| | - Alison G. Paquette
- Department of Pediatrics, School of Medicine, University of Washington; Seattle, Washington USA
- Center for Developmental Biology and Regenerative Medicine, Seattle Children’s Research Institute; Seattle, Washington USA
| | - Priyanka Baloni
- School of Health Sciences, Purdue University, West Lafayette, Indiana USA
| | - Nathan D. Price
- Institute for Systems Biology; 401 Terry Ave N, Seattle, Washington, USA 98109
- Thorne HealthTech, New York, New York, USA
| | - Leroy Hood
- Institute for Systems Biology; 401 Terry Ave N, Seattle, Washington, USA 98109
- Providence St. Joseph Health; Renton, Washington, USA
| | - Jennifer J. Hadlock
- Institute for Systems Biology; 401 Terry Ave N, Seattle, Washington, USA 98109
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Chiu YH, Huybrechts KF, Zhu Y, Straub L, Bateman BT, Logan R, Hernández-Díaz S. Internal validation of gestational age estimation algorithms in health-care databases using pregnancies conceived through fertility procedures. Am J Epidemiol 2024; 193:1168-1175. [PMID: 38583933 PMCID: PMC11299027 DOI: 10.1093/aje/kwae045] [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: 04/14/2023] [Revised: 01/15/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024] Open
Abstract
Fertility procedures recorded in health-care databases can be used to estimate the start of pregnancy, which can serve as a reference standard to validate gestational age estimates based on International Classification of Diseases codes. In a cohort of 17 398 US MarketScan pregnancies (2011-2020) in which conception was achieved via fertility procedures, we estimated gestational age at the end of pregnancy using algorithms based on (1) time (days) since the fertility procedure (the reference standard); (2) International Classification of Diseases, Ninth Revision (ICD-9)/International Classification of Diseases, Tenth Revision (ICD-10) (before/after October 2015) codes indicating gestational length recorded at the end of pregnancy (method A); and (3) ICD-10 end-of-pregnancy codes enhanced with Z3A codes denoting specific gestation weeks recorded at prenatal visits (method B). We calculated the proportion of pregnancies with an estimated gestational age falling within 14 days ($\pm$14 days) of the reference standard. Method A accuracy was similar for ICD-9 and ICD-10 codes. After 2015, method B was more accurate than method A: For term births, within-14-day agreement was 90.8% for method A and 98.7% for method B. Corresponding estimates were 70.1% and 95.6% for preterm births; 35.3% and 92.6% for stillbirths; 54.3% and 64.2% for spontaneous abortions; and 16.7% and 84.6% for elective terminations. ICD-10-based algorithms that incorporate Z3A codes improve the accuracy of gestational age estimation in health-care databases, especially for preterm births and non-live births.
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Affiliation(s)
- Yu-Han Chiu
- CAUSALab and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02120, United States
| | - Yanmin Zhu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02120, United States
| | - Loreen Straub
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02120, United States
| | - Brian T Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, CA 94305, United States
| | - Roger Logan
- CAUSALab and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Sonia Hernández-Díaz
- CAUSALab and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
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Kim K, Liu G, Dick AW, Choi SW, Agbese E, Corr TE, Hsuan C, Wright MS, Park S, Velott D, Leslie DL. Timing of treatment for opioid use disorder among birthing people. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 161:209289. [PMID: 38272119 PMCID: PMC11090704 DOI: 10.1016/j.josat.2024.209289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND The number of pregnant women with opioid use disorder (OUD) has increased over time. Although effective treatment options exist, little is known about the extent to which women receive treatment during pregnancy and at what stage of pregnancy care is initiated. METHODS Using a national private health insurance claims database, we identified women aged 13-49 who gave birth in 2006-2019 and had an OUD or nonfatal opioid overdose (NFOO) diagnosis during the year prior to or at delivery. We then identified women who received their first OUD treatment prior to or during pregnancy. In this cross-sectional study, we investigated how rates and timing of the initial OUD treatment changed over time. Furthermore, we examined factors associated with early initiation of OUD treatment among birthing people. RESULTS Of the 7057 deliveries from 6747 women with OUD or NFOO, 63.3 % received any OUD treatment. Rates of OUD treatment increased from 42.9 % in 2006 to 69 % in 2019. Of those treated, in 2006, 54.5 % received their first treatment prior to conception and 24.2 % initiated care during the 1st trimester. In 2019, 68.9 % received their first treatment prior to conception, and 15.1 % initiated care during the 1st trimester. The percentage of women who were first treated in the 2nd trimester or later decreased from 21.2 % in 2006 to 16.1 % in 2019. Factors associated with early treatment initiation include being 25 years or older (age 25-34: aOR, 1.51, 95 % CI, 1.28-1.78; age 35-49: aOR, 1.82, 95 % CI, 1.39-2.37), living in urban areas (aOR, 1.28; 95 % CI, 1.05-1.56), having pre-existing behavioral health comorbidities such as anxiety disorders (aOR, 1.8; 95 % CI, 1.40-2.32), mood disorders (aOR, 1.63; 95 % CI, 1.02-2.61), and substance use disorder other than OUD (aOR, 2.56; 95 % CI, 2.03-3.32). CONCLUSION Overall, rates of OUD treatment increased over time, and more women initiated OUD treatment prior to conception. Despite these improvements, over one-third of pregnant women with OUD/NFOO either received no treatment or did not initiate care until the 3rd trimester in 2019. Future research should examine barriers to OUD treatment initiation among pregnant women.
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Affiliation(s)
- Kyungha Kim
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | | | - Sung W Choi
- School of Public Affairs, The Pennsylvania State University, Harrisburg, PA, USA
| | - Edeanya Agbese
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Tammy E Corr
- Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Charleen Hsuan
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA
| | - Megan S Wright
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Penn State Law, University Park, PA, USA; Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
| | - Sujeong Park
- School of Public Affairs, The Pennsylvania State University, Harrisburg, PA, USA
| | - Diana Velott
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Douglas L Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
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Bane S, Wall-Wieler E, Druzin ML, Carmichael SL. Antihypertensive Medication Use before and during Pregnancy and the Risk of Severe Maternal Morbidity in Individuals with Prepregnancy Hypertension. Am J Perinatol 2024; 41:e728-e738. [PMID: 36261063 DOI: 10.1055/s-0042-1757354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Our objective is to examine severe maternal morbidity (SMM) and patterns of antihypertensive medication use before and during pregnancy among individuals with chronic hypertension. STUDY DESIGN We examined 11,759 pregnancies resulting in a live birth or stillbirth to individuals with chronic hypertension and one or more antihypertensive prescription 6 months before pregnancy (Optum, 2007-17). We examined whether study outcomes were associated with the use of medication as compared to no use during pregnancy. In addition, patterns of medication use based on the Food and Drug Administration guidance and literature were evaluated. Medication use was divided into prepregnancy and during pregnancy use and classified as pregnancy recommended (PR) or not pregnancy recommended (nPR) or no medication use. SMM was defined per the Centers for Disease Control and Prevention definition of 21 indicators. Risk ratios (RR) reflecting the association of SMM with the use of antihypertensive medications were computed using modified Poisson regression with robust standard errors and adjusted for maternal age, education, and birth year. RESULTS Overall, 83% of individuals filled an antihypertensive prescription during pregnancy and 6.3% experienced SMM. The majority of individuals with a prescription prior to pregnancy had a prescription for the same medication in pregnancy. Individuals with any versus no medication use in pregnancy had increased adjusted RR (aRR) of SMM (1.18, 95% confidence interval [CI]: 0.96-1.44). Compared to the use of PR medications before and during pregnancy, aRRs were 1.42 (95% CI: 1.18-1.69, 12.4% of sample) for nPR use before and during pregnancy, 1.52 (1.23-1.86; 12.4%) for nPR (before) and PR (during) use, and 2.67 (1.73-4.15) for PR and nPR use. Patterns with no medication use during pregnancy were not statistically significant. CONCLUSION Pattern of antihypertensive medication use before and during pregnancy may be associated with an elevated risk of SMM. Further research is required to elucidate whether this association is related to the severity of hypertension, medication effectiveness, or suboptimal quality of care. KEY POINTS · Individuals with any medication use compared to no medication use in pregnancy had an increased risk of SMM.. · Specific medication use patterns were associated with an elevated risk of SMM.. · Pattern of antihypertensive medication use before and during pregnancy may be associated with an increased risk of SMM..
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Affiliation(s)
- Shalmali Bane
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - Elizabeth Wall-Wieler
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maurice L Druzin
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Suzan L Carmichael
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Tan J, Xiong Y, Liu C, Zhao P, Gao P, Li G, Guo J, Li M, Wei W, Yao G, Qian Y, Ye L, Qi H, Liu H, Chen M, Zou K, Thabane L, Sun X. A population-based cohort of drug exposures and adverse pregnancy outcomes in China (DEEP): rationale, design, and baseline characteristics. Eur J Epidemiol 2024; 39:433-445. [PMID: 38589644 DOI: 10.1007/s10654-024-01124-6] [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: 11/18/2022] [Accepted: 03/25/2024] [Indexed: 04/10/2024]
Abstract
The DEEP cohort is the first population-based cohort of pregnant population in China that longitudinally documented drug uses throughout the pregnancy life course and adverse pregnancy outcomes. The main goal of the study aims to monitor and evaluate the safety of drug use through the pregnancy life course in the Chinese setting. The DEEP cohort is developed primarily based on the population-based data platforms in Xiamen, a municipal city of 5 million population in southeast China. Based on these data platforms, we developed a pregnancy database that documented health care services and outcomes in the maternal and other departments. For identifying drug uses, we developed a drug prescription database using electronic healthcare records documented in the platforms across the primary, secondary and tertiary hospitals. By linking these two databases, we developed the DEEP cohort. All the pregnant women and their offspring in Xiamen are provided with health care and followed up according to standard protocols, and the primary adverse outcomes - congenital malformations - are collected using a standardized Case Report Form. From January 2013 to December 2021, the DEEP cohort included 564,740 pregnancies among 470,137 mothers, and documented 526,276 live births, 14,090 miscarriages and 6,058 fetal deaths/stillbirths and 25,723 continuing pregnancies. In total, 13,284,982 prescriptions were documented, in which 2,096 chemicals drugs, 163 biological products, 847 Chinese patent medicines and 655 herbal medicines were prescribed. The overall incidence rate of congenital malformations was 2.0% (10,444/526,276), while there were 25,526 (4.9%) preterm births and 25,605 (4.9%) live births with low birth weight.
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Affiliation(s)
- Jing Tan
- Institute of Integrated Traditional Chinese and Western Medicine, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041, China
| | - Yiquan Xiong
- Institute of Integrated Traditional Chinese and Western Medicine, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041, China
| | - Chunrong Liu
- Institute of Integrated Traditional Chinese and Western Medicine, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041, China
| | - Peng Zhao
- Institute of Integrated Traditional Chinese and Western Medicine, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041, China
| | - Pei Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Jin Guo
- Institute of Integrated Traditional Chinese and Western Medicine, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041, China
| | - Mingxi Li
- Institute of Integrated Traditional Chinese and Western Medicine, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041, China
| | - Wanqiang Wei
- Institute of Integrated Traditional Chinese and Western Medicine, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041, China
| | - Guanhua Yao
- Xiamen Health Commission, Xiamen, 361000, China
| | | | - Lishan Ye
- Xiamen Health and Medical Big Data Center, Xiamen, 361008, China
| | - Huanyang Qi
- Xiamen Health and Medical Big Data Center, Xiamen, 361008, China
| | - Hui Liu
- Xiamen Health and Medical Big Data Center, Xiamen, 361008, China
| | - Moliang Chen
- Xiamen Health and Medical Big Data Center, Xiamen, 361008, China
| | - Kang Zou
- Institute of Integrated Traditional Chinese and Western Medicine, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041, China
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, Canada
| | - Xin Sun
- Institute of Integrated Traditional Chinese and Western Medicine, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China.
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041, China.
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Hakim JB, Zhou A, Hernandez-Diaz S, Hart JM, Wylie BJ, Beam AL. Effectiveness of 17-OHP for Prevention of Recurrent Preterm Birth: A Retrospective Cohort Study. Am J Perinatol 2024; 41:405-413. [PMID: 34972229 DOI: 10.1055/s-0041-1740512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE 17-α-hydroxyprogesterone caproate (17-OHP) has been recommended by professional societies for the prevention of recurrent preterm birth, but subsequent clinical studies have reported conflicting efficacy results. This study aimed to contribute to the evidence base regarding the effectiveness of 17-OHP in clinical practice using real-world data. STUDY DESIGN A total of 4,422 individuals meeting inclusion criteria representing recurrent spontaneous preterm birth (sPTB) were identified in a database of insurance claims, and 568 (12.8%) received 17-OHP. Crude and propensity score-matched recurrence rates and risk ratios (RRs) for the association of receiving 17-OHP on recurrent sPTB were calculated. RESULTS Raw sPTB recurrence rates were higher among those treated versus not treated; after propensity score matching, no association was detected (26.3 vs. 23.8%, RR = 1.1, 95% CI: 0.9-1.4). CONCLUSION We failed to identify a beneficial effect of 17-OHP for the prevention of spontaneous recurrent preterm birth in our observational, U.S. based cohort. KEY POINTS · We observed higher risk for sPTB in the group receiving 17-OHP in the unmatched analysis. · After propensity-score matching, we still failed to identify a beneficial effect of 17-OHP on sPTB. · Sensitivity analyses demonstrated robustness to the inclusion criteria and modeling assumptions..
