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. 2022 Aug;31(8):863-874.
doi: 10.1002/pds.5483. Epub 2022 Jun 7.

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

Monica L Bertoia  1 , Kelesitse Phiri  2 , C Robin Clifford  1 , Michael Doherty  1 , Li Zhou  1 , Laura T Wang  3 , Natalie A Bertoia  4 , Florence T Wang  1 , John D Seeger  1
Affiliations

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

Monica L Bertoia et al. Pharmacoepidemiol Drug Saf. 2022 Aug.

Abstract

Purpose: Health care insurance claims databases are becoming a more common data source for studies of medication safety during pregnancy. While pregnancies have historically been identified in such databases by pregnancy outcomes, International Classification of Diseases, 10th revision Clinical Modification (ICD-10-CM) Z3A codes denoting weeks of gestation provide more granular information on pregnancies and pregnancy periods (i.e., start and end dates). The purpose of this study was to develop a process that uses Z3A codes to identify pregnancies, pregnancy periods, and links infants within a commercial health insurance claims database.

Methods: We identified pregnancies, gestation periods, pregnancy outcomes, and linked infants within the US-based Optum Research Database between 2015 and 2020 via a series of algorithms utilizing diagnosis and procedure codes on claims. The diagnosis and procedure codes included ICD-10-CM codes, Current Procedural Terminology (CPT) codes, and Healthcare Common Procedure Coding System (HCPCS) codes.

Results: We identified 1 030 874 pregnancies among 841 196 women of reproductive age. Of pregnancies with livebirth outcomes, 84% were successfully linked to infants. The prevalence of pregnancy outcomes (livebirth, stillbirth, ectopic, molar, and abortion) was similar to national estimates.

Conclusions: This process provides an opportunity to study drug safety and care patterns during pregnancy and may be replicated in other claims databases containing ICD-10-CM, CPT, and HCPCS codes. Work is underway to validate and refine the various algorithms.

Keywords: administrative data; claims; infant; last menstrual period; pregnancy.

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Figures

FIGURE 1
FIGURE 1
Example of LMP clusters for a woman with three potential pregnancies. The x's mark the estimated LMP dates, clustered around three different time points.
FIGURE 2
FIGURE 2
Livebirth outcome algorithm. DX, diagnosis; LMP, last menstrual period; PX, procedure.
FIGURE 3
FIGURE 3
Stillbirth outcome algorithm. DX, diagnosis; LMP, last menstrual period; PX, procedure.
FIGURE 4
FIGURE 4
Live birth and stillbirth outcome algorithm. DX, diagnosis; LMP, last menstrual period; PX, procedure.
FIGURE 5
FIGURE 5
Ectopic pregnancy outcome algorithm. DX, diagnosis; LMP, last menstrual period; PX, procedure. Episodes <28 days were excluded.
FIGURE 6
FIGURE 6
Molar pregnancy outcome algorithm. DX, diagnosis; LMP, last menstrual period; PX, procedure.
FIGURE 7
FIGURE 7
Ectopic and molar pregnancy outcome algorithm. DX, diagnosis; LMP, last menstrual period; PX, procedure.
FIGURE 8
FIGURE 8
Abortion outcome algorithm. DX, diagnosis; LMP, last menstrual period; PX, procedure.
FIGURE 9
FIGURE 9
Pregnancy identification flow chart. 1170 431 (81%) disenrolled from health plan in the time window last menstrual period (LMP) to LMP + 42 weeks. 27478 (84%) episodes defined by delivery codes only.
FIGURE 10
FIGURE 10
Mother‐infant linkage and pregnancy outcomes. 1Includes multigestation with a livebirth and stillbirth. 2Includes ectopic and molar.
See this image and copyright information in PMC

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