Birth defects research. Part A, Clinical and molecular teratology最新文献_第3页

Geographic distribution of live births with tetralogy of Fallot in North Carolina 2003 to 2012. 2003 - 2012年北卡罗来纳州法洛四联症活产婴儿的地理分布。

Q Medicine

Birth defects research. Part A, Clinical and molecular teratology

Pub Date : 2016-11-01 DOI: 10.1002/bdra.23566

J. Nelson, Rebecca C. Stebbins, P. Strassle, R. Meyer

BACKGROUNDGeographic variation in congenital heart disease is not well-described. This study uses geographic information systems (GIS) to describe the spatial epidemiology of tetralogy of Fallot (TOF), in North Carolina (NC) and to compare travel time for cases to congenital heart centers in NC.METHODSUsing the NC Birth Defects Monitoring Program database, live births with TOF born between 2003 and 2012 were identified. Birth certificates provided demographic variables. A denominator of live births/zip code was obtained from the NC live births database. ArcGIS® software was used to illustrate TOF prevalence by zip code, and SatScanTM was used to identify spatial clusters of TOF cases and to identify changes in cluster location over time. Driving time to each of five NC congenital heart centers was predicted based on road systems information.RESULTSA total of 496 infants were born with TOF between 2003 and 2012. The prevalence was 4.2/10,000 live births. A large cluster (330 zip codes, 306 cases) was identified in northeastern NC. Average driving time for each case to closest congenital heart center was: University of North Carolina 37 min, Vident Medical Center 64 min, Duke University 58 min, Carolina's Medical Center 89 min, and Wake Forest Baptist Health 57 min. Overall, average predicted driving time to the nearest congenital heart center was 61 min.CONCLUSIONApproximately 50 infants/year were born with TOF in NC. One cluster was identified. Further study is necessary to explore potential explanations for the observed case cluster. As interest in regionalization of congenital heart surgery grows, GIS and spatial analysis can become increasingly useful tools for health care planning. Birth Defects Research (Part A) 106:881-887, 2016. © 2016 Wiley Periodicals, Inc.

背景:先天性心脏病的地理差异尚未得到很好的描述。本研究利用地理信息系统(GIS)描述了北卡罗来纳州法洛四联症(TOF)的空间流行病学，并比较了病例到北卡罗来纳州先天性心脏中心的旅行时间。方法利用NC出生缺陷监测程序数据库，对2003 ~ 2012年出生的TOF活产婴儿进行分析。出生证明提供了人口统计变量。从NC活产数据库中获得活产的分母/邮政编码。使用ArcGIS®软件按邮政编码说明TOF的流行情况，使用SatScanTM识别TOF病例的空间集群，并识别集群位置随时间的变化。根据道路系统信息预测到五个NC先天性心脏中心的驾驶时间。结果2003 - 2012年共496例TOF患儿。患病率为4.2/10,000活产。在北卡东北部发现了一个大集群(330个邮政编码，306例)。每个病例到最近的先天性心脏中心的平均开车时间为:北卡罗来纳大学37分钟，维登特医疗中心64分钟，杜克大学58分钟，卡罗莱纳医疗中心89分钟，维克森林浸信会健康中心57分钟。总体而言，到最近的先天性心脏中心的平均预测开车时间为61分钟。结论在北卡罗来纳州每年约有50名婴儿出生时患有TOF。确定了一个集群。有必要进一步研究以探索对观察到的病例聚集的潜在解释。随着对先天性心脏手术区域化的兴趣的增长，地理信息系统和空间分析可以成为越来越有用的卫生保健规划工具。出生缺陷研究(A辑)(6):881-887,2016。©2016 Wiley期刊公司

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引用次数: 10

Response to Dr. Kirby. 回复柯比博士。

Q Medicine

Birth defects research. Part A, Clinical and molecular teratology

Pub Date : 2016-11-01 DOI: 10.1002/bdra.23568

G. Shaw, Wei Yang, S. Carmichael

引用次数: 0

Paternal and joint parental occupational pesticide exposure and spina bifida in the National Birth Defects Prevention Study, 1997 to 2002. 1997年至2002年国家出生缺陷预防研究中父亲和父母共同职业农药暴露与脊柱裂的关系。