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Affiliation(s)
- Joe B Hakim
- Department of Health Sciences and Technology, Harvard-MIT, Cambridge, Massachusetts
| | - Amy Zhou
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jessica M Hart
- Divisiont of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Blair J Wylie
- Divisiont of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Andrew L Beam
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
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Koc D, El Marroun H, Stricker BH, Muetzel RL, Tiemeier H. Intrauterine Exposure to Antidepressants or Maternal Depressive Symptoms and Offspring Brain White Matter Trajectories From Late Childhood to Adolescence. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:217-226. [PMID: 37926188 DOI: 10.1016/j.bpsc.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND During pregnancy, both selective serotonin reuptake inhibitor (SSRI) exposure and maternal depression have been associated with poor offspring neurodevelopmental outcomes. In a population-based cohort, we investigated the association between intrauterine exposure to SSRIs and depressive symptoms and offspring white matter development from childhood to adolescence. METHODS Self-reported SSRI use was verified by pharmacy records. In midpregnancy, women reported on depressive symptoms using the Brief Symptom Inventory. Using diffusion tensor imaging, offspring white matter microstructure, including whole-brain and tract-specific fractional anisotropy (FA) and mean diffusivity, was measured at 3 assessments between ages 7 to 15 years. The participants were divided into 4 groups: prenatal SSRI exposure (n = 37 with 60 scans), prenatal depression exposure (n = 229 with 367 scans), SSRI use before pregnancy (n = 72 with 95 scans), and reference (n = 2640 with 4030 scans). RESULTS Intrauterine exposure to SSRIs and depressive symptoms were associated with lower FA in the whole-brain and the forceps minor at 7 years. Exposure to higher prenatal depressive symptom scores was associated with lower FA in the uncinate fasciculus, cingulum bundle, superior and inferior longitudinal fasciculi, and corticospinal tracts. From ages 7 to 15 years, children exposed to prenatal depressive symptoms showed a faster increase in FA in these white matter tracts. Prenatal SSRI exposure was not related to white matter microstructure growth over and above exposure to depressive symptoms. CONCLUSIONS These results suggest that prenatal exposure to maternal depressive symptoms was negatively associated with white matter microstructure in childhood, but these differences attenuated during development, suggesting catch-up growth.
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Affiliation(s)
- Dogukan Koc
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hanan El Marroun
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioral Science, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ryan L Muetzel
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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8
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Kaufman M, McConnell KJ, Rodriguez MI, Stratton K, Richardson D, Snowden JM. Hospital Encounters Within 1 Year Postpartum Across Insurance Types, Oregon 2012-2017. Med Care 2024; 62:109-116. [PMID: 38109156 DOI: 10.1097/mlr.0000000000001958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND Little is known about the timing and frequency of postpartum hospital encounters and postpartum visit attendance and how they may be associated with insurance types. Research on health insurance and its association with postpartum care utilization is often limited to the first 6 weeks. OBJECTIVE To assess whether postpartum utilization (hospital encounters within 1 year postpartum and postpartum visit attendance within 12 weeks) differs by insurance type at birth (Medicaid, high deductible health plans, and other commercial plans) and whether rates of hospital encounters differ by postpartum visit attendance and insurance status. METHODS Time-to-event analysis of Oregon hospital births from 2012 to 2017 using All Payer All Claims data. We conducted weighted Cox Proportional Hazard regressions and accounted for differences in insurance type at birth using multinomial propensity scores. RESULTS Among 202,167 hospital births, 24.9% of births had at least 1 hospital encounter within 1 year postpartum. Births funded by Medicaid had a higher risk of a postpartum emergency department (ED) visit (hazard ratio: 2.05, 95% CI: 1.99, 2.12) and lower postpartum visit attendance (hazard ratio: 0.71, 95% CI: 0.70, 0.72) compared with commercial plans. Among Medicaid beneficiaries, missing the postpartum visit in the first 6 weeks was associated with a lower risk of subsequent readmissions (adjusted hazard ratio 0.77, 95% CI: 0.68, 0.87) and ED visits (adjusted hazard ratio: 0.87 (0.85, 0.88). CONCLUSIONS Medicaid beneficiaries received more care in the ED within 1 year postpartum compared with those enrolled in other commercial plans. This highlights potential issues in postpartum care access.
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Affiliation(s)
- Menolly Kaufman
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR
| | - K John McConnell
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR
| | - Maria I Rodriguez
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Kalera Stratton
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR
| | - Dawn Richardson
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR
| | - Jonathan M Snowden
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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Lawal OD, Meador KJ, Hume AL, Wen X. Utilization of Antiseizure Medications in Women of Childbearing Age With Epilepsy and Nonepilepsy Indications: A Retrospective Cohort Study. Neurology 2023; 101:e1083-e1096. [PMID: 37407266 PMCID: PMC10491435 DOI: 10.1212/wnl.0000000000207580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 05/10/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Antiseizure medications (ASMs) are among the most commonly prescribed teratogenic drugs in women of childbearing age. Limited data exist on utilization patterns across different indications for therapy and for the newer-generation ASMs in this population. Thus, we assessed the pattern of ASM use in women of childbearing age with epilepsy and nonepilepsy indications (pain and psychiatric disorders). METHODS We conducted a retrospective analysis of deidentified administrative data submitted to the Optum Clinformatics database. Eligible participants included women aged 12-50 years who filled ASMs between year 2011 and 2017. Participants were followed from date of index prescription filled to study end or insurance disenrollment, whichever came first. For the overall cohort and potential therapy indications, we assessed the type and frequency of ASMs filled; proportion of participants on monotherapy, polytherapy, or treatment switching; and duration of continuous use. Trends were characterized using annual percent change from study start to study end. RESULTS Our analysis included 465,131 participants who filled 603,916 distinct ASM prescriptions. At baseline, most of the participants had chronic pain (51.0%) and psychiatric disorders (32.7%), with epilepsy the least common (0.9%). The most frequently dispensed were diazepam (24.3%), lorazepam (20.1%), gabapentin (17.4%), clonazepam (12.7%), topiramate (11.3%), and lamotrigine (4.6%). Significant linear increase in trends were observed with gabapentin (annual percent change [95% CI]: 8.4 [7.3-9.4]; p < 0.001) and levetiracetam (3.4 [0.7-6.2]; p = 0.022) and decreasing trends for diazepam (-3.5 [-2.4 to 4.5]; p < 0.001) and clonazepam (-3.4 [-2.3 to 4.5]; p = 0.001). No significant change in trend was observed with valproate (-0.4 [-2.7 to 1.9]; p = 0.651), while nonlinear changes in trends were observed with lorazepam, topiramate, lamotrigine, and pregabalin. DISCUSSION Decreasing trends were observed with older ASMs in the overall cohort and across the potential indications for therapy. Conversely, increasing trends were seen with the newer ASMs. Considering the risk of teratogenicity associated with the newer medications largely unknown, counseling and education in addition to a careful consideration of the benefits vs potential risks should remain pivotal when prescribing ASMs for women of childbearing age.
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Affiliation(s)
- Oluwadolapo D Lawal
- From the Department of Pharmacy Practice (O.D.L., A.L.H., X.W.), College of Pharmacy, University of Rhode Island, Kingstown; and Department of Neurology & Neurological Sciences (K.J.M.), Stanford University School of Medicine, CA
| | - Kimford J Meador
- From the Department of Pharmacy Practice (O.D.L., A.L.H., X.W.), College of Pharmacy, University of Rhode Island, Kingstown; and Department of Neurology & Neurological Sciences (K.J.M.), Stanford University School of Medicine, CA
| | - Anne L Hume
- From the Department of Pharmacy Practice (O.D.L., A.L.H., X.W.), College of Pharmacy, University of Rhode Island, Kingstown; and Department of Neurology & Neurological Sciences (K.J.M.), Stanford University School of Medicine, CA
| | - Xuerong Wen
- From the Department of Pharmacy Practice (O.D.L., A.L.H., X.W.), College of Pharmacy, University of Rhode Island, Kingstown; and Department of Neurology & Neurological Sciences (K.J.M.), Stanford University School of Medicine, CA.
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10
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Chen T, Zhang CA, Li S, Schroeder AR, Shaw GM, Eisenberg ML. The association of preconception paternal metabolic syndrome on early childhood emergency department visits and hospitalizations. Andrology 2023; 11:1057-1066. [PMID: 36542456 DOI: 10.1111/andr.13370] [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: 07/22/2022] [Revised: 11/10/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Increasing preconception paternal comorbidity has been associated with adverse pregnancy outcomes. However, whether the father's health impacts the child after birth is uncertain. OBJECTIVES In the present study, we examined the association of preconception paternal metabolic syndrome status with childhood emergency department visits and hospitalizations. MATERIALS AND METHODS This is a longitudinal cohort study of children (295,355 boys and 278,735 girls) born to linked pairs of fathers and mothers in the United States between 2009 and 2016 within the IBM MarketScan Research database. Associations between paternal and maternal metabolic syndrome component diagnoses and subsequent hospitalizations and emergency department visits for offspring within the first 2 years of life were determined. RESULTS Note that, 35.5% (203,617/574,090) of children had at least one emergency room visit and 6.1% (35,141/574,090) of children had an inpatient admission. After adjustment, the odds of inpatient admission and emergency department visits increased in a dose-dependent fashion among fathers with higher comorbidities. Similar trends were seen for emergency department visit utilization. DISCUSSION AND CONCLUSION Increasing paternal preconception comorbidity is associated with a higher risk that a child requires the emergency department and inpatient care in the first years of life. An opportunity exists to engage men in preconception counseling to optimize their and their offspring's health.
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Affiliation(s)
- Tony Chen
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Chiyuan A Zhang
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Shufeng Li
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Alan R Schroeder
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
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Isenhour CJ, Skoff TH, Lindley MC, Zhou F, Hariri S. Tetanus, Diphtheria, and Acellular Pertussis Vaccination Coverage Among Publicly Insured Pregnant Women, U.S., 2016-2019. AJPM FOCUS 2023; 2:100060. [PMID: 37789941 PMCID: PMC10546573 DOI: 10.1016/j.focus.2022.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Vaccination with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine during pregnancy is highly effective against Bordetella pertussis in young infants. We aimed to evaluate the uptake of maternal tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccination during the recommended gestation period of 27 through 36 weeks among women enrolled in a public medical insurance plan in the U.S. Methods In this analysis using Centers for Medicare and Medicaid Services insurance claims data, we identified women aged 15 through 49 years who delivered a live-born infant from 2016 through 2019. We identified claims for tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccination to calculate the proportion of women who were vaccinated during Weeks 27 through 36 of gestation in each calendar year. We also assessed the average annual maternal tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis coverage by age group, race and ethnicity, U.S. Census region of residence, and plan type. Data were analyzed in 2021. Results Among 4,318,823 deliveries, the 4-year national average for tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccination was 26%, improving from 22% in 2016 to 31% in 2019 (p<0.001). Within subgroups, the lowest 4-year average coverage was among women aged 15 through 18 years (22%); Black, non-Hispanic (23%) and Hispanic women (24%); those residing in the South (18%); those enrolled in a Children's Health Insurance Program plan (22%); and those covered by a fee-for-service plan (19%). Coverage increased across all subgroups from 2016 through 2019. Conclusions Although maternal tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis coverage among publicly insured women in the U.S. increased from 2016 through 2019, it remained considerably lower than estimated national coverage, with notable differences by race and ethnicity.
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Affiliation(s)
- Cheryl J. Isenhour
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tami H. Skoff
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Megan C. Lindley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fangjun Zhou
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan Hariri
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Kaufman M, McConnell KJ, Carmichael SL, Rodriguez MI, Richardson D, Snowden JM. Postpartum Hospital Readmissions With and Without Severe Maternal Morbidity Within 1 Year of Birth, Oregon, 2012-2017. Am J Epidemiol 2023; 192:158-170. [PMID: 36269008 DOI: 10.1093/aje/kwac183] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 08/12/2022] [Accepted: 10/12/2022] [Indexed: 02/07/2023] Open
Abstract
Postpartum readmissions (PPRs) represent a critical marker of maternal morbidity after hospital childbirth. Most severe maternal morbidity (SMM) events result in a hospital admission, but most PPRs do not have evidence of SMM. Little is known about PPR and SMM beyond the first 6 weeks postpartum. We examined the associations of maternal demographic and clinical factors with PPR within 12 months postpartum. We categorized PPR as being with or without evidence of SMM to assess whether risk factors and timing differed. Using the Oregon All Payer All Claims database, we analyzed hospital births from 2012-2017. We used log-binomial regression to estimate associations between maternal factors and PPR. Our final analytical sample included 158,653 births. Overall, 2.6% (n = 4,141) of births involved at least 1 readmission within 12 months postpartum (808 (19.5% of PPRs) with SMM). SMM at delivery was the strongest risk factor for PPR with SMM (risk ratio (RR) = 5.55, 95% confidence interval (CI): 4.14, 7.44). PPR without SMM had numerous risk factors, including any mental health diagnosis (RR = 2.10, 95% CI: 1.91, 2.30), chronic hypertension (RR = 2.17, 95% CI: 1.85, 2.55), and prepregnancy diabetes (RR = 2.85, 95% CI: 2.47, 3.30), all which were on par with SMM at delivery (RR = 1.89, 95% CI: 1.49, 2.40).
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13
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Farr SL, Downing KF, Tepper NK, Oster ME, Glidewell MJ, Reefhuis J. Reproductive Health of Women with Congenital Heart Defects. J Womens Health (Larchmt) 2023; 32:132-137. [PMID: 36757282 PMCID: PMC10680443 DOI: 10.1089/jwh.2022.0513] [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] [Indexed: 02/10/2023] Open
Abstract
This report provides an overview of the unique reproductive health issues facing women with congenital heart defects (CHDs) and of the clinical care and professional guidelines on contraception, preconception care, and pregnancy for this population. It describes Centers for Disease Control and Prevention (CDC) activities related to surveillance of reproductive health issues among females with CHDs. It also describes CDC's work bringing awareness to physicians who provide care to adolescents and women with CHDs, including obstetrician/gynecologists, about the need for lifelong cardiology care for their patients with CHDs.
