Are pregnancy outcomes associated with risk factor reporting in routinely collected perinatal data?

Aim: To assess reporting characteristics of commonly dichotomised pregnancy outcomes (e.g. preterm/term birth); and to investigate whether behaviours (e.g. smoking), medical conditions (e.g. diabetes) or interventions (e.g. induction) were reported differently by pregnancy outcomes.

Methods: Further analysis of a previous validation study was undertaken, in which 1680 perinatal records were compared with data extracted from medical records. Continuous and polytomous variables were dichotomised, and risk factor reporting was assessed within the dichotomised outcome groups. Agreement, kappa, sensitivity and positive predictive value calculations were undertaken.

Results: Gestational age, birthweight, Apgar scores, perineal trauma, regional analgesia and baby discharge status (live birth/stillbirth) were reported with high accuracy and reliability when dichotomised (kappa values 0.95-1.00, sensitivities 94.7-100.0%). Although not statistically significant, there were trends for hypertension, infant resuscitation and instrumental birth to be more accurately reported among births with adverse outcomes. In contrast, smoking ascertainment tended to be poorer among preterm births and when babies were <2500 g.

Conclusion: Dichotomising variables collected as continuous or polytomous variables in birth data results in accurate and well ascertained data items. There is no evidence of systematic differential reporting of risk factors.