Eltonsy Sherif, Forget Amelie, Blais Lucie
Faculté de pharmacie, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, QC, H3C 3J7, Canada.
Hôpital du Sacré-Cœur de Montréal, 5400, boul. Gouin Ouest, Montréal, QC, H4J 1C5, Canada.
Matern Child Health J. 2017 Mar;21(3):616-625. doi: 10.1007/s10995-016-2147-1.
Objectives To compare the prevalence of major malformations using different case ascertainment definitions and to evaluate their impact on maternal asthma-major malformations association. Methods A cohort of pregnancies with and without asthma between 1990 and 2010 was formed. We used two classification methods: the Two step Congenital Malformation Classification (TCMC) and the Canadian Congenital Anomalies Surveillance System (CCASS). Within each method, three case definitions were compared: (1) ≥1 diagnosis in the hospital database; (2) ≥1 diagnosis in the hospital database or ≥2 in the medical claims; and (3) ≥1 diagnosis in the hospital database or ≥1 in the medical claims. We calculated the prevalence of major malformations and adjusted odds ratios (aORs) for maternal asthma association. Results Of 467,946 pregnancies, 12.3 % were with active asthma. The prevalence estimates were: TCMC 5.10-7.08 % and CCASS 7.03-10.57 %. Asthma-major malformations association was weaker with the CCASS (aOR 1.14-1.20) versus TCMC (aOR 1.22-1.26). Discussion The case ascertainment definitions with ≥1 hospitalization are likely to be the most reliable in similar administrative databases. The case ascertainment definition had a considerable impact on the prevalence of major malformations, but hardly influenced the aORs. Future studies should formally assess the validity of the case ascertainment definitions and allow generalizability to other maternal exposures.
目的 使用不同的病例确诊定义比较主要畸形的患病率，并评估其对母亲哮喘与主要畸形关联的影响。方法 构建了一个1990年至2010年间患有和未患哮喘的妊娠队列。我们使用了两种分类方法：两步先天性畸形分类法（TCMC）和加拿大先天性异常监测系统（CCASS）。在每种方法中，比较了三种病例定义：（1）医院数据库中≥1次诊断；（2）医院数据库中≥1次诊断或医疗理赔中≥2次诊断；（3）医院数据库中≥1次诊断或医疗理赔中≥1次诊断。我们计算了主要畸形的患病率以及母亲哮喘关联的调整优势比（aORs）。结果 在467,946例妊娠中，12.3%患有活动性哮喘。患病率估计值为：TCMC为5.10 - 7.08%，CCASS为7.03 - 10.57%。与TCMC（aOR 1.22 - 1.26）相比，CCASS的哮喘与主要畸形关联较弱（aOR 1.14 - 1.20）。讨论 在类似的行政数据库中，≥1次住院的病例确诊定义可能是最可靠的。病例确诊定义对主要畸形的患病率有相当大的影响，但对aORs影响不大。未来的研究应正式评估病例确诊定义的有效性，并允许将其推广到其他母亲暴露情况。