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Affiliation(s)
- Sherry L Farr
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karrie F Downing
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Naomi K Tepper
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew E Oster
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa J Glidewell
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennita Reefhuis
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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14
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Bruno AM, Horns JJ, Allshouse AA, Metz TD, Debbink ML, Smid MC. Association Between Periviable Delivery and New Onset of or Exacerbation of Existing Mental Health Disorders. Obstet Gynecol 2023; 141:395-402. [PMID: 36657144 PMCID: PMC10477003 DOI: 10.1097/aog.0000000000005050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/27/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate whether there is an association between periviable delivery and new onset of or exacerbation of existing mental health disorders within 12 months postpartum. METHODS We conducted a retrospective cohort study of individuals with liveborn singleton neonates delivered at 22 or more weeks of gestation from 2008 to 2017 in the MarketScan Commercial Research Database. The exposure was periviable delivery , defined as delivery from 22 0/7 through 25 6/7 weeks of gestation. The primary outcome was a mental health morbidity composite of one or more of the following: emergency department encounter associated with depression, anxiety, psychosis, posttraumatic stress disorder, adjustment disorder, self-harm, or suicide; new psychotropic medication prescription; new behavioral therapy visit; and inpatient psychiatry admission in the 12 months postdelivery. Secondary outcomes included components of the primary composite. Those with and without periviable delivery were compared using multivariable logistic regression adjusted for clinically relevant covariates, with results reported as adjusted incident rate ratios (aIRRs). Effect modification by history of mental health diagnoses was assessed. Incidence of the primary outcome by 90-day intervals postdelivery was assessed. RESULTS Of 2,300,244 included deliveries, 16,275 (0.7%) were periviable. Individuals with periviable delivery were more likely to have a chronic health condition, to have undergone cesarean delivery, and to have experienced severe maternal morbidity. Periviable delivery was associated with a modestly increased risk of the primary composite outcome, occurring in 13.8% of individuals with periviable delivery and 11.0% of individuals without periviable delivery (aIRR 1.18, 95% CI 1.12-1.24). The highest-risk period for the composite primary outcome was the first 90 days in those with periviable delivery compared with those without periviable delivery (51.6% vs 42.4%; incident rate ratio 1.56, 95% CI 1.47-1.66). CONCLUSION Periviable delivery was associated with a modestly increased risk of mental health morbidity in the 12 months postpartum.
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Affiliation(s)
- Ann M Bruno
- University of Utah Health, Salt Lake City, and Intermountain Healthcare, Murray, Utah
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15
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Yu B, Zhang CA, Li S, Chen T, Mulloy E, Shaw GM, Eisenberg ML. Preconception paternal comorbidities and offspring birth defects: Analysis of a large national data set. Birth Defects Res 2023; 115:160-170. [PMID: 36106720 DOI: 10.1002/bdr2.2082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/25/2022] [Accepted: 08/21/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Despite the fact that the father contributes half the genome to a child, associations between paternal factors and birth defects are poorly understood. OBJECTIVES To investigate the association between preconception paternal health and birth defects in the offspring. MATERIALS AND METHODS We conducted analysis of a national cohort study utilizing the IBM Marketscan Research Database, which includes data on reimbursed private healthcare claims in the United States from 2007 to 2016. The potential association between paternal comorbidities, as measured by the components of metabolic syndrome (MetS), and any birth defect in the offspring was analyzed. RESULTS Of the 712,774 live births identified, 21.2% of children were born to fathers with at least one component of the metabolic syndrome (MetS ≥1) prior to conception. Compared to infants born to fathers with no components of the metabolic syndrome, a modestly higher percentage of infants with cardiac birth defects were born to fathers with more components of MetS (MetS = 1, OR [95% CI]: 1.07 [1.01-1.13]; MetS ≥2, 1.17 [1.08-1.26], in comparison to MetS = 0) after adjusting for maternal and paternal factors. Similarly, a higher percentage of infants with respiratory defects were born to fathers with two or more components of metabolic syndrome (MetS ≥2, OR [95% CI]: 1.45 [1.22-1.71]). DISCUSSION AND CONCLUSION In this private insurance claims-based study, we found that fathers with metabolic syndrome-related diseases before conception were at increased risk for having a child affected by birth defects, especially cardiac and respiratory defects, and this association was not influenced by paternal age or assessed maternal factors.
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Affiliation(s)
- Bo Yu
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
- Stanford Maternal & Child Health Research Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Chiyuan Amy Zhang
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Shufeng Li
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Tony Chen
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Evan Mulloy
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Michael L Eisenberg
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
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16
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Ailes EC, Zhu W, Clark EA, Huang YLA, Lampe MA, Kourtis AP, Reefhuis J, Hoover KW. Identification of pregnancies and their outcomes in healthcare claims data, 2008-2019: An algorithm. PLoS One 2023; 18:e0284893. [PMID: 37093890 PMCID: PMC10124843 DOI: 10.1371/journal.pone.0284893] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/11/2023] [Indexed: 04/25/2023] Open
Abstract
Pregnancy is a condition of broad interest across many medical and health services research domains, but one not easily identified in healthcare claims data. Our objective was to establish an algorithm to identify pregnant women and their pregnancies in claims data. We identified pregnancy-related diagnosis, procedure, and diagnosis-related group codes, accounting for the transition to International Statistical Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis and procedure codes, in health encounter reporting on 10/1/2015. We selected women in Merative MarketScan commercial databases aged 15-49 years with pregnancy-related claims, and their infants, during 2008-2019. Pregnancies, pregnancy outcomes, and gestational ages were assigned using the constellation of service dates, code types, pregnancy outcomes, and linkage to infant records. We describe pregnancy outcomes and gestational ages, as well as maternal age, census region, and health plan type. In a sensitivity analysis, we compared our algorithm-assigned date of last menstrual period (LMP) to fertility procedure-based LMP (date of procedure + 14 days) among women with embryo transfer or insemination procedures. Among 5,812,699 identified pregnancies, most (77.9%) were livebirths, followed by spontaneous abortions (16.2%); 3,274,353 (72.2%) livebirths could be linked to infants. Most pregnancies were among women 25-34 years (59.1%), living in the South (39.1%) and Midwest (22.4%), with large employer-sponsored insurance (52.0%). Outcome distributions were similar across ICD-9 and ICD-10 eras, with some variation in gestational age distribution observed. Sensitivity analyses supported our algorithm's framework; algorithm- and fertility procedure-derived LMP estimates were within a week of each other (mean difference: -4 days [IQR: -13 to 6 days]; n = 107,870). We have developed an algorithm to identify pregnancies, their gestational age, and outcomes, across ICD-9 and ICD-10 eras using administrative data. This algorithm may be useful to reproductive health researchers investigating a broad range of pregnancy and infant outcomes.
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Affiliation(s)
- Elizabeth C Ailes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Weiming Zhu
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elizabeth A Clark
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States of America
| | - Ya-Lin A Huang
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Margaret A Lampe
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Athena P Kourtis
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Karen W Hoover
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Zanetti A, Zambon A, Scirè CA, Bortoluzzi A. Impact of rheumatoid arthritis and methotrexate on pregnancy outcomes: retrospective cohort study of the Italian Society for Rheumatology. RMD Open 2022; 8:rmdopen-2022-002412. [PMID: 36597979 DOI: 10.1136/rmdopen-2022-002412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 11/02/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To evaluate the impact of rheumatoid arthritis (RA) and methotrexate (MTX) on the probability of becoming pregnant, pregnancy losses, elective termination of pregnancy (TOP) and congenital malformations. METHODS A retrospective cohort study on administrative healthcare databases was conducted. Three patients' cohorts were enrolled among childbearing-age women. The first cohort included patients with RA starting MTX between July 2004 and December 2011. The second cohort included patients with RA without MTX treatment randomly selected from the same population (ratio 1:1). Finally, a cohort of subjects without RA was identified (ratio 1:4). Multivariate logistic regression models were implemented, ORs and 95% CI were reported. RESULTS The two matched RA cohorts included 3564 patients with MTX and without MTX. The cohort without RA included 14 256 subjects. In the three cohorts, the proportion of women achieving pregnancy during follow-up was 6.3%, 9.1% and 11.9%, respectively. Congenital malformations were very rare in all cohorts. RA women treated with MTX at any time before conception showed significantly higher risks of pregnancy losses than non-RA women (OR (95% CI) 2.22 (1.40 to 3.45)). We observed a significant positive relationship between the exposure to MTX in the 3 months window before conception and increased risk of elective TOP (OR (95% CI) 4.77 (1.08 to 19.40)). CONCLUSION MTX-treated patients appeared to be the cohort with the highest risk of pregnancy losses. The positive association with elective TOP and exposure to MTX in the three months window before conception in patients with RA reinforces the need for adequate preconception counselling to avoid unplanned pregnancies.
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Affiliation(s)
- Anna Zanetti
- Epidemiology Unit, Italian Society of Rheumatology, Milano, Italy.,Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Antonella Zambon
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.,IRCCS Istituto Auxologico Italiano, Biostatistics Unit, Milan, Italy
| | - Carlo Alberto Scirè
- Epidemiology Unit, Italian Society of Rheumatology, Milano, Italy .,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alessandra Bortoluzzi
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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18
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Santillan DA, Davis HA, Faro EZ, Knosp BM, Santillan MK. Need for Improved Collection and Harmonization of Rural Maternal Healthcare Data. Clin Obstet Gynecol 2022; 65:856-867. [PMID: 36260014 PMCID: PMC9586468 DOI: 10.1097/grf.0000000000000752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Representation in data sets is critical to improving healthcare for the largest possible number of people. Unfortunately, pregnancy is a very understudied period of time. Further, the gap in available data is wide between pregnancies in urban areas versus rural areas. There are many limitations in the current data that is available. Herein, we review these limitations and strengths of available data sources. In addition, we propose a new mechanism to enhance the granularity, depth, and speed with which data is made available regarding rural pregnancy.
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Affiliation(s)
- Donna A. Santillan
- Department of Obstetrics & Gynecology, University of Iowa Hospitals & Clinics
| | - Heather A. Davis
- Institute for Clinical and Translational Science, University of Iowa
- Carver College of Medicine, University of Iowa
| | - Elissa Z. Faro
- Department of Internal Medicine, University of Iowa Hospitals & Clinics
| | - Boyd M. Knosp
- Institute for Clinical and Translational Science, University of Iowa
- Carver College of Medicine, University of Iowa
| | - Mark K. Santillan
- Department of Obstetrics & Gynecology, University of Iowa Hospitals & Clinics
- Institute for Clinical and Translational Science, University of Iowa
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Murugappan MN, Westberg SM, Contag S, Melnik TE, Kumar A, Rajpurohit A, Thorsness K, Farley JF. Maternal ADHD and Perinatal Prescription Stimulant Use. J Atten Disord 2022; 26:1347-1356. [PMID: 35048729 DOI: 10.1177/10870547211073472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe patterns and predictors of perinatal prescription stimulant use. METHODS We used MarketScan® commercial claims data (2013-2018) and a repeated cross-sectional study design to assess perinatal use of prescription stimulants. Clinical/demographic characteristics were compared across cohorts of women who continued versus discontinued stimulant treatment at various stages of pregnancy. Associations were tested for significance using chi-square tests (categorical variables) and independent t-tests (continuous variables). RESULTS Out of 612,001 pregnancies, 15,413 involved pre-pregnancy stimulant use. Of these, stimulant treatment was discontinued prior to conception in 6,416 (42%), discontinued during trimester 1 in 5,977 (39%), and continued into later trimesters in 3,020 (19%). Compared with pregnancies involving stimulant discontinuation prior to conception, those that continued into pregnancy occurred in women who were older (29.9 vs. 28.9 years) and had more severe ADHD (3.1 vs. 1.8 ADHD-related billing claims). CONCLUSIONS There is considerable heterogeneity in the management of ADHD during pregnancy.
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Affiliation(s)
| | | | - Stephen Contag
- M-Health Fairview, Minneapolis, MN, USA.,University of Minnesota Medical School, Minneapolis, USA
| | - Tanya E Melnik
- M-Health Fairview, Minneapolis, MN, USA.,University of Minnesota Medical School, Minneapolis, USA
| | - Arun Kumar
- University of Minnesota - College of Pharmacy, Minneapolis, USA
| | | | | | - Joel F Farley
- University of Minnesota - College of Pharmacy, Minneapolis, USA
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20
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Regan AK, Arah OA, Sullivan SG. Performance of diagnostic coding and laboratory testing results to measure COVID-19 during pregnancy and associations with pregnancy outcomes. Paediatr Perinat Epidemiol 2022; 36:508-517. [PMID: 35077581 PMCID: PMC9303575 DOI: 10.1111/ppe.12863] [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: 09/17/2021] [Revised: 01/02/2022] [Accepted: 01/03/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Large-scale evaluation of COVID-19 is likely to rely on the quality of ICD coding. However, little is known about the validity of ICD-coded COVID-19 diagnoses. OBJECTIVES To evaluate the performance of diagnostic codes in detecting COVID-19 during pregnancy. METHODS We used data from a national cohort of 78,283 individuals with a pregnancy ending between 11 March 2020 and 31 January 2021 in the OptumLabs® Data Warehouse (OLDW). OLDW is a longitudinal, real-world data asset with de-identified administrative claims and electronic health record data. We identified all services with an ICD-10-CM diagnostic code of U07.1 and all laboratory claims records for COVID-19 diagnostic testing. We compared ICD-coded diagnoses to testing results to estimate positive and negative predictive values (PPV and NPV). To evaluate impact on risk estimation, we estimated risk of adverse pregnancy outcomes by source of exposure information. RESULTS Of 78,283 pregnancies, 5644 had a laboratory test result for COVID-19. Testing was most common among older individuals, Hispanic individuals, those with higher socioeconomic status and those with a diagnosed medical condition or pregnancy complication; 52% of COVID-19 cases was identified through ICD-coded diagnosis alone, 19% from laboratory test results alone and 29% from both sources. Agreement between ICD-coded diagnosis and laboratory testing records was high 91% (95% confidence interval [CI] 90, 92). However, the PPV of ICD-code diagnosis was low (36%; 95% CI 33, 39). We observed up to a 50% difference in risk estimates of adverse pregnancy outcomes when exposure was based on laboratory testing results or diagnostic coding alone. CONCLUSIONS More than one-in-five COVID-19 cases would be missed by using ICD-coded diagnoses alone to identify COVID-19 during pregnancy. Epidemiological studies exclusively relying on diagnostic coding or laboratory testing results are likely to be affected by exposure misclassification. Research and surveillance should draw upon multiple sources of COVID-19 diagnostic information.
