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Nava de Escalante Y, Abayomi A, Langlois S, Ye X, Erickson A, Ngo H, Armour R, Okamoto R, Arbour L, Bedard T, Der K, Van Allen M, Skarsgard E, Lavoie M, Henry B. Validation of case definition algorithms for the ascertainment of congenital anomalies. Birth Defects Res 2023; 115:302-317. [PMID: 36369700 PMCID: PMC10099451 DOI: 10.1002/bdr2.2112] [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: 03/07/2022] [Revised: 09/06/2022] [Accepted: 09/25/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Congenital anomalies (CA) are one of the leading causes of infant mortality and long-term disability. Many jurisdictions rely on health administrative data to monitor these conditions. Case definition algorithms can be used to monitor CA; however, validation of these algorithms is needed to understand the strengths and limitations of the data. This study aimed to validate case definition algorithms used in a CA surveillance system in British Columbia (BC), Canada. METHODS A cohort of births between March 2000 and April 2002 in BC was linked to the Health Status Registry (HSR) and the BC Congenital Anomalies Surveillance System (BCCASS) to identify cases and non-cases of specific anomalies within each surveillance system. Measures of algorithm performance were calculated for each CA using the HSR as the reference standard. Agreement between both databases was calculated using kappa coefficient. The modified Standards for Reporting Diagnostic Accuracy guidelines were used to enhance the quality of the study. RESULTS Measures of algorithm performance varied by condition. Positive predictive value (PPV) ranged between approximately 73%-100%. Sensitivity was lower than PPV for most conditions. Internal congenital anomalies or conditions not easily identifiable at birth had the lowest sensitivity. Specificity and negative predictive value exceeded 99% for all algorithms. CONCLUSION Case definition algorithms may be used to monitor CA at the population level. Accuracy of algorithms is higher for conditions that are easily identified at birth. Jurisdictions with similar administrative data may benefit from using validated case definitions for CA surveillance as this facilitates cross-jurisdictional comparison.
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Affiliation(s)
| | - Aanu Abayomi
- British Columbia Ministry of Health, Victoria, British Columbia, Canada
| | - Sylvie Langlois
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Xibiao Ye
- British Columbia Ministry of Health, Victoria, British Columbia, Canada.,Health Information Science, University of Victoria, Vancouver, British Columbia, Canada
| | - Anders Erickson
- British Columbia Ministry of Health, Victoria, British Columbia, Canada
| | - Henry Ngo
- British Columbia Ministry of Health, Victoria, British Columbia, Canada
| | - Rosemary Armour
- British Columbia Vital Statistics Agency, Vancouver, British Columbia, Canada
| | - Reiko Okamoto
- British Columbia Ministry of Health, Victoria, British Columbia, Canada.,Digital Technologies Research Centre, National Research Council Canada, Ottawa, Ontario, Canada
| | - Laura Arbour
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Community Genetics Research Program/Island Medical Program, University of Victoria, Victoria, British Columbia, Canada
| | - Tanya Bedard
- Health Standards, Quality and Performance, Alberta Health, Edmonton, Alberta, Canada
| | - Kenny Der
- Health Information Science, University of Victoria, Vancouver, British Columbia, Canada
| | - Margot Van Allen
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Medical Genetics, Vancouver Island Health Authority, Vancouver, British Columbia, Canada
| | - Erik Skarsgard
- Department of Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Martin Lavoie
- British Columbia Ministry of Health, Victoria, British Columbia, Canada
| | - Bonnie Henry
- British Columbia Ministry of Health, Victoria, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Demir LÜ, Mathiesen ER, Damm P, Ringholm L. Major congenital malformations in offspring of women with chronic diseases-impact of the disease or the treatment? AJOG GLOBAL REPORTS 2022; 3:100153. [PMID: 36655167 PMCID: PMC9841280 DOI: 10.1016/j.xagr.2022.100153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
In a narrative review, we summarized previous findings on the risk of major congenital malformations in offspring of women with chronic hypertension, hypothyroidism, or depression compared with the background population, and evaluated whether exposure to medical treatment in the first trimester affected this risk. In a literature search in the PubMed database, cohort studies were included if they were published from 2010 to 2022 and contained data on major congenital malformations from ≥500 offspring of women with chronic hypertension, hypothyroidism, or depression during the first trimester of pregnancy, and data on both untreated and treated women. Data were compared with the background population of women without these diseases. In total, 7 cohort studies were identified. In comparison with the background population, 2 studies including 54,996 offspring of women with chronic hypertension showed an adjusted odds ratio of 1.20 to 1.30 for major congenital malformations in the offspring, regardless of antihypertensive treatment. One study including 16,364 offspring of women with hypothyroidism showed an adjusted odds ratio of 1.14 (1.06-1.22) for major congenital malformations in the offspring, regardless of thyroid substitution. Four studies including 48,913 offspring of women with depression showed adjusted odds ratios of 1.07 to 1.27 (0.91-1.78) for major congenital malformations in the offspring of untreated women. Three of these 4 studies showed similar prevalence of malformations in women treated for depression. The findings of this narrative review suggest that chronic hypertension and hypothyroidism, rather than exposure to their medical treatments in the first trimester, were associated with increased risk of major congenital malformations, whereas depression was generally not associated with major congenital malformations.