Q Medicine

Birth defects research. Part A, Clinical and molecular teratology

Pub Date : 2016-11-01 DOI: 10.1002/bdra.23551

S. Pettigrew, E. Bell, Alissa R Van Zutphen, Carissa M Rocheleau, G. Shaw, P. Romitti, A. Olshan, P. Lupo, A. Soim, Jennifer A. Makelarski, Adrian M. Michalski, W. Sanderson

BACKGROUNDBecause of persistent concerns over the association between pesticides and spina bifida, we examined the role of paternal and combined parental occupational pesticide exposures in spina bifida in offspring using data from a large population-based study of birth defects.METHODSOccupational information from fathers of 291 spina bifida cases and 2745 unaffected live born control infants with estimated dates of delivery from 1997 to 2002 were collected by means of maternal report. Two expert industrial hygienists estimated exposure intensity and frequency to insecticides, herbicides, and fungicides. Multivariable logistic regression models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for exposure to any pesticide and to any class of pesticide (yes/no; and by median), and exposure to combinations of pesticides (yes/no) and risk of spina bifida. Adjusted odds ratios were also estimated by parent exposed to pesticides (neither, mother only, father only, both parents).RESULTSJoint parental occupational pesticide exposure was positively associated with spina bifida (aOR, 1.5; 95% CI, 0.9-2.4) when compared with infants with neither maternal nor paternal exposures; a similar association was not observed when only one parent was exposed. There was a suggested positive association between combined paternal insecticide and fungicide exposures and spina bifida (aOR, 1.5; 95% CI, 0.8-2.8), however, nearly all other aORs were close to unity.CONCLUSIONOverall, there was little evidence paternal occupational pesticide exposure was associated with spina bifida. However, the small numbers make it difficult to precisely evaluate the role of pesticide classes, individually and in combination. Birth Defects Research (Part A) 106:963-971, 2016. © 2016 Wiley Periodicals, Inc.

背景:由于人们一直关注农药与脊柱裂之间的关系，我们利用一项基于大量人口的出生缺陷研究的数据，研究了父亲和父母联合职业农药暴露在后代脊柱裂中的作用。方法采用产妇报告法收集1997 ~ 2002年291例脊柱裂病例和2745例正常活产对照婴儿的父亲职业信息。两位工业卫生专家估计了杀虫剂、除草剂和杀菌剂的暴露强度和频率。多变量logistic回归模型用于估计暴露于任何农药和任何类别农药的调整优势比(aOR)和95%置信区间(CI)(是/否;以及暴露于农药组合(是/否)和脊柱裂的风险。调整后的优势比也通过父母接触杀虫剂(没有，只有母亲，只有父亲，父母双方)来估计。结果父母联合职业农药暴露与脊柱裂呈正相关(aOR, 1.5;95% CI, 0.9-2.4)，与母亲和父亲均未暴露的婴儿相比;当只有一方父母受到辐射时，没有观察到类似的关联。父亲杀虫剂和杀菌剂联合暴露与脊柱裂呈正相关(aOR, 1.5;95% CI, 0.8-2.8)，然而，几乎所有其他aor都接近一致。结论总体而言，没有证据表明父亲职业农药暴露与脊柱裂有关。然而，由于数量少，很难准确评估农药类别的作用，无论是单独的还是组合的。出生缺陷研究(A辑)106:963-971,2016。©2016 Wiley期刊公司

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引用次数: 7

Response to letter to the editor by Wise. 对Wise给编辑的信的回应。

Q Medicine

Birth defects research. Part A, Clinical and molecular teratology

Pub Date : 2016-11-01 DOI: 10.1002/bdra.23580

Laetitia Laurent, Chunwei Huang, Sheila R. Ernest, A. Bérard, C. Vaillancourt, B. Hales

引用次数: 0

Association between antibiotic use among pregnant women with urinary tract infections in the first trimester and birth defects, National Birth Defects Prevention Study 1997 to 2011. 1997 - 2011年国家出生缺陷预防研究:妊娠早期尿路感染孕妇使用抗生素与出生缺陷之间的关系。