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Affiliation(s)
- Annette K. Regan
- School of Nursing and Health ProfessionsUniversity of San FranciscoOrangeCaliforniaUSA,Department of EpidemiologyFielding School of Public HealthUniversity of California Los Angeles (UCLA)Los AngelesCaliforniaUSA,OptumLabs Visiting FellowOptumLabsEden PrairieMNUSA
| | - Onyebuchi A. Arah
- Department of EpidemiologyFielding School of Public HealthUniversity of California Los Angeles (UCLA)Los AngelesCaliforniaUSA,Department of StatisticsCollege of Letters and ScienceUCLALos AngelesCaliforniaUSA
| | - Sheena G. Sullivan
- Department of EpidemiologyFielding School of Public HealthUniversity of California Los Angeles (UCLA)Los AngelesCaliforniaUSA,WHO Collaborating Centre for Reference and Research on InfluenzaMelbourneVictoriaAustralia
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21
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Regan AK, Arah O, Fell DB, Sullivan SG. SARS-CoV-2 Infection During Pregnancy and Associated Perinatal Health Outcomes: A National US Cohort Study. J Infect Dis 2021; 225:759-767. [PMID: 34958090 PMCID: PMC8755310 DOI: 10.1093/infdis/jiab626] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/23/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with increased risk of adverse perinatal health outcomes, few large-scale, community-based epidemiological studies have been conducted. METHODS We conducted a national cohort study using deidentified administrative claims data for 78 283 pregnancies with estimated conception before 30 April 2020 and pregnancy end after 11 March 2020. We identified SARS-CoV-2 infections using diagnostic and laboratory testing data, and compared the risk of pregnancy outcomes using Cox proportional hazard models treating coronavirus disease 2019 (COVID-19) as a time-varying exposure and adjusting for baseline covariates. RESULTS Of the pregnancies, 2655 (3.4%) had a documented SARS-CoV-2 infection. COVID-19 during pregnancy was not associated with risk of miscarriage, antepartum hemorrhage, or stillbirth, but was associated with 2-3 fold higher risk of induced abortion (adjusted hazard ratio [aHR], 2.60; 95% confidence interval [CI], 1.17-5.78), cesarean delivery (aHR, 1.99; 95% CI, 1.71-2.31), clinician-initiated preterm birth (aHR, 2.88; 95% CI, 1.93-4.30), spontaneous preterm birth (aHR, 1.79; 95% CI, 1.37-2.34), and fetal growth restriction (aHR, 2.04; 95% CI, 1.72-2.43). CONCLUSIONS Prenatal SARS-CoV-2 infection was associated with increased risk of adverse pregnancy outcomes. Prevention could have fetal health benefits.
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Affiliation(s)
- Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, Orange CA, United States,Fielding School of Public Health, UCLA, Los Angeles CA, United States,OptumLabs Visiting Fellow, Prairie MN, United States,Corresponding author: Annette Regan Assistant Professor School of Nursing and Public Health University of San Francisco 480 S Batavia Street Orange CA 98484 T: +1 714.221.6213
| | - Onyebuchi Arah
- Fielding School of Public Health, UCLA, Los Angeles CA, United States,OptumLabs Visiting Fellow, Prairie MN, United States,Department of Statistics, College of Letters and Science, UCLLA, Los Angeles CA, United States
| | - Deshayne B Fell
- Department of Public Health, Aarhus University, Aarhus, Denmark,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada,Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Sheena G Sullivan
- Fielding School of Public Health, UCLA, Los Angeles CA, United States,WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, Melbourne VIC, Australia,Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC, Australia,Alternate corresponding author: Sheena Sullivan Senior Epidemiologist 790 Elizabeth Street Melbourne VIC 3000, Australia
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22
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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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23
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Moll K, Wong HL, Fingar K, Hobbi S, Sheng M, Burrell TA, Eckert LO, Munoz FM, Baer B, Shoaibi A, Anderson S. Validating Claims-Based Algorithms Determining Pregnancy Outcomes and Gestational Age Using a Linked Claims-Electronic Medical Record Database. Drug Saf 2021; 44:1151-1164. [PMID: 34591264 PMCID: PMC8481319 DOI: 10.1007/s40264-021-01113-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 11/17/2022]
Abstract
Introduction Pregnancy outcome identification and precise estimates of gestational age (GA) are critical in drug safety studies of pregnant women. Validated pregnancy outcome algorithms based on the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) have not previously been published. Methods We developed algorithms to classify pregnancy outcomes and estimate GA using ICD-10-CM/PCS and service codes on claims in the 2016–2018 IBM® MarketScan® Explorys® Claims-EMR Data Set and compared the results with ob-gyn adjudication of electronic medical records (EMRs). Obstetric services were grouped into episodes using hierarchical and spacing requirements. GA was based on evidence with the highest clinical accuracy. Among pregnancies with obstetric EMRs, 100 full-term live births (FTBs), 100 preterm live births (PTBs), 100 spontaneous abortions (SAs), and 24 stillbirths were selected for review. Physicians adjudicated cases using Global Alignment of Immunization safety Assessment in pregnancy (GAIA) definitions applied to structured EMRs. Results The claims-based algorithms identified 34,204 pregnancies, of which 9.9% had obstetric EMRs. Of sampled pregnancies, 92 FTBs, 93 PTBs, 75 SAs, and 24 stillbirths were adjudicated. Among these pregnancies, the percent agreement was 97.8%, 62.4%, 100.0%, and 70.8% for FTBs, PTBs, SAs, and stillbirths, respectively. The percent agreement on GA within 7 and 28 days, respectively, was 85.9% and 100.0% for FTBs, 81.7% and 98.9% for PTBs, 61.3% and 94.7% for SAs, and 66.7% and 79.2% for stillbirths. Conclusions The pregnancy outcome algorithms had high agreement with physician adjudication of EMRs and may inform post-market maternal safety surveillance. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-021-01113-8.
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Affiliation(s)
| | - Hui Lee Wong
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | | | - Linda O Eckert
- University of Washington School of Medicine, Seattle, WA, USA
| | | | - Bethany Baer
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Azadeh Shoaibi
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Steven Anderson
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
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24
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Ames JL, Ladd-Acosta C, Fallin MD, Qian Y, Schieve LA, DiGuiseppi C, Lee LC, Kasten EP, Zhou G, Pinto-Martin J, Howerton E, Eaton CL, Croen LA. Maternal Psychiatric Conditions, Treatment With Selective Serotonin Reuptake Inhibitors, and Neurodevelopmental Disorders. Biol Psychiatry 2021; 90:253-262. [PMID: 34116791 PMCID: PMC8504533 DOI: 10.1016/j.biopsych.2021.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND This study aims to clarify relationships of maternal psychiatric conditions and selective serotonin reuptake inhibitor (SSRI) use during preconception and pregnancy with risk of neurodevelopmental disorders in offspring. METHODS We used data from the Study to Explore Early Development, a multisite case-control study conducted in the United States among children born between 2003 and 2011. Final study group classifications of autism spectrum disorder (ASD) (n = 1367), developmental delays or disorders (DDs) (n = 1750), and general population controls (n = 1671) were determined by an in-person standardized developmental assessment. Maternal psychiatric conditions and SSRI use during pregnancy were ascertained from both self-report and medical records. We used logistic regression to evaluate associations of ASD and DDs (vs. population controls) with maternal psychiatric conditions and SSRI treatment in pregnancy. To reduce confounding by indication, we also examined SSRI associations in analyses restricted to mothers with psychiatric conditions during pregnancy. RESULTS Psychiatric conditions and SSRI use during pregnancy were significantly more common among mothers of children with either ASD or DDs than among population controls. Odds of ASD were similarly elevated among mothers with psychiatric conditions who did not use SSRIs during pregnancy (adjusted odds ratio 1.81, 95% confidence interval 1.44-2.27) as in mothers who did use SSRIs (adjusted odds ratio 2.05, 95% confidence interval 1.50-2.80). Among mothers with psychiatric conditions, SSRI use was not significantly associated with ASD in offspring (adjusted odds ratio 1.14, 95% confidence interval 0.80-1.62). Primary findings for DDs exhibited similar relationships to those observed with ASD. CONCLUSIONS Maternal psychiatric conditions but not use of SSRIs during pregnancy were associated with increased risk of neurodevelopmental disorders in offspring.
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Affiliation(s)
| | - Christine Ladd-Acosta
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - M. Daniele Fallin
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Yinge Qian
- Division of Research, Kaiser Permanente, Oakland, CA
| | | | - Carolyn DiGuiseppi
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Li-Ching Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Eric P. Kasten
- Clinical and Translational Sciences Institute, Michigan State University, East Lansing, MI
| | - Guoli Zhou
- Clinical and Translational Sciences Institute, Michigan State University, East Lansing, MI
| | - Jennifer Pinto-Martin
- School of Nursing and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ellen Howerton
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Christopher L. Eaton
- The Permanente Medical Group, Kaiser Permanente Medical Center, San Francisco, CA
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente, Oakland, CA
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25
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Savitz DA, Hu H. Ambient heat and stillbirth in Northern and Central Florida. ENVIRONMENTAL RESEARCH 2021; 199:111262. [PMID: 33974845 PMCID: PMC8638076 DOI: 10.1016/j.envres.2021.111262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Elevated temperature is well-recognized as a health hazard, and may be particularly harmful to pregnant women, including increasing risk of stillbirth. We conducted a study in Northern and Central Florida, an area prone to periodic extreme heat but with significant seasonal variation, focusing on the most socioeconomically vulnerable populations least able to mitigate the impact of heat. METHODS We obtained electronic health records data from the OneFlorida Data Trust for the period 2012-2017, with 1876 stillbirths included in the analysis. We used a case-crossover design to examine the risk of stillbirth associated with acute exposures to elevated heat prior to the outcome, contrasting the case period (the week preceding the stillbirth) with a control period (the week prior to the case period and the week after the stillbirth). Average heat index and maximum warning level during the case and control periods of each woman were assigned by ZIP code. Conditional logistic regression models were used to assess the association between stillbirth and heat exposure, controlling for PM2.5 and O3. RESULTS The adjusted odds ratio showed no overall association with stillbirth except for a weak association for exposure above the 90th percentile which was larger among the most socioeconomically deprived and non-Hispanic Black women. In the hot months, there was a clear association for all indices of heat exposure, but largest again for the most socioeconomically deprived population (aOR = 2.4, 95% CI: 1.2-5.2 in the 4th vs. 1st quartile) and among non-Hispanic Black women (aOR = 1.8, 95% CI: 1.0-3.2 in the 4th vs. 1st quartile). CONCLUSIONS Our results provide further evidence that elevated ambient heat is related to stillbirth and encourage a focus on the most susceptible individuals and possible clinical pathways.
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Affiliation(s)
- David A Savitz
- Department of Epidemiology Brown University School of Public Health Providence, RI, USA.
| | - Hui Hu
- Department of Epidemiology College of Public Health and Health Professions & College of Medicine University of Florida Gainesville, FL, USA
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26
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Measuring Female Veterans' Prepregnancy Wellness Using Department of Veterans Affairs' Health Record Data. Obstet Gynecol 2021; 137:471-480. [PMID: 33543894 DOI: 10.1097/aog.0000000000004293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/10/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the feasibility of using measures developed by the Clinical Workgroup of the National Preconception Health and Health Care Initiative to assess women's prepregnancy wellness in a large health care system. METHODS We examined Department of Veterans Affairs' (VA) national administrative data, including inpatient, outpatient, fee-basis, laboratory, pharmacy, and screening data for female veterans aged 18-45 who had at least one pregnancy outcome (ectopic pregnancy, spontaneous abortion, stillbirth, and live birth) during fiscal years 2010-2015 and a VA primary care visit within 1 year before last menstrual period (LMP). LMP was estimated from gestational age at the time of pregnancy outcome, then used as a reference point to assess eight prepregnancy indicators from the Workgroup consensus measures (eg, 3 or 12 months before LMP). RESULTS We identified 19,839 pregnancy outcomes from 16,034 female veterans. Most (74.9%) pregnancies ended in live birth; 22.6% resulted in spontaneous abortion or ectopic pregnancy, and 0.5% in stillbirth. More than one third (39.2%) of pregnancies had no documentation of prenatal care within 14 weeks of LMP. Nearly one third (31.2%) of pregnancies occurred in women with obesity. Among pregnancies with a recent relevant screening, 29.2% were positive for smoking and 28.4% for depression. More than half (57.4%) of pregnancies in women with preexisting diabetes did not have documentation of optimal glycemic control. Absence of sexually transmitted infection screening in the year before or within 3 months of LMP was high. Documentation of prenatal folic acid use was also high. Exposure in the same timeframe to six classes of teratogenic medications was low. CONCLUSION Despite limitations of administrative data, monitoring measures of prepregnancy wellness can provide benchmarks for improving women's health across health care systems and communities. Areas for intervention to improve female veterans' prepregnancy wellness include healthy weight, optimizing control of diabetes before pregnancy, and improved use and documentation of key prepregnancy health screenings.
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27
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Spradling K, Zhang CA, Pao AC, Liao JC, Leppert JT, Elliott CS, Conti SL. Risk of Postpartum Urinary Stone Disease in Women with History of Urinary Stone Disease During Pregnancy. J Endourol 2021; 36:138-142. [PMID: 34235965 DOI: 10.1089/end.2021.0223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the risk of postpartum urinary stone disease in women with a history of stone disease during pregnancy. METHODS Using the Optum® de-identified Clinformatics® Datamart we identified pregnant women with urinary stone disease in the United States between January 2003 to December 2017 by standardized ICD-9, ICD-10, and CPT code criteria. We limited the cohort to include women without evidence of urinary stone disease prior to pregnancy. We abstracted patient demographic characteristics, clinical risk factors for stone disease, and data for urinary stone disease encounters and related procedures after pregnancy. Encounters occurring within 1 year of pregnancy were excluded. Cox proportional hazard models were used to analyze for significance. RESULTS We identified a total of 1,395,783 pregnant women with a median postpartum follow-up of 4.0 years, including 5,971 (0.4%) women diagnosed with a urinary stone during pregnancy. Of these, 736 (12.3%) had an additional urinary stone diagnosis claim after pregnancy, compared with 13,275 (0.95%) women without a history of stone disease during pregnancy (p < 0.0001). In multivariable proportional hazards models urinary stone disease during pregnancy (HR 12.8, 95% CI [11.8 - 13.8]) was independently associated with a higher hazard of urinary stone disease after pregnancy. CONCLUSION Women urinary stone disease during pregnancy were more likely to present with recurrent urinary stone disease after pregnancy. Given the 1 in 8 chance of needing further care, women with history of stone disease during pregnancy may benefit from risk counseling, surveillance, or secondary prevention efforts in the postpartum period.
