Allen V M, Dodds L, Spencer A, Cummings E A, MacDonald N, Kephart G
Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada.
Chronic Dis Inj Can. 2012 Jun;32(3):113-20.
Accurate ascertainment of pregnant women with pre-existing diabetes allows for the comprehensive surveillance of maternal and neonatal outcomes associated with this chronic disease.
To determine the accuracy of case definitions for pre-existing diabetes mellitus when applied to a pregnant population, a cohort of women who were pregnant in Nova Scotia, Canada, between 1991 and 2003 was obtained from a population-based provincial perinatal database, the Nova Scotia Atlee Perinatal Database (NSAPD). Person-level data from administrative databases using hospital discharge abstract data and outpatient physician services data were linked to this cohort. Various algorithms for defining diabetes mellitus from the administrative data, including the algorithm suggested by the National Diabetes Surveillance System (NDSS), were compared to a reference standard definition from the NSAPD.
Validation of the NDSS case definition applied to this pregnant population demonstrated a sensitivity of 87% and a positive predictive value (PPV) of 66.4%. Use of ICD-9 and ICD-10 diagnostic codes among hospitalizations with diabetes mellitus in pregnancy showed important increases in sensitivity and PPV, especially for those pregnancies delivered in tertiary centres. In this population, pregnancy-related administrative data from the hospitalization database alone appear to be a more accurate data source for identifying pre-existing diabetes than applying the NDSS case definition, particularly when pregnant women are delivered in a tertiary hospital.
Although the NDSS definition of diabetes performs reasonably well compared to a reference standard definition of diabetes, using this definition for evaluating maternal and perinatal outcomes associated with diabetes in pregnancy will result in a certain degree of misclassification and, therefore, biased estimates of outcomes.
准确确定患有孕前糖尿病的孕妇，有助于全面监测与这种慢性疾病相关的母婴结局。
为了确定孕前糖尿病病例定义应用于孕妇群体时的准确性，从基于人群的省级围产期数据库——新斯科舍省阿特利围产期数据库（NSAPD）中获取了1991年至2003年间在加拿大新斯科舍省怀孕的一组女性。使用医院出院摘要数据和门诊医生服务数据的行政数据库中的个人层面数据与该队列相关联。将各种从行政数据中定义糖尿病的算法，包括国家糖尿病监测系统（NDSS）建议的算法，与NSAPD的参考标准定义进行比较。
应用于该孕妇群体的NDSS病例定义的验证显示，敏感性为87%，阳性预测值（PPV）为66.4%。在妊娠合并糖尿病的住院病例中使用ICD - 9和ICD - 10诊断代码，敏感性和PPV有显著提高，特别是对于那些在三级中心分娩的孕妇。在这个群体中，仅住院数据库中与妊娠相关的行政数据似乎是识别孕前糖尿病比应用NDSS病例定义更准确的数据源，尤其是当孕妇在三级医院分娩时。
尽管与糖尿病的参考标准定义相比，NDSS糖尿病定义表现得相当不错，但使用该定义评估与妊娠糖尿病相关的母婴结局会导致一定程度的错误分类，从而导致结局估计存在偏差。
