Abstract

Objectives

To define pregnancy episodes and estimate gestational age within electronic health record (EHR) data from the National COVID Cohort Collaborative (N3C).

Materials and Methods

We developed a comprehensive approach, named Hierarchy and rule-based pregnancy episode Inference integrated with Pregnancy Progression Signatures (HIPPS), and applied it to EHR data in the N3C (January 1, 2018–April 7, 2022). HIPPS combines: (1) an extension of a previously published pregnancy episode algorithm, (2) a novel algorithm to detect gestational age-specific signatures of a progressing pregnancy for further episode support, and (3) pregnancy start date inference. Clinicians performed validation of HIPPS on a subset of episodes. We then generated pregnancy cohorts based on gestational age precision and pregnancy outcomes for assessment of accuracy and comparison of COVID-19 and other characteristics.

Results

We identified 628 165 pregnant persons with 816 471 pregnancy episodes, of which 52.3% were live births, 24.4% were other outcomes (stillbirth, ectopic pregnancy, abortions), and 23.3% had unknown outcomes. Clinician validation agreed 98.8% with HIPPS-identified episodes. We were able to estimate start dates within 1 week of precision for 475 433 (58.2%) episodes. 62 540 (7.7%) episodes had incident COVID-19 during pregnancy.

Discussion

HIPPS provides measures of support for pregnancy-related variables such as gestational age and pregnancy outcomes based on N3C data. Gestational age precision allows researchers to find time to events with reasonable confidence.

Conclusion

We have developed a novel and robust approach for inferring pregnancy episodes and gestational age that addresses data inconsistency and missingness in EHR data.

Details

Title
Who is pregnant? Defining real-world data-based pregnancy episodes in the National COVID Cohort Collaborative (N3C)
Author
Jones, Sara E 1   VIAFID ORCID Logo  ; Bradwell, Katie R 2   VIAFID ORCID Logo  ; Chan, Lauren E 3   VIAFID ORCID Logo  ; McMurry, Julie A 4 ; Olson-Chen, Courtney 5 ; Tarleton, Jessica 6   VIAFID ORCID Logo  ; Wilkins, Kenneth J 7 ; Ly, Victoria 5 ; Ljazouli, Saad 2 ; Qin, Qiuyuan 8 ; Emily Groene Faherty 9 ; Yan Kwan Lau 10 ; Xie, Catherine 8 ; Yu-Han, Kao 10 ; Liebman, Michael N 11 ; Federico Mariona 12 ; Challa, Anup P 13 ; Li, Li 10   VIAFID ORCID Logo  ; Ratcliffe, Sarah J 14 ; Haendel, Melissa A 3 ; Patel, Rena C 15 ; Hill, Elaine L 5 ; Wilcox, Adam B; Lee, Adam M; Graves, Alexis; Alfred (Jerrod) Anzalone; Manna, Amin; Saha, Amit; Olex, Amy; Zhou, Andrea; Williams, Andrew E; Southerland, Andrew; Girvin, Andrew T; Walden, Anita; Sharathkumar, Anjali A; Amor, Benjamin; Bates, Benjamin; Hendricks, Brian; Patel, Brijesh; Alexander, Caleb; Bramante, Carolyn; Ward-Caviness, Cavin; Madlock-Brown, Charisse; Suver, Christine; Chute, Christopher; Dillon, Christopher; Wu, Chunlei; Schmitt, Clare; Takemoto, Cliff; Housman, Dan; Davera Gabriel; Eichmann, David A; Mazzotti, Diego; Brown, Don; Boudreau, Eilis; Zampino, Elizabeth; Emily Carlson Marti; Pfaff, Emily R; French, Evan; Koraishy, Farrukh M; Prior, Fred; Sokos, George; Martin, Greg; Lehmann, Harold; Spratt, Heidi; Mehta, Hemalkumar; Liu, Hongfang; Sidky, Hythem; Awori Hayanga, J W; Pincavitch, Jami; Clark, Jaylyn; Harper, Jeremy Richard; Islam, Jessica; Ge, Jin; Gagnier, Joel; Saltz, Joel H; Loomba, Johanna; Buse, John; Mathew, Jomol; Rutter, Joni L; Starren, Justin; Crowley, Karen; Bradwell, Katie Rebecca; Walters, Kellie M; Wilkins, Ken; Gersing, Kenneth R; Cato, Kenrick Dwain; Murray, Kimberly; Kostka, Kristin; Northington, Lavance; Pyles, Lee Allan; Misquitta, Leonie; Cottrell, Lesley; Portilla, Lili; Deacy, Mariam; Bissell, Mark M; Clark, Marshall; Emmett, Mary; Mary Morrison Saltz; Palchuk, Matvey B; Adams, Meredith; Temple-O'Connor, Meredith; Kurilla, Michael G; Morris, Michele; Qureshi, Nabeel; Safdar, Nasia; Garbarini, Nicole; Sharafeldin, Noha; Sadan, Ofer; Francis, Patricia A; Penny Wung Burgoon; Robinson, Peter; Payne, Philip R O; Fuentes, Rafael; Jawa, Randeep; Erwin-Cohen, Rebecca; Patel, Rena; Moffitt, Richard A; Zhu, Richard L; Kamaleswaran, Rishi; Hurley, Robert; Miller, Robert T; Pyarajan, Saiju; Michael, Sam G; Bozzette, Samuel; Mallipattu, Sandeep; Satyanarayana Vedula; Chapman, Scott; O'Neil, Shawn T; Setoguchi, Soko; Hong, Stephanie S; Johnson, Steve; Bennett, Tellen D; Callahan, Tiffany; Topaloglu, Umit; Sheikh, Usman; Gordon, Valery; Subbian, Vignesh; Kibbe, Warren A; Hernandez, Wenndy; Beasley, Will; Cooper, Will; Hillegass, William; Xiaohan Tanner Zhang

1  Office of Data Science and Emerging Technologies, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Rockville, MD 20852, United States 
2  Palantir Technologies , Denver, CO 80202, United States 
3  College of Public Health and Human Sciences, Oregon State University , Corvallis, OR 97331, United States 
4  Department of Biomedical Informatics, University of Colorado, Anschutz Medical Campus , Aurora, CO 80045, United States 
5  Department of Obstetrics and Gynecology, University of Rochester Medical Center , Rochester, NY 14620, United States 
6  Department of Obstetrics and Gynecology, Medical University of South Carolina , Charleston, SC 29425, United States 
7  Biostatistics Program, Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health , Bethesda, MD 20892, United States 
8  Department of Public Health Sciences, University of Rochester Medical Center , Rochester, NY 14618, United States 
9  School of Public Health, University of Minnesota , Minneapolis, MN 55455, United States 
10  Sema4 , Stamford, CT 06902, United States 
11  IPQ Analytics, LLC, Kennett Square , PA 19348, United States 
12  Beaumont Hospital , Dearborn, MI 48124, United States 
13  Department of Chemical and Biomolecular Engineering, Vanderbilt University , Nashville, TN 37212, United States 
14  Department of Public Health Sciences, University of Virginia , Charlottesville, VA 22903, United States 
15  Department of Medicine and Global Health, University of Washington , Seattle, WA 98105, United States 
Publication year
2023
Publication date
Oct 2023
Publisher
Oxford University Press
e-ISSN
25742531
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1093/jamiaopen/ooad067
ProQuest document ID
3168347480
Copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of the American Medical Informatics Association. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.