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Affiliation(s)
- Kyle Spradling
- Stanford University School of Medicine, 10624, Urology, 300 Pasteur Drive, Stanford, California, United States, 94305;
| | | | - Alan C Pao
- Stanford University School of Medicine, 10624, Nephrology, 777 Welch Road, Suite DE, Palo Alto, California, United States, 94304;
| | - Joseph C Liao
- Stanford, Urology, 300 Pasteur Dr., S-287, Stanford, California, United States, 94305-5118;
| | - John T Leppert
- Stanford University School of Medicine, Urology, Room S-287, 300 Pasteur Drive, Stanford, California, United States, 94305;
| | - Christopher S Elliott
- Santa Clara Valley Medical Center, 14454, Urology, San Jose, California, United States;
| | - Simon L Conti
- Stanford Hospital and Clinics, 10623, Urology, 300 Pasteur Drive, Stanford, California, United States, 94305.,Stanford, Urology;
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28
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Murugappan G, Li S, Alvero RJ, Luke B, Eisenberg ML. Association between infertility and all-cause mortality: analysis of US claims data. Am J Obstet Gynecol 2021; 225:57.e1-57.e11. [PMID: 33577764 DOI: 10.1016/j.ajog.2021.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/25/2021] [Accepted: 02/02/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The consequences of an infertility diagnosis extend beyond the pursuit of family building, because women with infertility also face increased risks for severe maternal morbidity, cancer, and chronic disease. OBJECTIVE This study aimed to examine the association between female infertility and all-cause mortality. STUDY DESIGN This retrospective analysis compared 72,786 women with infertility, identified in the Optum Clinformatics Datamart from 2003 to 2019 by infertility diagnosis, testing, and treatment codes, with 3,845,790 women without infertility seeking routine gynecologic care. The baseline comorbidities were assessed using the presence of ≥1 metabolic syndrome diagnoses and the Charlson Comorbidity Index. The primary outcome, which was all-cause mortality, was identified by linkage to the Social Security Administration Death Master File outcomes and medical claims. The association between infertility and mortality was examined using a Cox proportional hazard regression by adjusting for age, hypertension, hyperlipidemia, type II diabetes, year of evaluation, smoking, number of visits per year, nulliparity, obesity, region of the country, and race. RESULTS Among 16,473,458 person-years of follow-ups, 13,934 women died. Women with infertility had a 32% higher relative risk for death from any cause (0.42% vs 0.35%, adjusted hazard ratio, 1.32; 95% confidence interval, 1.18-1.48) than women without infertility. The mean follow-up time per patient was 4.0±3.7 years vs 4.2±3.8 years for women with and without infertility, respectively. When stratified by age of <35 or ≥35 years or baseline medical comorbidity, the association between infertility and mortality remained. Women with infertility who delivered a child during the follow-up period faced a similar increased risk for mortality than the overall infertile group. Finally, receiving fertility treatment was not associated with a higher risk for death than receiving an infertility diagnosis or testing alone. CONCLUSION Although the absolute risk for death was low in both groups, women with infertility faced a higher relative risk for mortality than women without infertility. The association remained across all age, race and ethnicity groups, morbidities, and delivery strata. Importantly, infertility treatment was not associated with an increased risk for death. These findings reinforce the disease burden associated with infertility and its potential for long-term sequelae.
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29
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Qato DM, Gandhi AB. Opioid and benzodiazepine dispensing and co-dispensing patterns among commercially insured pregnant women in the United States, 2007-2015. BMC Pregnancy Childbirth 2021; 21:350. [PMID: 33941106 PMCID: PMC8091773 DOI: 10.1186/s12884-021-03787-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 04/09/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Little is known about benzodiazepine and opioid-benzodiazepine co-dispensing patterns among pregnant women. Understanding these patterns is necessary to mitigate high-risk medication use during pregnancy. Our objective in this analysis was to evaluate opioid and benzodiazepine dispensing and co-dispensing patterns among commercially insured pregnant women in the United States. METHODS This retrospective study used a 10% random sample of commercially insured enrollees from the IQVIA™ Adjudicated Health Plan Claims Data from 2007 to 2015. The study included women (12-55 years of age) with completed pregnancies who had continuous medical and prescription drug coverage from 3 months prior to the date of conception through 3 months post-delivery. We estimated the prevalence of opioid and benzodiazepine dispensing and co-dispensing before, during, and after pregnancy, and evaluated trends in dispensing patterns across the study period (2007-2015) using Cochrane-Armitage tests. Chi-square tests were used to examine differences in demographic and clinical characteristics by dispensing and co-dispensing patterns. Among women that received an opioid or benzodiazepine during pregnancy, logistic regression models were used to quantify the association between sample characteristics and dispensing patterns (co-dispensing vs single dispensing). RESULTS Of 168,025 pregnant women that met our inclusion criteria, 10.1% received at least one opioid and 2.0% received at least one benzodiazepine during pregnancy, while 0.5% were co-dispensed these drugs. During the study period (2007 vs 2015), prevalence of opioid dispensing during pregnancy decreased from 11.2 to 8.6% (p < 0.01); while benzodiazepine dispensing increased from 1.3 to 2.9% (p < 0.01), and the prevalence of co-dispensing, while low and stable, increased slightly from 0.39 to 0.44% (p < 0.01). Older age, a higher comorbidity burden, pain diagnosis, anxiety diagnosis, and alcohol, tobacco, and drug use disorders, were all associated with an increased odds of co-dispensing during pregnancy. CONCLUSIONS This study provides evidence that while opioid dispensing during pregnancy has decreased in the past decade, benzodiazepine dispensing has increased. The prevalence of opioid-benzodiazepine co-dispensing was rare and remained fairly stable during our study period. Those co-dispensed both drugs had a higher prevalence of adverse birth outcomes. Further research to establish the potentially causal relationship between opioid and benzodiazepine co-dispensing and adverse birth outcomes should be undertaken.
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Affiliation(s)
- Danya M Qato
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Aakash Bipin Gandhi
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
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30
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Wall-Wieler E, Robakis TK, Lyell DJ, Masarwa R, Platt RW, Carmichael SL. Benzodiazepine use before conception and risk of ectopic pregnancy. Hum Reprod 2021; 35:1685-1692. [PMID: 32485732 DOI: 10.1093/humrep/deaa082] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/19/2020] [Indexed: 02/06/2023] Open
Abstract
STUDY QUESTION Are women who fill a benzodiazepine prescription before conception at increased risk of ectopic pregnancy? SUMMARY ANSWER Risk of ectopic pregnancy is 50% higher among women who fill a benzodiazepine prescription before conception. WHAT IS KNOWN ALREADY Benzodiazepine use in pregnancy increases the risk of miscarriage, adverse birth outcomes and adverse child development outcomes. STUDY DESIGN, SIZE, DURATION Using data from US commercial insurance claims, we performed a cohort study of 1 691 366 pregnancies between 1 November 2008 and 30 September 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS We identified ectopic pregnancies using diagnosis and procedure codes and used unadjusted and inverse probability of treatment (IPT)-weighted log-binomial models to calculate relative risks (RR) of ectopic pregnancy for pregnant women who did and did not fill any prescriptions for benzodiazepines in the 90 days before conception. Two sub-groups of women with specific indications for benzodiazepine use were also examined-women who had a least one diagnosis for anxiety disorder and women who had at least one diagnosis of insomnia in the year before conception. MAIN RESULTS AND THE ROLE OF CHANCE Of the 1 691 366 pregnancies, 1.06% filled at least two benzodiazepine prescriptions totaling at least 10 days supply in the 90 days before conception. Among women with a benzodiazepine prescription, there was an excess of 80 ectopic pregnancies per 10 000 pregnancies, and their IPT-weighted risk of ectopic pregnancies was 1.47 (95% CI 1.32 to 1.63) times greater relative to women without benzodiazepine prescriptions before conception. The IPT-weighted RR between ectopic pregnancy and benzodiazepine use was 1.34 (95% CI 1.18 to 1.53) among women with anxiety disorder diagnoses and 1.28 (95% CI 0.99 to 1.68) among women with an insomnia diagnosis. LIMITATIONS, REASONS FOR CAUTION We relied on outpatient prescription data to identify benzodiazepine use before conception, which could result in over- or under-estimation of actual benzodiazepine consumption. We relied on medical claim codes to identify pregnancies and conception date, which may result in misclassification of pregnancy outcomes and gestational length. WIDER IMPLICATIONS OF THE FINDINGS This study found that women who have a benzodiazepine prescription before conception are at an increased risk of ectopic pregnancy. This information can help women, and their healthcare providers make more fully informed decisions about benzodiazepine use in their reproductive years. STUDY FUNDING/COMPETING INTEREST(S) Funding for this project was provided by a Banting Postdoctoral Fellowship and a Stanford Maternal and Child Health Research Institute Postdoctoral Award. Data access for this project was provided by the Stanford Center for Population Health Sciences Data Core. The PHS Data Core is supported by a National Institutes of Health National Center for Advancing Translational Science Clinical and Translational Science Award (UL1 TR001085) and internal Stanford funding. The authors have no competing interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
| | - Thalia K Robakis
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deirdre J Lyell
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Reem Masarwa
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Robert W Platt
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.,Departments of Pediatrics, McGill University, Montreal, Canada
| | - Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
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Sun AJ, Li S, Zhang CA, Jensen TK, Lindahl-Jacobsen R, Eisenberg ML. Parental comorbidity and medication use in the USA: a panel study of 785 000 live births. Hum Reprod 2021; 35:669-675. [PMID: 32187368 DOI: 10.1093/humrep/deaa022] [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] [Received: 10/01/2019] [Revised: 01/01/2020] [Indexed: 01/24/2023] Open
Abstract
STUDY QUESTION How prevalent is paternal medication use and comorbidity, and are rates of these rising? SUMMARY ANSWER Paternal medication use and comorbidity is common and rising, similar to trends previously described in mothers. WHAT IS KNOWN ALREADY Maternal medication use and comorbidity has been rising for the past few decades. These trends have been linked to potential teratogenicity, maternal morbidity and mortality and poorer fetal outcomes. STUDY DESIGN, SIZE, DURATION This is a Panel (trend) study of 785 809 live births from 2008 to 2016. PARTICIPANTS/MATERIALS, SETTING, METHODS We used the IBM© Marketscan®™ database to gather data on demographic information and International Classification of Diseases codes and Charlson comorbidity index (CCI) during the 12 months prior to the estimated date of conception for mothers and fathers. We similarly examined claims of prescriptions in the 3 months prior to conception. We performed companion analyses of medications used for >90 days in the 12 months prior to conception and of any medication use in the 12 months prior to conception. MAIN RESULTS AND THE ROLE OF CHANCE We confirmed that both maternal medication use and comorbidity (e.g. hypertension, diabetes, hyperlipidemia) rose over the study period, consistent with prior studies. We found a concurrent rise in both paternal medication use 3 months prior to conception (overall use, 31.5-34.9% during the study period; P < 0.0001) and comorbidity (CCI of ≥1 and 10.6-18.0% over study period; P < 0.0001). The most common conditions seen in the CCI were chronic obstructive pulmonary disease for mothers (6.6-11.6%) and hyperlipidemia for fathers (8.6-13.7%). Similar trends for individual medication classes and specific comorbidities such as hypertension, diabetes and hyperlipidemia were also seen. All primary result trends were statistically significant, making the role of chance minimal. LIMITATIONS, REASONS FOR CAUTION As this is a descriptive study, the clinical impact is uncertain and no causal associations may be made. Though the study uses a large and curated database that includes patients from across the USA, our study population is an insured population and our findings may not be generalizable. Mean parental age was seen to slightly increase over the course of the study (<1 year) and may be associated with increased comorbidity and medication use. WIDER IMPLICATIONS OF THE FINDINGS As parental comorbidity and certain medication use may impact fecundability, temporal declines in parental health may impact conception, pregnancy and fetal outcomes. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Andrew J Sun
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Shufeng Li
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Chiyuan A Zhang
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Tina K Jensen
- Department of Environmental Health, University of Southern Denmark, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- Department of Epidemiology, Biostatistics, and Biodemography, University of Southern Denmark, Odense, Denmark.,Interdisciplinary Centre on Population Dynamics (CPop), University of Southern Denmark, Odense, Denmark
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
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Summers AD, Anderson KN, Ailes EC, Grosse SD, Bobo WV, Tepper NK, Reefhuis J. Venlafaxine prescription claims among insured women of reproductive age and pregnant women, 2011-2016. Birth Defects Res 2021; 113:1052-1056. [PMID: 33860984 DOI: 10.1002/bdr2.1897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/23/2021] [Accepted: 04/05/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Some studies have reported associations between prenatal use of venlafaxine, a serotonin-norepinephrine reuptake inhibitor used for depressive and anxiety disorders, and some birth defects. We described the prevalence of venlafaxine prescription claims among privately insured women of reproductive age and pregnant women. METHODS Venlafaxine prescription claims were examined using the IBM MarketScan Commercial Databases. We included women of reproductive age (15-44 years) who had ≤45 days of lapsed enrollment during the calendar year of interest (2011-2016) in a non-capitated healthcare plan sponsored by a large, self-insured employer with prescription drug coverage and no mental health service carve-out. Annual cohorts of pregnant women were identified among eligible women of reproductive age via pregnancy diagnosis and procedure codes. Venlafaxine prescriptions were identified via National Drug Codes in outpatient pharmacy claims and we estimated the annual proportion of women with venlafaxine claims by pregnancy trimester (pregnant women only), age, and Census division. RESULTS Each year during 2011-2016, approximately 1.2% of eligible reproductive-aged and 0.3% of eligible pregnant women filled a venlafaxine prescription. Among pregnant women, the proportion with venlafaxine claims was highest during the first trimester and decreased during the second and third trimesters. Small temporal increases in venlafaxine claims were observed for reproductive-aged and pregnant women, with the largest among women aged 15-19 years. CONCLUSIONS Venlafaxine prescription claims were low among women of reproductive age and pregnant women during 2011-2016, with some increasing use over time among women aged 15-19 years.