Q Medicine

Birth defects research. Part A, Clinical and molecular teratology

Pub Date : 2016-11-01 DOI: 10.1002/bdra.23570

E. Ailes, S. Gilboa, S. Gill, C. Broussard, Krista S. Crider, R. Berry, Tonia C. Carter, C. Hobbs, J. Interrante, J. Reefhuis

BACKGROUNDPrevious studies noted associations between birth defects and some antibiotics (e.g., nitrofurantoin, sulfonamides) but not others (e.g., penicillins). It is unclear if previous findings were due to antibiotic use, infections, or chance. To control for potential confounding by indication, we examined associations between antibiotic use and birth defects, among women reporting urinary tract infections (UTIs).METHODSThe National Birth Defects Prevention Study is a multi-site, population-based case-control study. Case infants/fetuses have any of over 30 major birth defects and controls are live-born infants without major birth defects. We analyzed pregnancies from 1997 to 2011 to estimate the association between maternally reported periconceptional (month before conception through the third month of pregnancy) use of nitrofurantoin, trimethoprim-sulfamethoxazole, or cephalosporins and specific birth defects, among women with periconceptional UTIs. Women with periconceptional UTIs who reported penicillin use served as the comparator.RESULTSPericonceptional UTIs were reported by 7.8% (2029/26,068) of case and 6.7% (686/10,198) of control mothers. Most (68.2% of case, 66.6% of control mothers) also reported antibiotic use. Among 608 case and 231 control mothers reporting at least one periconceptional UTI and certain antibiotic use, compared with penicillin, nitrofurantoin use was associated with oral clefts in the offspring (adjusted odds ratio, 1.97 [95% confidence interval, 1.10-3.53]), trimethoprim-sulfamethoxazole use with esophageal atresia (5.31 [1.39-20.24]) and diaphragmatic hernia (5.09 [1.20-21.69]), and cephalosporin use with anorectal atresia/stenosis (5.01 [1.34-18.76]).CONCLUSIONPericonceptional exposure to some antibiotics might increase the risk for certain birth defects. However, because individual birth defects are rare, absolute risks should drive treatment decisions.Birth Defects Research (Part A) 106:940-949, 2016.© 2016 Wiley Periodicals, Inc.

背景:以前的研究指出了出生缺陷与某些抗生素(如呋喃妥因、磺胺类药物)之间的关联，但与其他抗生素(如青霉素类药物)无关。目前尚不清楚之前的发现是由于抗生素的使用、感染还是偶然。为了控制潜在的适应症混淆，我们在报告尿路感染(uti)的妇女中研究了抗生素使用与出生缺陷之间的关系。方法国家出生缺陷预防研究是一项多地点、基于人群的病例对照研究。病例婴儿/胎儿有30多种严重出生缺陷中的任何一种，对照组是没有严重出生缺陷的活产婴儿。我们分析了1997年至2011年的妊娠情况，以估计孕妇报告的围孕期(受孕前一个月至妊娠第三个月)使用呋喃妥英、甲氧苄啶-磺胺甲恶唑或头孢菌素与围孕期尿路感染妇女特定出生缺陷之间的关系。报告使用青霉素的围孕期尿路感染妇女作为比较组。结果妊娠期尿路感染发生率为7.8%(2029/26,068)，对照组为6.7%(686/10,198)。大多数(68.2%的病例，66.6%的对照母亲)也报告使用抗生素。在608例病例和231例对照母亲中，报告至少有一次围期尿路感染并使用某种抗生素的母亲中，与青霉素相比，呋喃酮的使用与后代的口腔裂相关(校正优势比为1.97[95%可信区间，1.10-3.53])，甲氧苄啶-磺胺甲恶唑合并食管闭锁(5.31[1.39-20.24])和膈疝(5.09[1.20-21.69])，头孢菌素合并肛肠闭锁/狭窄(5.01[1.34-18.76])。结论围孕期接触某些抗生素可能增加某些出生缺陷的发生风险。然而，由于个体出生缺陷是罕见的，绝对风险应该推动治疗决定。出生缺陷研究(A辑)(06):940-949,2016。©2016 Wiley期刊公司

