Palmsten Kristin, Hulugalle Avanthi, Bandoli Gretchen, Kuo Grace M, Ansari Shayda, Xu Ronghui, Chambers Christina D
School of Medicine, Department of Pediatrics, University of California, San Diego, La Jolla, CA.
College of Global Public Health, New York University, New York, NY.
Paediatr Perinat Epidemiol. 2018 Jan;32(1):68-77. doi: 10.1111/ppe.12415. Epub 2017 Oct 3.
There are limited data regarding the comparability of medication exposure information during pregnancy from maternal report and medical records, including for rheumatoid arthritis and asthma-related medications.
This study included pregnant women with rheumatoid arthritis (n = 216) and asthma (n = 172) enrolled in the MothertoBaby Pregnancy Studies (2009-2014). Women reported types and dates of medications used through semi-structured telephone interviews up to three times during pregnancy and once after delivery, and medical records were obtained. We calculated Cohen's kappa coefficients and 95% confidence intervals (CIs) and per cent agreement for agreement between report and records.
For rheumatoid arthritis, prednisone was reported most frequently (53%). During pregnancy, kappa coefficients for rheumatoid arthritis medications ranged from 0.32 (95% CI 0.15, 0.50) for ibuprofen, with 84.3% agreement, to 0.90 (95% CI 0.84, 0.96) for etanercept with 95.4% agreement, and was 0.44 (95% CI 0.33, 0.55) for prednisone, with 71.3% agreement. For asthma, albuterol was reported most frequently (77.9%). During pregnancy, kappa coefficients for asthma medications ranged from 0.21 (95% CI 0.08, 0.35), with 64.5% agreement for albuterol to 0.84 (95% CI 0.71, 0.96) for budesonide/formoterol, with 96.5% agreement. Where kappas for any use during pregnancy were less than excellent (i.e. ≤0.80), medication use was more frequently captured by report than record.
Agreement was higher for medications typically used continuously than sporadically. Information on medication use from medical records alone may not be adequate when studying the impact of intermittently used medications during pregnancy on perinatal outcomes.
关于孕期用药暴露信息通过母亲报告与医疗记录的可比性的数据有限，包括类风湿关节炎和哮喘相关药物。
本研究纳入了参与母婴孕期研究（2009 - 2014年）的类风湿关节炎孕妇（n = 216）和哮喘孕妇（n = 172）。女性通过半结构化电话访谈报告孕期使用药物的类型和日期，孕期最多进行三次，产后一次，并获取医疗记录。我们计算了科恩kappa系数、95%置信区间（CI）以及报告与记录之间的一致百分比。
对于类风湿关节炎，泼尼松的报告频率最高（53%）。孕期，类风湿关节炎药物的kappa系数范围从布洛芬的0.32（95%CI 0.15，0.50），一致性为84.3%，到依那西普的0.90（95%CI 0.84，0.96），一致性为95.4%，泼尼松的kappa系数为0.44（95%CI 0.33，0.55），一致性为71.3%。对于哮喘，沙丁胺醇的报告频率最高（77.9%）。孕期，哮喘药物的kappa系数范围从沙丁胺醇的0.21（95%CI 0.08，0.35），一致性为64.5%，到布地奈德/福莫特罗的0.84（95%CI 0.71，0.96），一致性为96.5%。在孕期任何用药的kappa系数低于优秀水平（即≤0.80）的情况下，报告捕获的用药情况比记录更频繁。
对于通常持续使用而非偶尔使用的药物，一致性更高。在研究孕期间歇性使用药物对围产期结局的影响时，仅依靠医疗记录获取的用药信息可能并不充分。