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Affiliation(s)
- April D Summers
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kayla N Anderson
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth C Ailes
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott D Grosse
- Office of the Director, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA
| | - Naomi K Tepper
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennita Reefhuis
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Li R, Kuklina EV, Ailes EC, Shrestha SS, Grosse SD, Fang J, Wang G, Leung J, Barfield WD, Cox S. Medical expenditures for hypertensive disorders during pregnancy that resulted in a live birth among privately insured women. Pregnancy Hypertens 2021; 23:155-162. [PMID: 33418425 PMCID: PMC10423979 DOI: 10.1016/j.preghy.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/17/2020] [Accepted: 12/08/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To estimate the excess maternal health services utilization and direct maternal medical expenditures associated with hypertensive disorders during pregnancy and one year postpartum among women with private insurance in the United States. STUDY DESIGN We used 2008-2014 IBM MarketScan® Commercial Databases to identify women aged 15-44 who had a pregnancy resulting in live birth during 1/1/09-12/31/13 and were continuously enrolled with non-capitated or partially capitated coverage from 12 months before pregnancy through 12 months after delivery. Hypertensive disorders identified by diagnosis codes were categorized into three mutually exclusive types: preeclampsia and eclampsia, chronic hypertension, and gestational hypertension. Multivariate negative binomial and generalized linear models were used to estimate service utilization and expenditures, respectively. MAIN OUTCOME MEASURES Per person excess health services utilization and medical expenditures during pregnancy and one year postpartum associated with hypertensive disorders (in 2014 US dollars). RESULTS Women with preeclampsia and eclampsia, chronic hypertension, and gestational hypertension had $9,389, $6,041, and $2,237 higher mean medical expenditures compared to women without hypertensive disorders ($20,252), respectively (ps < 0.001). One-third (36%) of excess expenditure associated with hypertensive disorders during pregnancy was attributable to outpatient services. CONCLUSIONS Hypertensive disorders during pregnancy were associated with significantly higher health services utilization and medical expenditures among privately insured women with hypertensive disorders. Medical expenditures varied by types of hypertensive disorders. Stakeholders can use this information to assess the potential economic benefits of interventions that prevent these conditions or their complications.
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Affiliation(s)
- Rui Li
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States.
| | - Elena V Kuklina
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Elizabeth C Ailes
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, United States
| | - Sundar S Shrestha
- Office on Smoking Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Scott D Grosse
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, United States
| | - Jing Fang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, United States
| | - Wanda D Barfield
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
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Kasman AM, Zhang CA, Li S, Lu Y, Lathi RB, Stevenson DK, Shaw GM, Eisenberg ML. Association between preconception paternal health and pregnancy loss in the USA: an analysis of US claims data. Hum Reprod 2021; 36:785-793. [PMID: 33336240 PMCID: PMC8679308 DOI: 10.1093/humrep/deaa332] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/24/2020] [Indexed: 09/16/2023] Open
Abstract
STUDY QUESTION Is preconception paternal health associated with pregnancy loss? SUMMARY ANSWER Poor preconception paternal health is associated with a higher risk of pregnancy loss as confirmed in sensitivity analyses accounting for maternal age and health. WHAT IS KNOWN ALREADY Preconception paternal health can negatively impact perinatal outcomes. STUDY DESIGN, SIZE, DURATION Retrospective cohort study of US insurance claims database from 2009 to 2016 covering 958 804 pregnancies. PARTICIPANTS/MATERIALS, SETTING, METHODS US insurance claims database including women, men and pregnancies within the USA between 2007 and 2016. Paternal preconception health status (e.g. metabolic syndrome diagnoses (MetS), Charlson comorbidity index (CCI) and individual chronic disease diagnoses) was examined in relation to pregnancy loss (e.g. ectopic pregnancy, miscarriage and stillbirth). MAIN RESULTS AND THE ROLE OF CHANCE In all, 958 804 pregnancies were analyzed. The average paternal age was 35.3 years (SD 5.3) and maternal age was 33.1 years (SD 4.4). Twenty-two percent of all pregnancies ended in a loss. After adjusting for maternal factors, the risk of pregnancy loss increased with increasing paternal comorbidity. For example, compared to men with no components of MetS, the risk of pregnancy loss increased for men with one (relative risk (RR) 1.10, 95% CI 1.09-1.12), two (RR 1.15, 95% CI 1.13-1.17) or three or more (RR 1.19, 95% CI 1.14-1.24) components. Specifically, less healthy men had a higher risk of siring a pregnancy ending in spontaneous abortion, stillbirth and ectopic pregnancies. Similar patterns remained with other measures of paternal health (e.g. CCI, chronic diseases, etc.). When stratifying by maternal age as well as maternal health, a similar pattern of increasing pregnancy loss risk for men with 1, 2 or 3+ MetS was observed. A statistically significant but weak association between timing of pregnancy loss and paternal health was found. LIMITATIONS, REASONS FOR CAUTION Retrospective study design covering only employer insured individuals may limit generalizability. WIDER IMPLICATIONS OF THE FINDINGS Optimization of a father's health may improve pregnancy outcomes. STUDY FUNDING/COMPETING INTERESTS National Institutes of Health National Center for Advancing Translational Science Clinical and Translational Science Award (UL1 TR001085). M.L.E. is an advisor for Sandstone Diagnostics, Dadi, Hannah and Underdog. No other competing interests were declared. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Alex M Kasman
- Department of Urology, Stanford University School of
Medicine, Stanford, CA 94305-5118, USA
| | - Chiyuan A Zhang
- Department of Urology, Stanford University School of
Medicine, Stanford, CA 94305-5118, USA
| | - Shufeng Li
- Department of Urology, Stanford University School of
Medicine, Stanford, CA 94305-5118, USA
| | - Ying Lu
- Department of Biomedical Data Science, Stanford
University School of Medicine, Stanford, CA 94305-5118, USA
| | - Ruth B Lathi
- Department of Pediatrics, Stanford University School
of Medicine, Stanford, CA 94305-5118, USA
| | - David K Stevenson
- Department of Pediatrics, Stanford University School
of Medicine, Stanford, CA 94305-5118, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School
of Medicine, Stanford, CA 94305-5118, USA
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of
Medicine, Stanford, CA 94305-5118, USA
- Department of Obstetrics and Gynecology, Stanford
University School of Medicine, Stanford, CA 94305-5118, USA
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Espinosa C, Becker M, Marić I, Wong RJ, Shaw GM, Gaudilliere B, Aghaeepour N, Stevenson DK. Data-Driven Modeling of Pregnancy-Related Complications. Trends Mol Med 2021; 27:762-776. [PMID: 33573911 DOI: 10.1016/j.molmed.2021.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/01/2020] [Accepted: 01/20/2021] [Indexed: 12/11/2022]
Abstract
A healthy pregnancy depends on complex interrelated biological adaptations involving placentation, maternal immune responses, and hormonal homeostasis. Recent advances in high-throughput technologies have provided access to multiomics biological data that, combined with clinical and social data, can provide a deeper understanding of normal and abnormal pregnancies. Integration of these heterogeneous datasets using state-of-the-art machine-learning methods can enable the prediction of short- and long-term health trajectories for a mother and offspring and the development of treatments to prevent or minimize complications. We review advanced machine-learning methods that could: provide deeper biological insights into a pregnancy not yet unveiled by current methodologies; clarify the etiologies and heterogeneity of pathologies that affect a pregnancy; and suggest the best approaches to address disparities in outcomes affecting vulnerable populations.
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Affiliation(s)
- Camilo Espinosa
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Biomedical Data Sciences, Stanford University, Stanford, CA, USA
| | - Martin Becker
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Biomedical Data Sciences, Stanford University, Stanford, CA, USA
| | - Ivana Marić
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ronald J Wong
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Gary M Shaw
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Biomedical Data Sciences, Stanford University, Stanford, CA, USA; Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - David K Stevenson
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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Chen J, Cox S, Kuklina EV, Ferre C, Barfield W, Li R. Assessment of Incidence and Factors Associated With Severe Maternal Morbidity After Delivery Discharge Among Women in the US. JAMA Netw Open 2021; 4:e2036148. [PMID: 33528553 PMCID: PMC7856547 DOI: 10.1001/jamanetworkopen.2020.36148] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Previous efforts to examine severe maternal morbidity (SMM) in the US have focused on delivery hospitalizations. Little is known about de novo SMM that occurs after delivery discharge. OBJECTIVE To investigate the incidence, timing, factors, and maternal characteristics associated with de novo SMM after delivery discharge among women in the US. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study, data from the IBM MarketScan Multi-State Medicaid database and the IBM MarketScan Commercial Claims and Encounters database were used to construct a sample of women aged 15 to 44 years who delivered between January 1, 2010, and September 30, 2014. Severe maternal morbidity was reported by the timing of diagnosis, and the associated maternal characteristics were examined. Women in the Medicaid and commercial insurance sample were classified into 3 distinct outcome groups: (1) those without any SMM during the delivery hospitalization and the postdelivery period (reference group), (2) those who exhibited at least 1 factor associated with SMM during the delivery hospitalization, and (3) those who exhibited any factor associated with de novo SMM after delivery discharge (defined as SMM that was first diagnosed in the inpatient setting during the 6 weeks [or 42 days] after discharge from the delivery hospitalization, conditional on no factor associated with SMM being identified during delivery). Data were analyzed from February to July 2020. EXPOSURES Timing of SMM diagnosis. MAIN OUTCOMES AND MEASURES Women with SMM were identified using diagnosis and procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification for the 21 factors associated with SMM that were developed by the Centers for Disease Control and Prevention. RESULTS A total of 2 667 325 women in the US with delivery hospitalizations between 2010 and 2014 were identified; of those, 809 377 women (30.3%) had Medicaid insurance (30.3%; mean [SD] age, 25.6 [5.5] years; 51.1% White), and 1 857 948 women (69.7%; mean [SD] age, 30.6 [5.4] years; 36.4% from the southern region of the US) had commercial insurance. Among those with Medicaid insurance, 17 584 women (2.2%) experienced SMM during the delivery hospitalization, and 3265 women (0.4%) experienced de novo SMM after delivery discharge. Among those with commercial insurance, 32 079 women (1.7%) experienced SMM during the delivery hospitalization, and 5275 women (0.3%) experienced de novo SMM after hospital discharge. A total of 5275 SMM cases (14.1%) and 3265 SMM cases (15.7%) among women with commercial and Medicaid insurance, respectively, developed de novo within 6 weeks after hospital discharge; of those, 3993 cases (75.7%) in the commercial insurance cohort and 2399 cases (73.5%) in the Medicaid cohort were identified in the first 2 weeks after discharge. The most common factors associated with SMM varied based on the timing of diagnosis. In the Medicaid population, non-Hispanic Black women (adjusted odds ratio [aOR], 1.53; 95% CI, 1.48-1.58), Hispanic women (aOR, 1.46; 95% CI, 1.37-1.57), and women of other races or ethnicities (aOR, 1.40; 95% CI, 1.33-1.47) had higher rates of SMM during delivery hospitalization than non-Hispanic White women; however, only the disparity between Black and White women (aOR, 1.69; 95% CI, 1.57-1.81) persisted into the postdischarge period. CONCLUSIONS AND RELEVANCE In this study, 15.7% of SMM cases in the Medicaid cohort and 14.1% of SMM cases in the commercial insurance cohort first occurred after the delivery hospitalization, with notable disparities in factors and maternal characteristics associated with the development of SMM. These findings suggest a need to expand the focus of SMM assessment to the postdelivery discharge period.
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Affiliation(s)
- Jiajia Chen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elena V. Kuklina
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cynthia Ferre
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wanda Barfield
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rui Li
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Now with Division of Research, Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
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Selective serotonin reuptake inhibitor use patterns among commercially insured US pregnancies (2005-2014). Arch Womens Ment Health 2021; 24:155-164. [PMID: 32222834 DOI: 10.1007/s00737-020-01027-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/10/2020] [Indexed: 12/14/2022]
Abstract
The goal of this study was to describe patterns of selective serotonin reuptake inhibitor (SSRI) use during pregnancy in a US cohort (2005-2014) of > 1 million commercially insured women using administrative claims. We used international classification of disease (ICD-9) diagnosis and procedure and current procedural terminology codes in the OptumLabs® Data Warehouse to identify deliveries (including losses) among US women aged 15-45 (n = 1,061,023). SSRI dispensings that overlapped with the timing of pregnancy were identified using national drug codes in linked pharmacy claims. Demographic characteristics were imputed based on residential location, census data, and consumer information. We investigated patterns by trimester, agent, and demographic subgroups. A total of 46,087 of women (4.34%) were dispensed SSRIs during the estimated pregnancy period. Sertraline was the most common overall and had the highest initial use after trimester 1, including women who switched from another SSRI, although dispensing for > 1 SSRI during pregnancy was uncommon. Use of vilazodone was rare and had the highest discontinuation after trimester 1, followed by paroxetine. SSRI use was more common among women who were older, White, college-educated, higher income (≥ $100,000), or resided in the Midwest. Paroxetine and dispensings for > 1 SSRI were more common in lower education subgroups. White women had the highest proportion of use in all trimesters of pregnancy, whereas Hispanic women had the lowest. Among commercially insured US women, SSRI use during pregnancy differed by agent and demographics. More research is needed to understand whether these differences are due to symptom reporting, cultural beliefs, and/or physician preferences.