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引用次数: 41

Twenty-five-year survival for aboriginal and caucasian children with congenital heart defects in Western Australia, 1980 to 2010. 1980年至2010年西澳大利亚土著和高加索儿童先天性心脏缺陷的25年生存率。

Q Medicine

Birth defects research. Part A, Clinical and molecular teratology

Pub Date : 2016-11-01 DOI: 10.1002/bdra.23572

W. Nembhard, J. Bourke, H. Leonard, L. Eckersley, Jingyun Li, C. Bower

BACKGROUNDAustralian Aboriginal children have increased infant and childhood mortality compared with Caucasian children, but their mortality related to congenital heart defects (CHDs) throughout life is unknown.METHODSWe conducted a retrospective cohort study using data on 8,110 live born, singleton infants with CHDs born January 1980 to December 2010 from the Western Australian Register of Developmental Anomalies. Vital status was determined from death and medical records. Data for infants with chromosomal anomalies (except Down syndrome) were excluded. Kaplan-Meier Product-Limit estimates and 95% confidence intervals (CIs) were computed by Aboriginality. Hazard ratios (HRs) and 95% CIs were calculated from multivariable Cox-Proportional Hazard Regression models.RESULTSAboriginal children had lower survival than Caucasians for all CHDs combined but most notably during the neonatal period for functional single ventricle (50.0% vs. 86.1%; p = 0.015) and during the postneonatal period for tetralogy of Fallot (87.0% vs. 97.4%; p = 0.021) and atrioventricular septal defect (60.0% vs. 94.6%; p = 0.010). After adjusting for covariates except remoteness and socioeconomic status (SES), Aboriginal children with all CHDs combined (HR = 1.4; 95% CI, 1.0-1.9), with transposition of the great arteries (HR = 4.3; 95% CI, 1.0-18.9) or functional single ventricle (HR = 8.6; 95% CI, 1.3-57.9) had increased risk of mortality compared with Caucasian children. When remoteness and SES were included, the risks were not statistically significant.CONCLUSIONLong-term survival was lower for Aboriginal children with CHDs, and Aboriginal children with specific CHD phenotypes had increased risk of mortality throughout life. Increased risk may be due to SES and environmental factors. Birth Defects Research (Part A), 2016. © 2016 Wiley Periodicals, Inc. Birth Defects Research (Part A) 106:1016-1031, 2016. © 2016 Wiley Periodicals, Inc.

澳大利亚土著儿童的婴儿和儿童死亡率比白种人儿童高，但他们一生中与先天性心脏缺陷(CHDs)相关的死亡率尚不清楚。方法:我们对1980年1月至2010年12月出生的8110名CHDs活产单胎婴儿进行了回顾性队列研究，数据来自西澳大利亚发育异常登记处。根据死亡和医疗记录确定生命状况。排除了染色体异常婴儿(唐氏综合征除外)的数据。Kaplan-Meier产品极限估计和95%置信区间(ci)由Aboriginality计算。通过多变量cox -比例风险回归模型计算风险比(hr)和95% ci。结果原住民儿童合并冠心病的生存率均低于白种人，但在新生儿期的单心室功能最明显(50.0% vs. 86.1%;p = 0.015)和新生儿后期法洛四联症(87.0% vs. 97.4%;P = 0.021)和房室间隔缺损(60.0% vs. 94.6%;P = 0.010)。在调整除偏远地区和社会经济地位(SES)以外的协变量后，所有冠心病的原住民儿童合并(HR = 1.4;95% CI, 1.0-1.9)，伴有大动脉转位(HR = 4.3;95% CI, 1.0-18.9)或功能性单心室(HR = 8.6;95% CI(1.3-57.9)与白种人儿童相比死亡风险增加。当包括偏远和SES时，风险无统计学意义。结论土著儿童冠心病患者的长期生存率较低，具有特定冠心病表型的土著儿童终生死亡风险增加。增加的风险可能是由于SES和环境因素。出生缺陷研究(上)，2016。©2016 Wiley期刊公司出生缺陷研究(A辑)106:1016-1031,2016。©2016 Wiley期刊公司

