Diabetes Unit, Massachusetts General Hospital, Boston, MA (Ms Hsu and Drs Selen and Powe); Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, MA (Ms Hsu and Dr Powe).
Diabetes Unit, Massachusetts General Hospital, Boston, MA (Ms Hsu and Drs Selen and Powe); Harvard Medical School, Boston, MA (Drs Selen, James, Camargo, Kaimal, and Powe).
Am J Obstet Gynecol MFM. 2023 Feb;5(2):100814. doi: 10.1016/j.ajogmf.2022.100814. Epub 2022 Nov 15.
Administrative data, including International Classification of Diseases codes and birth certificate records, are often used for retrospective gestational diabetes research investigations to describe associations of gestational diabetes with perinatal complications and long-term outcomes, and to determine gestational diabetes prevalence. Research investigating the validity of using International Classification of Diseases codes and birth certificates for gestational diabetes ascertainment shows varying degrees of reliability.
This study aimed to evaluate the accuracy of both International Classification of Diseases codes and birth certificate diagnosis for gestational diabetes ascertainment in a large hospital-based cohort of pregnant individuals, using laboratory criteria for gestational diabetes mellitus as the reference.
We studied individuals who received prenatal care at an academic hospital and affiliated community health centers between 1998 and 2016. In the setting of universal 2-step screening for gestational diabetes, pregnant individuals were classified as having gestational diabetes if ≥2 oral glucose tolerance test values met or exceeded National Diabetes Data Group thresholds. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value for International Classification of Diseases code and birth certificate ascertainment of gestational diabetes, and their exact binomial 95% confidence intervals.
In a cohort of 51,059 pregnancies with complete glucose screening, 1303 (2.6%) met National Diabetes Data Group laboratory criteria for gestational diabetes. Gestational diabetes International Classification of Diseases codes had moderate sensitivity of 70.5% (95% confidence interval, 67.9-72.9), high specificity of 99.3% (95% confidence interval, 99.3-99.4), a positive predictive value of 73.3% (95% confidence interval, 70.8-75.8), and a negative predictive value of 99.2% (95% confidence interval, 99.1-99.3). In the 46,512 pregnancies linked to birth certificate data, birth certificate diagnosis had moderate sensitivity (66.3% [95% confidence interval, 63.6-69.0]), high specificity (98.9% [95% confidence interval, 98.8-99.0]), moderate positive predictive value (62.1% [95% confidence interval, 59.8-64.4]), and high negative predictive value (99.1% [95% confidence interval, 99.0-99.2]).
Ascertainment of gestational diabetes using administrative data, including International Classification of Diseases codes or birth certificates, has moderate sensitivity, moderate positive predictive value, high specificity, and high negative predictive value. Our findings provide context for interpreting the validity of studies that depend on administrative data for ascertainment of gestational diabetes and comparing them with prospective studies that use laboratory-based gestational diabetes criteria.
行政数据，包括国际疾病分类代码和出生证明记录，常用于回顾性妊娠期糖尿病研究调查，以描述妊娠期糖尿病与围产期并发症和长期结局的关联，并确定妊娠期糖尿病的患病率。研究表明，使用国际疾病分类代码和出生证明来确定妊娠期糖尿病的准确性存在一定程度的可靠性。
本研究旨在评估在一个大型基于医院的孕妇队列中，使用实验室标准确定妊娠期糖尿病的国际疾病分类代码和出生证明的准确性。
我们研究了 1998 年至 2016 年期间在学术医院和附属社区卫生中心接受产前护理的个体。在普遍进行两步筛查的情况下，对于妊娠期糖尿病，如果≥2 个口服葡萄糖耐量试验值符合或超过国家糖尿病数据组的标准，则将个体归类为患有妊娠期糖尿病。我们计算了国际疾病分类代码和出生证明确定妊娠期糖尿病的灵敏度、特异性、阳性预测值和阴性预测值，并计算了它们确切的二项式 95%置信区间。
在一项包含 51059 例完整葡萄糖筛查的队列中，有 1303 例（2.6%）符合国家糖尿病数据组实验室标准的妊娠期糖尿病。妊娠期糖尿病国际疾病分类代码的灵敏度为 70.5%（95%置信区间，67.9-72.9），特异性为 99.3%（95%置信区间，99.3-99.4），阳性预测值为 73.3%（95%置信区间，70.8-75.8），阴性预测值为 99.2%（95%置信区间，99.1-99.3）。在与出生证明数据相关联的 46512 例妊娠中，出生证明诊断的灵敏度为 66.3%（95%置信区间，63.6-69.0%），特异性为 98.9%（95%置信区间，98.8-99.0%），阳性预测值为 62.1%（95%置信区间，59.8-64.4%），阴性预测值为 99.1%（95%置信区间，99.0-99.2%）。
使用行政数据（包括国际疾病分类代码或出生证明）确定妊娠期糖尿病的方法具有中等的灵敏度、中等的阳性预测值、高特异性和高阴性预测值。我们的研究结果为解释基于实验室标准的前瞻性研究与依赖行政数据确定妊娠期糖尿病的研究之间的有效性提供了背景，并为它们提供了比较。