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Wall-Wieler E, Robakis TK, Cesta CE, Masarwa R, Lyell DJ, Liu C, Platt RW, Carmichael SL. Antidepressant Use around Conception, Prepregnancy Depression, and Risk of Ectopic Pregnancy. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:845-853. [PMID: 32436752 PMCID: PMC7658419 DOI: 10.1177/0706743720927829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the risk of ectopic pregnancy among women with and women without antidepressant prescriptions around conception and examine whether this risk differs by prepregnancy depression status. METHODS We conducted a cohort study of all pregnancies between November 1, 2008, and September 30, 2015, identified in the nationwide (American) IBM® MarketScan® Databases. At least one day's supply of antidepressants in the 3 weeks after a woman's last menstrual period defined active antidepressant use around conception. At least one depression diagnosis in the year before the last menstrual period defined prepregnancy depression. Relative risk (RR) of ectopic pregnancy was estimated using unadjusted and inverse probability of treatment (IPT)-weighted log-binomial models. RESULTS Of the 1,703,245 pregnancies, 106,788 (6.3%) women had a prepregnancy depression diagnosis. Among women with a depression diagnosis, 40,287 (37.7%) had an active antidepressant prescription around conception; the IPT-weighted risk of ectopic pregnancy was similar among women who did and did not fill an antidepressant prescription around conception (IPT-weighted RR = 1.01; 95% CI, 0.93 to 1.10). Overall, the risk of ectopic pregnancy was higher among women who had a prepregnancy depression diagnosis than women who did not have a prepregnancy depression diagnosis (IPT-weighted RR = 1.09; 95% CI, 1.04 to 1.15). CONCLUSIONS This study's findings suggest that women who have a prepregnancy depression diagnosis are at a slightly increased risk of ectopic pregnancy, and among women who have a prepregnancy depression diagnosis, the use of antidepressants around conception does not increase the risk of ectopic pregnancy.
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Affiliation(s)
| | - Thalia K. Robakis
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Carolyn E. Cesta
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institute, Solna, Sweden
| | - Reem Masarwa
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Deirdre J. Lyell
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, CA, USA
| | - Can Liu
- Department of Pediatrics, Stanford University School of Medicine, CA, USA
| | - Robert W. Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Suzan L. Carmichael
- Department of Pediatrics, Stanford University School of Medicine, CA, USA
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, CA, USA
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Bais B, Kamperman AM, Bijma HH, Hoogendijk WJ, Souman JL, Knijff E, Lambregtse-van den Berg MP. Effects of bright light therapy for depression during pregnancy: a randomised, double-blind controlled trial. BMJ Open 2020; 10:e038030. [PMID: 33115894 PMCID: PMC7594358 DOI: 10.1136/bmjopen-2020-038030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Approximately 11%-13% of pregnant women suffer from depression. Bright light therapy (BLT) is a promising treatment, combining direct availability, sufficient efficacy, low costs and high safety for both mother and child. Here, we examined the effects of BLT on depression during pregnancy. DESIGN Randomised, double-blind controlled trial. SETTING Primary and secondary care in The Netherlands, from November 2016 to March 2019. PARTICIPANTS 67 pregnant women (12-32 weeks gestational age) with a DSM-5 diagnosis of depressive disorder (Diagnostic and Statistical Manual of Mental Disorders). INTERVENTIONS Participants were randomly allocated to treatment with either BLT (9000 lux, 5000 K) or dim red light therapy (DRLT, 100 lux, 2700 K), which is considered placebo. For 6 weeks, both groups were treated daily at home for 30 min on awakening. Follow-up took place weekly during the intervention, after 6 weeks of therapy, 3 and 10 weeks after treatment and 2 months postpartum. PRIMARY AND SECONDARY OUTCOME MEASURES Depressive symptoms were measured primarily with the Structured Interview Guide for the Hamilton Depression Scale-Seasonal Affective Disorder. Secondary measures were the Hamilton Rating Scale for Depression and the Edinburgh Postnatal Depression Scale. Changes in rating scale scores of these questionnaires over time were analysed using generalised linear mixed models. RESULTS Median depression scores decreased by 40.6%-53.1% in the BLT group and by 50.9%-66.7% in the DRLT group. We found no statistically significant difference in symptom change scores between BLT and DRLT. Sensitivity and post-hoc analyses did not change our findings. CONCLUSIONS Depressive symptoms of pregnant women with depression improved in both treatment arms. More research is necessary to determine whether these responses represent true treatment effects, non-specific treatment responses, placebo effects or a combination hereof. TRIAL REGISTRATION NUMBER NTR5476.
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Affiliation(s)
- Babette Bais
- Psychiatry, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Astrid M Kamperman
- Psychiatry, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Hilmar H Bijma
- Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Witte Jg Hoogendijk
- Psychiatry, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Jan L Souman
- Lighting Applications, Signify NV, Eindhoven, Noord-Brabant, The Netherlands
| | - Esther Knijff
- Psychiatry, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Mijke P Lambregtse-van den Berg
- Psychiatry, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
- Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
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40
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DeCarlo C, Boitano LT, Molina RL, Weinberg I, Conrad MF, Eagleton MJ, Dua A. Pregnancy and Preeclampsia Are Associated With Acute Adverse Peripheral Arterial Events. Arterioscler Thromb Vasc Biol 2020; 41:526-533. [PMID: 33054392 DOI: 10.1161/atvbaha.120.315174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Acute peripheral arterial events, such as aortic dissection, carotid artery dissection, vertebral artery dissection, and ruptured renoviseral aneurysms, have been reported during pregnancy in case series, but there is a paucity of population-based data. This study sought to establish pregnancy and preeclampsia as risk factors for acute peripheral arterial events. Approach and Results: All women who gave birth between 1998 and 2020 within a multicenter health care system were identified. Births that occurred in women <18 or >50 years of age were excluded. Primary outcome was any acute peripheral arterial event that was symptomatic or required intervention. Cox regression model was used to evaluate the association between vascular events and pregnancy as a time-varying covariate. The pregnancy exposure period was from the estimated date of conception to 3 months postpartum. There were 277 697 pregnancies (81.3% deliveries, 17.0% abortions, and 1.7% ectopics) among 176 635 women with 1.68 million patient-years of total follow-up (median, 7.9 years; interquartile range, 2.4-16.2). Preeclampsia complicated 5.3% of pregnancies; 67 790 of 225 763 (30.0%) deliveries were delivered by cesarean. Ninety-six acute arterial events occurred during follow-up, of which 24 occurred during pregnancy, including the postpartum period. Pregnancy (hazard ratio, 1.85 [95% CI, 1.01-3.38]; P=0.046) and preeclampsia (hazard ratio, 10.9 [95% CI, 5.24-22.7]; P<0.001) were significant independent predictors of acute arterial events. CONCLUSIONS While taking into account limitations from estimating conception and outcome dates, pregnancy, especially when complicated by preeclampsia, is associated with an increased risk of acute peripheral arterial events.
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Affiliation(s)
- Charles DeCarlo
- Division of Vascular Surgery, Department of Surgery (C.D., L.T.B., M.F.C., M.J.E., A.D.), Massachusetts General Hospital, Boston
| | - Laura T Boitano
- Division of Vascular Surgery, Department of Surgery (C.D., L.T.B., M.F.C., M.J.E., A.D.), Massachusetts General Hospital, Boston
| | - Rose L Molina
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (R.L.M.).,Division of Women's Health, Brigham and Women's Hospital, Boston, MA (R.L.M.)
| | - Ido Weinberg
- Fireman Vascular Center (I.W.), Massachusetts General Hospital, Boston.,Department of Medicine, Division of Vascular Medicine (I.W.), Massachusetts General Hospital, Boston
| | - Mark F Conrad
- Division of Vascular Surgery, Department of Surgery (C.D., L.T.B., M.F.C., M.J.E., A.D.), Massachusetts General Hospital, Boston
| | - Matthew J Eagleton
- Division of Vascular Surgery, Department of Surgery (C.D., L.T.B., M.F.C., M.J.E., A.D.), Massachusetts General Hospital, Boston
| | - Anahita Dua
- Division of Vascular Surgery, Department of Surgery (C.D., L.T.B., M.F.C., M.J.E., A.D.), Massachusetts General Hospital, Boston
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Gibbs SE, Oakley LP, Harvey SM. Development and validation of a claims-based measure of abortion services. J Eval Clin Pract 2020; 26:1383-1388. [PMID: 31997579 DOI: 10.1111/jep.13315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/16/2019] [Accepted: 10/24/2019] [Indexed: 11/28/2022]
Abstract
RATIONALE Data on abortion services are critical for monitoring trends in access and utilization, evaluating policies, and examining a wide range of research questions. Accurate and timely data, however, can be difficult to obtain for abortion services. Oregon is one of several states that use state funds to finance abortion services in their Medicaid programmes. Oregon's Medicaid programme contracts with managed care plans that receive global budgets to provide care. Abortion services, however, must be billed directly to the state through fee-for-service (FFS) billing to ensure that federal funds are not used. In this study, we identify possible abortions using Medicaid insurance claims data from Oregon and categorize identified abortions as high, medium, or low confidence according to convergent validity analysis of FFS billing. METHODS We used individually linked Medicaid eligibility and claims data from women ages 15 to 44 enrolled in Oregon's Medicaid programme from 2008 to 2013. Abortion-related Medicaid claims were identified and categorized based on diagnosis, procedure, and drug codes. These categories were assessed for convergent validity by examining FFS billing for possible abortions to women enrolled in managed care plans. RESULTS In total, 23 763 possible abortions obtained by 18 518 women were classified with high (n = 21 450), medium (n = 562), and low (n = 1751) confidence. Among managed care abortions, more than 99% of high confidence abortions were billed on an FFS basis compared with 72% of medium confidence and <1% of low confidence abortions. The majority of high confidence abortions were to urban-residing (89%) white (73%) women. CONCLUSIONS Research on abortion services using insurance claims has important implications for women's health care and public health policy. A high-quality claims-based measure can facilitate monitoring the provision of abortion services within health systems and evaluation of initiatives to increase equitable abortion access.
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Affiliation(s)
- Susannah E Gibbs
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Lisa P Oakley
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - S Marie Harvey
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
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42
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Kasman AM, Bhambhvani HP, Li S, Zhang CA, Stevenson DK, Shaw GM, Simard JF, Eisenberg ML. Reproductive sequelae of parental severe illness before the pandemic: implications for the COVID-19 pandemic. Fertil Steril 2020; 114:1242-1249. [PMID: 33280730 PMCID: PMC7510413 DOI: 10.1016/j.fertnstert.2020.09.153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To investigate, with pre-COVID-19 data, whether parental exposure to severe systemic infections near the time of conception is associated with pregnancy outcomes. DESIGN Retrospective cohort study. SETTING Population-based study covering births within the United States from 2009 to 2016. PARTICIPANTS The IBM MarketScan Research database covers reimbursed health care claims data on inpatient and outpatient encounters that are privately insured through employment-sponsored health insurance. Our analytic sample included pregnancies to paired fathers and mothers. INTERVENTIONS(S) Parental preconception exposure (0-6 months before conception) to severe systemic infection (e.g., sepsis, hypotension, respiratory failure, critical care evaluation). MAIN OUTCOME MEASURE(S) Preterm birth (i.e., live birth before 37 weeks) and pregnancy loss. RESULT(S) A total of 999,866 pregnancies were recorded with 214,057 pregnancy losses (21.4%) and 51,759 preterm births (5.2%). Mothers receiving intensive care in the preconception period had increased risk of pregnancy loss, as did fathers. Mothers with preconception sepsis had higher risk of preterm birth and pregnancy loss, and paternal sepsis exposure was associated with an increased risk of pregnancy loss. Similar results were noted for hypotension. In addition, a dose response was observed for both mothers and fathers between preconception time in intensive care and the risk of preterm birth and pregnancy loss. CONCLUSION(S) In a pre-COVID-19 cohort, parental preconception severe systemic infection was associated with increased odds of preterm birth and pregnancy loss when conception was soon after the illness.
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Affiliation(s)
- Alex M Kasman
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Hriday P Bhambhvani
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Shufeng Li
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Chiyuan A Zhang
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - David K Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Julia F Simard
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, California; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
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Garabedian LF, LeCates R, Galbraith A, Ross-Degnan D, Wharam JF. Costs Are Higher For Marketplace Members Who Enroll During Special Enrollment Periods Compared With Open Enrollment. Health Aff (Millwood) 2020; 39:1354-1361. [PMID: 32744945 DOI: 10.1377/hlthaff.2019.01155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
More than 20 percent of Affordable Care Act (ACA) exchange market (Marketplace) members insured by a large national insurer in 2015 and 2016 enrolled during a special enrollment period (SEP), defined as any enrollment outside the annual open enrollment period. These members were younger and had approximately 34 percent higher average monthly total costs than members who enrolled during open enrollment. SEP members had 69-114 percent higher inpatient costs and 11-19 percent higher emergency department costs than open enrollment members. Higher costs, especially among a slightly younger population, may suggest potential adverse selection among SEP members, which could contribute to increased premiums and insurer exit from ACA Marketplaces. Although SEP members had a shorter average enrollment length per calendar year, they were more likely than open enrollment members to stay insured through the end of the calendar year and to renew in a Marketplace plan offered by the insurer in the following year. However, renewing SEP and open enrollment members were older, sicker, and costlier than nonrenewing members of both enrollee types, which suggests that healthier members are switching carriers or leaving the market over time. Additional research is urgently needed to inform evidence-based policy regarding Marketplace risk adjustment and SEP eligibility rules and to improve outreach to people who are eligible for SEP enrollment.
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Affiliation(s)
- Laura F Garabedian
- Laura F. Garabedian is an assistant professor in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute, in Boston, Massachusetts
| | - Robert LeCates
- Robert LeCates is a research associate in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute
| | - Alison Galbraith
- Alison Galbraith is an associate professor in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute
| | - Dennis Ross-Degnan
- Dennis Ross-Degnan is an associate professor in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute
| | - J Frank Wharam
- J. Frank Wharam is an associate professor in and director of the Division of Health Policy and Insurance Research, Department of Population Medicine, at Harvard Medical School and the Harvard Pilgrim Health Care Institute
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Challa AP, Beam AL, Shen M, Peryea T, Lavieri RR, Lippmann ES, Aronoff DM. Machine learning on drug-specific data to predict small molecule teratogenicity. Reprod Toxicol 2020; 95:148-158. [PMID: 32428651 PMCID: PMC7577422 DOI: 10.1016/j.reprotox.2020.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 12/23/2022]
Abstract
Pregnant women are an especially vulnerable population, given the sensitivity of a developing fetus to chemical exposures. However, prescribing behavior for the gravid patient is guided on limited human data and conflicting cases of adverse outcomes due to the exclusion of pregnant populations from randomized, controlled trials. These factors increase risk for adverse drug outcomes and reduce quality of care for pregnant populations. Herein, we propose the application of artificial intelligence to systematically predict the teratogenicity of a prescriptible small molecule from information inherent to the drug. Using unsupervised and supervised machine learning, our model probes all small molecules with known structure and teratogenicity data published in research-amenable formats to identify patterns among structural, meta-structural, and in vitro bioactivity data for each drug and its teratogenicity score. With this workflow, we discovered three chemical functionalities that predispose a drug towards increased teratogenicity and two moieties with potentially protective effects. Our models predict three clinically-relevant classes of teratogenicity with AUC = 0.8 and nearly double the predictive accuracy of a blind control for the same task, suggesting successful modeling. We also present extensive barriers to translational research that restrict data-driven studies in pregnancy and therapeutically "orphan" pregnant populations. Collectively, this work represents a first-in-kind platform for the application of computing to study and predict teratogenicity.
