检测和追溯早期非活产妊娠结局：基于挪威关联健康登记系统的新型妊娠算法的建立。

Detecting and Dating Early Non-live Pregnancy Outcomes: Generation of a Novel Pregnancy Algorithm From Norwegian Linked Health Registries.

机构信息

PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.

UiORealArt Convergence Environment, University of Oslo, Oslo, Norway.

出版信息

Pharmacoepidemiol Drug Saf. 2024 Sep;33(9):e70002. doi: 10.1002/pds.70002.

DOI:10.1002/pds.70002

PMID:39238438

Abstract

PURPOSE

Pregnancies ending before gestational week 12 are common but not notified to the Medical Birth Registry of Norway. Our goal was to develop an algorithm that more completely detects and dates all possible pregnancy outcomes (i.e., miscarriages, elective terminations, ectopic pregnancies, molar pregnancies, stillbirths, and live births) by using diagnostic codes from primary and secondary care registries to complement information from the birth registry.

METHODS

We used nationwide linked registry data between 2008 and 2018 in a hierarchical manner: We developed the UiO pregnancy algorithm to arrive at unique pregnancy outcomes, considering codes within 56 days as the same event. To estimate the gestational age of pregnancy outcomes identified in the primary and secondary care registries, we inferred the median gestational age of pregnancy markers (45 ICD-10 codes and 9 ICPC-2 codes) from pregnancies registered in the medical birth registry. When no pregnancy markers were available, we assigned outcome-specific gestational age estimates. The performance of the algorithm was assessed by blinded clinicians.

RESULTS

Using only the medical birth registry, we identified 649 703 pregnancies, including 1369 (0.2%) miscarriages and 3058 (0.5%) elective terminations. With the new algorithm, we detected 859 449 pregnancies, including 642 712 live-births (74.8%), 112 257 miscarriages (13.1%), 94 664 elective terminations (11.0%), 6429 ectopic pregnancies (0.7%), 2564 stillbirths (0.3%), and 823 molar pregnancies (0.1%). The median gestational age was 10 weeks (IQR 10-12) for miscarriages and 8 weeks (IQR 8-9) for elective terminations. Gestational age could be inferred using pregnancy markers for 66.3% of miscarriages and 47.2% of elective terminations.

CONCLUSION

The UiO pregnancy algorithm improved the detection and dating of early non-live pregnancy outcomes that would have gone unnoticed if relying solely on the medical birth registry information.

摘要

目的

妊娠 12 周前终止的妊娠很常见，但挪威医学出生登记处并未对此进行通知。我们的目标是开发一种算法，通过使用初级和二级保健登记处的诊断代码来补充出生登记处的信息，更全面地检测和确定所有可能的妊娠结局（即流产、选择性终止妊娠、异位妊娠、葡萄胎、死产和活产）。

方法

我们在 2008 年至 2018 年期间以分层方式使用全国性的注册数据：我们开发了 UiO 妊娠算法来确定独特的妊娠结局，将 56 天内的代码视为同一事件。为了估计初级和二级保健登记处中确定的妊娠结局的胎龄，我们从医学出生登记处中登记的妊娠中推断出妊娠标志物的中位数胎龄（45 个 ICD-10 代码和 9 个 ICPC-2 代码）。当没有妊娠标志物时，我们分配特定于结局的胎龄估计值。该算法的性能由盲法临床医生进行评估。

结果

仅使用医学出生登记处，我们确定了 649703 例妊娠，其中包括 1369 例（0.2%）流产和 3058 例（0.5%）选择性终止妊娠。使用新算法，我们检测到 859449 例妊娠，其中包括 642712 例活产（74.8%）、112257 例流产（13.1%）、94664 例选择性终止妊娠（11.0%）、6429 例异位妊娠（0.7%）、2564 例死产（0.3%）和 823 例葡萄胎（0.1%）。流产的中位胎龄为 10 周（IQR 10-12），选择性终止妊娠的中位胎龄为 8 周（IQR 8-9）。对于 66.3%的流产和 47.2%的选择性终止妊娠，可以使用妊娠标志物推断胎龄。