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引用次数: 4

Surveillance of ventricular septal defects in Delaware. 特拉华州室间隔缺损的监测。

Q Medicine

Birth defects research. Part A, Clinical and molecular teratology

Pub Date : 2016-11-01 DOI: 10.1002/bdra.23574

Amy Acheson, A. Vaidy, Kathleen Stomieroski, D. R. Thompson, K. Maiden, Deborah B. Ehrenthal, Samir G Yezdani, A. Bhat, R. Locke, L. Bartoshesky

BACKGROUNDThe prevalence of ventricular septal defects (VSDs), a birth defect in which there is an opening in the wall that separates the left and right ventricles of the heart, seemed to be substantially higher in Delaware compared with the National Birth Defects Prevention Network (NBDPN). The Delaware Birth Defects Registry (BDR) noted their high prevalence of VSDs in comparison with other states.METHODSA subset of children with a VSD born in 2007 through 2010 was identified from the complete reportable statewide defect list that the BDR creates each year. VSDs were categorized by type of VSD (muscular, perimembranous, conotruncal, or atrioventricular septal defect), by either isolated or complex, and then by spontaneously closed, surgically closed, open but clinically insignificant, lost to follow-up, fetal or neonatal death.RESULTSThe BDR team found a prevalence of VSD of 83.4 per 10,000 including fetal/neonatal deaths. Excluding fetal and neonatal deaths the prevalence was 78.7 per 10,000 live births. Excluding small muscular VSDs, the prevalence in Delaware falls to 25.7 per 10,000.CONCLUSIONThe BDR team chose to include all babies with all types of VSDs. Using these criteria Delaware's prevalence of 78.7 was higher than that reported by other states (whose prevalence ranges from 1.6 to 70.0 per 10,000 live births) (National Birth Defects Prevention Network, ). Delaware's prevalence is similar to other states when small muscular VSDs are excluded. Birth Defects Research (Part A) 106:888-893, 2016. © 2016 Wiley Periodicals, Inc.

背景:与全国出生缺陷预防网络(NBDPN)相比，特拉华州室间隔缺损(VSDs)的患病率似乎要高得多，室间隔缺损是一种出生缺陷，即在心室壁上有一个开口，将左心室和右心室分开。特拉华州出生缺陷登记处(BDR)指出，与其他州相比，他们的VSDs患病率较高。方法从BDR每年创建的完整的可报告的全州缺陷列表中确定2007年至2010年出生的VSD儿童子集。根据室间隔缺损的类型(肌肉型、膜周型、椎体状或房室间隔缺损)、单纯性或复合性室间隔缺损、自发闭合性、手术闭合性、开放性但临床不明显、随访失败、胎儿或新生儿死亡进行分类。结果BDR团队发现VSD患病率为83.4 / 10000，包括胎儿/新生儿死亡。不包括胎儿和新生儿死亡，患病率为每10 000例活产78.7例。不包括小型肌肉性室性血管病，特拉华州的患病率降至25.7 / 10000。结论BDR团队选择包括所有类型室间隔的婴儿。使用这些标准，特拉华州的患病率为78.7，高于其他州的报告(其患病率范围为每10,000例活产1.6至70.0)(国家出生缺陷预防网络，)。特拉华州的患病率与其他州相似，但不包括小型肌肉性室性血管病。出生缺陷研究(A辑)(6):888-893,2016。©2016 Wiley期刊公司

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引用次数: 3

ICD-10-based expanded code set for use in cleft lip/palate research and surveillance. 用于唇腭裂研究和监测的基于icd -10的扩展代码集。

