PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.
Applied Research and Development, Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
Cephalalgia. 2024 Apr;44(4):3331024241248846. doi: 10.1177/03331024241248846.
Migraine is common in women of reproductive age. Migraine's episodic manifestation and acute and preventive pharmacological treatment options challenge studying drug safety for this condition during pregnancy. To improve such studies, we aimed to develop algorithms to identify and characterize migraines in electronic healthcare registries and to assess the level of care.
We linked four registries to detect pregnancies from 2009-2018 and used three algorithms for migraine identification: i) diagnostic codes, ii) triptans dispensed, and iii) a combination of both. We assessed migraine severity using dispensed drugs as proxies. ICD-10 diagnostic subcodes of migraine (G43) allowed the allocation of four subtypes: complicated and/or status migrainosus; with aura; without aura; other/unspecified.
We included 535,089 pregnancies in 367,908 women with available one-year lookback. The prevalence of migraines identified was 2.9%-4.3% before, and 0.8%-1.5% during pregnancy, depending on algorithm used. Pregnant women with migraine were mostly managed in primary care.
Primary care data in combination with drug dispensation records were instrumental for identification of migraine in electronic healthcare registries. Data from secondary care and drug dispensations allow better characterization of migraines. Jointly, these algorithms may contribute to improved perinatal pharmacoepidemiological studies in this population by addressing confounding by maternal migraine indication.
偏头痛在育龄期妇女中很常见。偏头痛的发作性表现以及急性和预防性药物治疗选择，给妊娠期偏头痛药物安全性研究带来了挑战。为了改进此类研究，我们旨在开发算法，以识别和描述电子医疗记录中的偏头痛，并评估其护理水平。
我们将四个注册中心链接起来，以检测 2009 年至 2018 年期间的妊娠，并使用三种偏头痛识别算法：i）诊断代码，ii）曲普坦类药物的配给，iii）两者的组合。我们使用配给药物作为偏头痛严重程度的替代指标。偏头痛的 ICD-10 诊断子代码（G43）允许分配四种亚型：复杂型和/或偏头痛持续状态；有先兆；无先兆；其他/未特指。
我们纳入了 367908 名女性的 535089 次妊娠，其中 1 年的回溯数据可用。根据所使用的算法，偏头痛的患病率在妊娠前为 2.9%-4.3%，而在妊娠期间为 0.8%-1.5%。有偏头痛的孕妇大多在初级保健中接受治疗。
初级保健数据与药物配给记录相结合，对电子医疗记录中的偏头痛识别具有重要作用。来自二级保健和药物配给的数据可以更好地描述偏头痛。这些算法共同为改善该人群的围产期药物流行病学研究做出了贡献，因为它们解决了偏头痛的母源性指示因素所导致的混杂。