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Affiliation(s)
- Anup P Challa
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville 37203, TN, United States; Department of Biomedical Informatics, Harvard Medical School, Boston 02115, MA, United States; National Center for Advancing Translational Sciences, National Institutes of Health, Rockville 20850, MD, United States; Department of Chemical and Biomolecular Engineering, Vanderbilt University, Nashville 37212, TN, United States.
| | - Andrew L Beam
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston 02115, MA, United States; Department of Biomedical Informatics, Harvard Medical School, Boston 02115, MA, United States
| | - Min Shen
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville 20850, MD, United States
| | - Tyler Peryea
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville 20850, MD, United States
| | - Robert R Lavieri
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville 37203, TN, United States
| | - Ethan S Lippmann
- Department of Chemical and Biomolecular Engineering, Vanderbilt University, Nashville 37212, TN, United States
| | - David M Aronoff
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville 37203, TN, United States; Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville 37203, TN, United States; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville 37203, TN, United States
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45
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Downing KF, Tepper NK, Simeone RM, Ailes EC, Gurvitz M, Boulet SL, Honein MA, Howards PP, Valente AM, Farr SL. Adverse Pregnancy Conditions Among Privately Insured Women With and Without Congenital Heart Defects. Circ Cardiovasc Qual Outcomes 2020; 13:e006311. [PMID: 32506927 DOI: 10.1161/circoutcomes.119.006311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background In women with congenital heart defects (CHD), changes in blood volume, heart rate, respiration, and edema during pregnancy may lead to increased risk of adverse outcomes and conditions. The American Heart Association recommends providers of pregnant women with CHD assess cardiac health and discuss risks and benefits of cardiac-related medications. We described receipt of American Heart Association-recommended cardiac evaluations, filled potentially teratogenic or fetotoxic (Food and Drug Administration pregnancy category D/X) cardiac-related prescriptions, and adverse conditions among pregnant women with CHD compared with those without CHD. Methods and Results Using 2007 to 2014 US healthcare claims data, we ascertained a retrospective cohort of women with and without CHD aged 15 to 44 years with private insurance covering prescriptions during pregnancy. CHD was defined as ≥1 inpatient code or ≥2 outpatient CHD diagnosis codes >30 days apart documented outside of pregnancy and categorized as severe or nonsevere. Log-linear regression, accounting for multiple pregnancies per woman, generated adjusted prevalence ratios (aPRs) for associations between the presence/severity of CHD and stillbirth, preterm birth, and adverse conditions from the last menstrual period to 90 days postpartum. We identified 2056 women with CHD (2334 pregnancies) and 1 374 982 women without (1 524 077 pregnancies). During the last menstrual period to 90 days postpartum, 56% of women with CHD had comprehensive echocardiograms and, during pregnancy, 4% filled potentially teratogenic or fetotoxic cardiac-related prescriptions. Women with CHD, compared with those without, experienced more adverse conditions overall (aPR, 1.9 [95% CI, 1.7-2.1]) and, specifically, obstetric (aPR, 1.3 [95% CI, 1.2-1.4]) and cardiac conditions (aPR, 10.2 [95% CI, 9.1-11.4]), stillbirth (aPR, 1.6 [95% CI, 1.1-2.4]), and preterm delivery (aPR, 1.6 [95% CI, 1.4-1.8]). More women with severe CHD, compared with nonsevere, experienced adverse conditions overall (aPR, 1.5 [95% CI, 1.2-1.9]). Conclusions Women with CHD have elevated prevalence of adverse cardiac and obstetric conditions during pregnancy; 4 in 100 used potentially teratogenic or fetotoxic medications, and only half received an American Heart Association-recommended comprehensive echocardiogram.
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Affiliation(s)
- Karrie F Downing
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (K.F.D., R.M.S., E.C.A., M.A.H., S.L.F.), Centers for Disease Control and Prevention, Atlanta, GA
| | - Naomi K Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (N.K.T.), Centers for Disease Control and Prevention, Atlanta, GA
| | - Regina M Simeone
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (K.F.D., R.M.S., E.C.A., M.A.H., S.L.F.), Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth C Ailes
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (K.F.D., R.M.S., E.C.A., M.A.H., S.L.F.), Centers for Disease Control and Prevention, Atlanta, GA
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (M.G., A.M.V.).,Department of Medicine, Division of Cardiovascular Disease, Brigham and Women's Hospital, Boston, MA (M.G., A.M.V.)
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA (S.L.B.)
| | - Margaret A Honein
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (K.F.D., R.M.S., E.C.A., M.A.H., S.L.F.), Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Anne M Valente
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (M.G., A.M.V.).,Department of Medicine, Division of Cardiovascular Disease, Brigham and Women's Hospital, Boston, MA (M.G., A.M.V.)
| | - Sherry L Farr
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (K.F.D., R.M.S., E.C.A., M.A.H., S.L.F.), Centers for Disease Control and Prevention, Atlanta, GA
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46
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Kasman AM, Zhang CA, Li S, Stevenson DK, Shaw GM, Eisenberg ML. Association of preconception paternal health on perinatal outcomes: analysis of U.S. claims data. Fertil Steril 2020; 113:947-954. [DOI: 10.1016/j.fertnstert.2019.12.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 12/13/2022]
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47
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Spradling K, Sohlberg EM, Li S, Zhang CA, Brubaker WD, Dallas K, Pao AC, Liao J, Leppert JT, Elliott CS, Chung BI, Min GE, Conti SL. Urinary Stone Disease in Pregnancy: Current Management Practices in a Large National Cohort. Urology 2020; 142:60-64. [PMID: 32311447 DOI: 10.1016/j.urology.2020.03.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/16/2020] [Accepted: 03/30/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To define current national practice patterns of imaging modalities and urologic procedures in pregnant women with urinary stone disease. METHODS Using the IBM MarketScan national insurance claims database, we identified pregnant women with urinary stone disease and their corresponding gestational age between 2011 and 2016 using administrative claims data. We then assessed each encounter for urinary stone disease or stone-related urologic procedure during their pregnancy. We abstracted demographic information as well as codes for stone procedures and imaging. RESULTS We identified 14,298 pregnant women with urinary stone disease during the study period. Of the 12,315 undergoing abdominal imaging (86.1%), magnetic resonance imaging was used in 2.8%, x-ray in 9%, and ultrasound in 74.3%. Computed tomography was not used as a diagnostic modality during pregnancy. Procedural intervention was performed in 749 women (5.2%): 476 (3.3%) ureteral stent placement without definitive stone treatment, 93 (0.6%) percutaneous nephrostomy placement, and 180 (1.3%) ureteroscopy (URS) for definitive stone treatment. URS was most commonly performed before 34 weeks gestation with only 27 cases (15%) performed after. CONCLUSION This large national cohort reveals the current imaging and procedural practice patterns for urinary stone disease during pregnancy and provides a critical baseline as these practice patterns evolve in the future.
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Affiliation(s)
- Kyle Spradling
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Ericka M Sohlberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Shufeng Li
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Chiyuan Amy Zhang
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - William D Brubaker
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Kai Dallas
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Alan C Pao
- Division of Nephrology, Stanford University School of Medicine, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Joseph Liao
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - John T Leppert
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Division of Nephrology, Stanford University School of Medicine, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Christopher S Elliott
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Division of Urology, Santa Clara Valley Medical Center, San Jose, CA
| | - Benjamin I Chung
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Gyeong Eun Min
- Department of Urology, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
| | - Simon L Conti
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
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48
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Anderson KN, Tepper NK, Downing K, Ailes EC, Abarbanell G, Farr SL. Contraceptive methods of privately insured US women with congenital heart defects. Am Heart J 2020; 222:38-45. [PMID: 32014720 PMCID: PMC7521137 DOI: 10.1016/j.ahj.2020.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/11/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The American Heart Association recommends women with congenital heart defects (CHD) receive contraceptive counseling early in their reproductive years, but little is known about contraceptive method use among women with CHD. We describe recent female sterilization and reversible prescription contraceptive method use by presence of CHD and CHD severity in 2014. METHODS Using IBM MarketScan Commercial Databases, we included women aged 15 to 44 years with prescription drug coverage in 2014 who were enrolled ≥11 months annually in employer-sponsored health plans between 2011 and 2014. CHD, CHD severity, contraceptive methods, and obstetrics-gynecology and cardiology provider encounters were identified using billing codes. We used log-binomial regression to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) to compare contraceptive method use overall and by effectiveness tier by CHD presence and, for women with CHD, severity. RESULTS Recent sterilization or current reversible prescription contraceptive method use varied slightly among women with (39.2%) and without (37.3%) CHD, aPR = 1.04, 95% CI [1.01-1.07]. Women with CHD were more likely to use any Tier I method (12.9%) than women without CHD (9.3%), aPR = 1.41, 95% CI [1.33-1.50]. Women with severe, compared to non-severe, CHD were less likely to use any method, aPR = 0.85, 95% CI [0.78-0.92], or Tier I method, aPR = 0.84, 95% CI [0.70-0.99]. Approximately 60% of women with obstetrics-gynecology and <40% with cardiology encounters used any included method. CONCLUSIONS There may be missed opportunities for providers to improve uptake of safe, effective contraceptive methods for women with CHD who wish to avoid pregnancy.
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Affiliation(s)
- Kayla N Anderson
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Naomi K Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karrie Downing
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth C Ailes
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ginnie Abarbanell
- Department of Pediatrics, Division of Pediatric Cardiology, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, USA
| | - Sherry L Farr
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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49
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Leslie DL, Liu G, Jones BS, Roberts SCM. Healthcare costs for abortions performed in ambulatory surgery centers vs office-based settings. Am J Obstet Gynecol 2020; 222:348.e1-348.e9. [PMID: 31629727 DOI: 10.1016/j.ajog.2019.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/06/2019] [Accepted: 10/12/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several states require that abortions be provided in ambulatory surgery centers. Supporters of such laws argue that they make abortions safer, yet previous studies have found no differences in abortion-related morbidities or adverse events for abortions performed in ambulatory surgery centers versus office-based settings. However, little is known about how costs of abortions provided in ambulatory surgery centers differ from those provided in office-based settings. OBJECTIVE To compare healthcare expenditures for abortions performed in ambulatory surgery centers versus office-based settings using a large national private insurance claims database. MATERIALS AND METHODS A retrospective cohort study compared expenditures for abortions performed in ambulatory surgery centers versus office-based settings. Data on women who had abortions in an ambulatory surgery center or office-based setting between January 1, 2011, and December 31, 2014 were obtained from the MarketScan Commercial Claims and Encounters database. The sample was limited to women who were continuously enrolled in their insurance plans for at least 1 year before and at least 6 weeks after the abortion. Healthcare expenditures were assessed separately for the index abortion and the 6-week period after the abortion. Costs were measured from the perspective of the healthcare system and included all payments to the provider, including insurance company payments and any patient out-of-pocket payments. RESULTS Overall, 49,287 beneficiaries who had 50,311 abortions met inclusion criteria. Of the included abortions, 47% were first-trimester aspiration, 27% first-trimester medication, and 26% second-trimester or later abortions. Most abortions (89%) were provided in office-based settings, with 11% provided in ambulatory surgery centers. Unadjusted mean index abortion costs were higher in ambulatory surgery centers than in office-based settings ($1704 versus $810; P < .001). After adjusting for patient clinical and demographic characteristics, costs of index abortions were $772 higher (95% confidence interval, $746-$797), total follow-up costs for abortions that had any follow-up care were $1099 higher (95% confidence interval, $1004-$1,195), and total follow-up costs for abortions that had an abortion-related morbidity or adverse event were not significantly different in ambulatory surgery centers compared to office-based settings. There were also no significant differences in the likelihood of having any follow-up care or abortion-related event follow-up care. CONCLUSION Abortions performed at ambulatory surgery centers are significantly more costly than those performed in office-based settings, with no difference in the likelihood of receiving follow-up care. Laws requiring that abortions be provided in ambulatory surgery centers may only result in increased costs for abortions, with no effect on abortion safety.
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Affiliation(s)
- Douglas L Leslie
- Center for Applied Studies in Health Economics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA.
| | - Guodong Liu
- Center for Applied Studies in Health Economics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Bonnie Scott Jones
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
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50
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John McConnell K, Kaufman MR, Grunditz JI, Bellanca H, Risser A, Rodriguez MI, Renfro S. Project Nurture Integrates Care And Services To Improve Outcomes For Opioid-Dependent Mothers And Their Children. Health Aff (Millwood) 2020; 39:595-602. [DOI: 10.1377/hlthaff.2019.01574] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- K. John McConnell
- K. John McConnell is director of the Center for Health Systems Effectiveness and a professor in the Department of Emergency Medicine, both at Oregon Health & Science University, in Portland
| | - Menolly R. Kaufman
- Menolly R. Kaufman is a research associate in the Center for Health Systems Effectiveness, Oregon Health & Science University
| | - Jenny I. Grunditz
- Jenny I. Grunditz is a senior research associate in the Center for Health Systems Effectiveness, Oregon Health & Science University
| | - Helen Bellanca
- Helen Bellanca is an attending physician in the Urgent Care Department of Northwest Permanente, in Portland
| | - Amanda Risser
- Amanda Risser is senior medical director for substance use disorder services at Central City Concern, in Portland
| | - Maria I. Rodriguez
- Maria I. Rodriguez is an associate professor of obstetrics and gynecology at Oregon Health & Science University
| | - Stephanie Renfro
- Stephanie Renfro is associate director of the Center for Health Systems Effectiveness, Oregon Health & Science University
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