Q Medicine

Birth defects research. Part A, Clinical and molecular teratology

Pub Date : 2016-11-01 DOI: 10.1002/bdra.23544

A. Allori, J. Cragan, Cynthia H. Cassell, J. Marcus

BACKGROUNDOn October 1, 2015, the United States required use of the Clinical Modification of the International Classification of Diseases, 10th Revision (ICD-10-CM) for diagnostic coding. The ICD-10-CM code set is limited to gross categories for cleft lip and/or cleft palate (using only four of a possible seven characters).METHODSHerein, a clinically useful expansion of the ICD-10-CM code set is proposed to improve the diagnostic accuracy necessary for individual clinical, research, and statistical projects that require it. (This is similar to how the Centers for Disease Control and Prevention/British Paediatric Association Code served to extend the ICD-9 code base.) RESULTS: Our proposed expansion does not replace the required use of ICD-10-CM for clinical, administrative, or financial transactions. Rather, it is offered as an optional set of cleft codes that could be used in parallel to document true classification-level data with phenotypic accuracy.CONCLUSIONThe expanded set is "collapsible" into the official ICD-10-CM codes; this improves compatibility of the expanded codes that would be contained in research and epidemiologic databases with the standard codes from hospital electronic medical record systems and administrative billing data. Birth Defects Research (Part A) 106:905-914, 2016. © 2016 Wiley Periodicals, Inc.

背景2015年10月1日，美国要求使用《国际疾病分类临床修改第十版》(ICD-10-CM)进行诊断编码。ICD-10-CM代码集仅限于唇裂和/或腭裂的总类别(仅使用可能的七个字符中的四个)。方法对ICD-10-CM代码集进行扩充，以提高个别临床、研究和统计项目所需的诊断准确性。(这与疾病控制和预防中心/英国儿科协会代码扩展ICD-9代码库的方式类似。)结果:我们提出的扩展并没有取代临床、行政或金融交易中ICD-10-CM的必要使用。相反，它是作为一组可选的间隙代码提供的，可以并行地用于记录具有表型准确性的真正分类级数据。结论扩展集可“折叠”成官方ICD-10-CM规范;这提高了研究和流行病学数据库中包含的扩展代码与医院电子病历系统和行政计费数据中的标准代码的兼容性。出生缺陷研究(A辑)(06):905-914,2016。©2016 Wiley期刊公司

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引用次数: 11

A quality assessment of reporting sources for microcephaly in Utah, 2003 to 2013. 2003 - 2013年犹他州小头症报告来源的质量评估

Q Medicine

Birth defects research. Part A, Clinical and molecular teratology

Pub Date : 2016-11-01 DOI: 10.1002/bdra.23593

A. Steele, Jane Johnson, A. Nance, R. Satterfield, C. Alverson, Cara T Mai

BACKGROUNDObtaining accurate microcephaly prevalence is important given the recent association between microcephaly and Zika virus. Assessing the quality of data sources can guide surveillance programs as they focus their data collection efforts. The Utah Birth Defect Network (UBDN) has monitored microcephaly by data sources since 2003. The objective of this study was to examine the impact of reporting sources for microcephaly surveillance.METHODSAll reported cases of microcephaly among Utah mothers from 2003 to 2013 were clinically reviewed and confirmed. The UBDN database was linked to state vital records and hospital discharge data for analysis. Reporting sources were analyzed for positive predictive value and sensitivity.RESULTSOf the 477 reported cases of microcephaly, 251 (52.6%) were confirmed as true cases. The UBDN identified 94 additional cases that were reported to the surveillance system as another birth defect, but were ultimately determined to be true microcephaly cases. The prevalence for microcephaly based on the UBDN medical record abstraction and clinical review was 8.2 per 10,000 live births. Data sources varied in the number and accuracy of reporting, but a case was more likely to be a true case if identified from multiple sources than from a single source.CONCLUSIONWhile some reporting sources are more likely to identify possible and true microcephaly cases, maintaining a multiple source methodology allows for more complete case ascertainment. Surveillance programs should conduct periodic assessments of data sources to ensure their systems are capturing all possible birth defects cases. Birth Defects Research (Part A) 106:983-988, 2016. © 2016 Wiley Periodicals, Inc.

背景:鉴于最近小头症与寨卡病毒之间的关联，获得准确的小头症患病率非常重要。评估数据来源的质量可以指导监控项目集中数据收集工作。自2003年以来，犹他州出生缺陷网络(UBDN)一直通过数据来源监测小头症。本研究的目的是检查报告来源对小头症监测的影响。方法对2003 - 2013年犹他州所有报告的小头畸形病例进行临床回顾性分析。UBDN数据库与州生命记录和医院出院数据相联系，以供分析。对报告来源进行阳性预测值和敏感性分析。结果477例小头畸形确诊251例(52.6%)。UBDN确定了另外94例向监测系统报告为另一种出生缺陷的病例，但最终确定为真正的小头畸形病例。根据UBDN医疗记录摘录和临床回顾，小头畸形的患病率为8.2 / 10,000活产。数据来源在报告的数量和准确性方面各不相同，但如果从多个来源确定病例，而不是从单一来源确定病例，则更有可能是真实病例。结论虽然一些报告来源更有可能识别出可能的和真实的小头畸形病例，但保持多来源方法可以更完整地确定病例。监测项目应对数据来源进行定期评估，以确保其系统捕捉到所有可能的出生缺陷病例。出生缺陷研究(A辑)(06):983-988,2016。©2016 Wiley期刊公司