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Affiliation(s)
- Laila Ülkü Demir
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark (Ms Demir, Dr Mathiesen, and Dr Ringholm)
| | - Elisabeth Reinhardt Mathiesen
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark (Ms Demir, Dr Mathiesen, and Dr Ringholm),Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark (Dr Mathiesen, Dr Damm, and Dr Ringholm),Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Mathiesen and Dr Damm)
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark (Dr Mathiesen, Dr Damm, and Dr Ringholm),Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Mathiesen and Dr Damm),Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark (Dr Damm)
| | - Lene Ringholm
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark (Ms Demir, Dr Mathiesen, and Dr Ringholm),Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark (Dr Mathiesen, Dr Damm, and Dr Ringholm),Corresponding author: Lene Ringholm, PhD.
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Longo C, Forget A, Schnitzer M, Blais L. Timing of Maternal Asthma Diagnosis in Relation to Adverse Perinatal Outcomes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1938-1946.e4. [PMID: 32018035 DOI: 10.1016/j.jaip.2020.01.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/07/2020] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND It is unclear if asthma diagnosed during pregnancy puts the fetus at a higher risk of poor perinatal outcomes than pre-existing asthma. OBJECTIVE To assess if the risks of prematurity, major malformations, and small-for-gestational age (SGA) are higher in women with asthma diagnosed during versus pre-pregnancy. METHODS We retrospectively analyzed a cohort of pregnant women aged ≥15 years with and without incident asthma, constructed from health administrative databases. Follow-up began 24 months before pregnancy onset (cohort entry) and ended at delivery. Incident asthma was defined as a first diagnosis among those without asthma in the 8 years before cohort entry. Time was classified into pre-pregnancy and each trimester until delivery. We fit inverse probability weighted Poisson models to estimate marginal relative risks (RRs) for prematurity (delivery <37th week), major malformations, and SGA (birth weight <10th percentile) comparing women with and without asthma, assessing the asthma timing of diagnosis interaction term via a Wald test. RESULTS In a cohort of 122,880 deliveries, the increased risk of prematurity, but not SGA, due to incident asthma was higher in those diagnosed during the second (RR, 1.34; 95% confidence interval [CI], 1.08-1.65; Wald P = .05) and third (RR, 1.93; 95% CI, 1.62-2.29; Wald P < .01) trimesters relative to pre-pregnancy (RR, 1.06; 95% CI, 0.98-1.15). A trend toward an increased risk of major malformations was observed in those diagnosed during the first trimester (RR, 1.18; 95% CI, 0.94-1.49; Wald P = .15) than pre-pregnancy (RR, 0.99; 95% CI, 0.92-1.07). CONCLUSIONS Asthma diagnosed during, versus before, pregnancy was associated with a greater prematurity risk, suggesting an important role of preconception and prenatal screening.
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Affiliation(s)
- Cristina Longo
- Faculty of Pharmacy, University of Montreal, Montréal, QC, Canada.
| | - Amélie Forget
- Faculty of Pharmacy, University of Montreal, Montréal, QC, Canada
| | | | - Lucie Blais
- Faculty of Pharmacy, University of Montreal, Montréal, QC, Canada; Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, QC, Canada; Endowment Pharmaceutical Chair AstraZeneca in Respiratory Health, Montréal, QC, Canada
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