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引用次数: 3

Using insurance claims data to identify and estimate critical periods in pregnancy: An application to antidepressants. 使用保险索赔数据来识别和估计怀孕的关键时期:抗抑郁药的应用。

Q Medicine

Birth defects research. Part A, Clinical and molecular teratology

Pub Date : 2016-11-01 DOI: 10.1002/bdra.23573

E. Ailes, Regina M. Simeone, April L. Dawson, E. Petersen, S. Gilboa

BACKGROUNDHealth insurance claims are a rich data source to examine medication use in pregnancy. Our objective was to identify pregnant women, their pregnancy outcomes, and date of their last menstrual period (LMP), and to estimate antidepressant dispensations in pregnancy.METHODSFrom a literature search, we identified diagnosis and procedure codes indicating the end of a pregnancy. Using Truven Health MarketScan® Commercial Claims and Encounters Databases, we identified all inpatient admissions and outpatient service claims with these codes. We developed an algorithm to assign: (1) pregnancy outcome (ectopic pregnancy, induced or spontaneous abortion, live birth, or stillbirth), and (2) estimated gestational age, to each inpatient or outpatient visit. For each pregnancy outcome, we estimated the LMP as the admission (for inpatient visits) or service (for outpatient visits) date minus the gestational age. To differentiate visits associated with separate pregnancies, we required ≥ 2 months between one pregnancy outcomes and the LMP of the next pregnancy. We used this algorithm to identify pregnancies in 2013 and to estimate the proportion of women who filled a prescription for an antidepressant from an outpatient pharmacy at various time points in pregnancy.RESULTSWe identified 488,887 pregnancies in 2013; 79% resulted in a live birth. A prescription for an antidepressant was filled in 6.2% of pregnancies. Dispensations varied throughout pregnancy and were lowest (3.1%) during the second trimester.CONCLUSIONThis work will inform future efforts to estimate medication dispensations during critical periods of preconception, interconception, and pregnancy using health insurance claims data. Birth Defects Research (Part A) 106:927-934, 2016. © 2016 Wiley Periodicals, Inc.

背景:健康保险索赔是检查妊娠期药物使用的丰富数据来源。我们的目的是确定孕妇，她们的妊娠结局和最后一次月经(LMP)的日期，并估计怀孕期间抗抑郁药的配用情况。方法通过文献检索，我们确定了指示妊娠结束的诊断和程序代码。使用Truven Health MarketScan®商业索赔和遭遇数据库，我们确定了所有住院和门诊服务索赔与这些代码。我们开发了一种算法来分配:(1)妊娠结局(异位妊娠、人工流产或自然流产、活产或死产)和(2)估计胎龄，用于每次住院或门诊就诊。对于每个妊娠结局，我们估计LMP为入院(住院就诊)或服务(门诊就诊)日期减去胎龄。为了区分与单独妊娠相关的就诊，我们要求一次妊娠结局与下一次妊娠的LMP之间≥2个月。我们使用该算法识别了2013年的怀孕情况，并估计了在怀孕的不同时间点从门诊药房开抗抑郁药处方的女性比例。结果2013年共发现488,887例妊娠;79%的人活产。6.2%的孕妇服用了抗抑郁药。分配在整个妊娠期间各不相同，在妊娠中期最低(3.1%)。结论本研究将为今后利用健康保险索赔数据估计孕前、孕间和妊娠关键时期的药物分配提供依据。出生缺陷研究(A辑)(06):927-934,2016。©2016 Wiley期刊公司

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引用次数: 65