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BACKGROUND: Antidepressant use later in pregnancy has been associated with preeclampsia and postpartum hemorrhage (PPH) in some studies. OBJECTIVE: To evaluate the association between patterns of prenatal antidepressant dose across gestation and risk of precclampsia and PPH. METHODS: We utilized OptumLabs® Data Warehouse (2012–2016) administrative health care claims, identifying 226,932 singleton live-born deliveries for this retrospective cohort study. Antidepressant dispensing doses were converted to fluoxetine equivalents. Using k-means longitudinal, we identified women with similar patterns of antidepressant exposure, i.e., trajectory groups, during the first 20 and 35 gestational weeks. We estimated risk ratios (RR) and 95% confidence intervals (CI) for the association between trajectory groups and preeclampisa (20-week groups) and PPH (35-week groups), adjusting for demographics, comorbidities, and other psychotropic medications. Linear trend tests assessing increasing risk of the outcomes across groups were performed. RESULTS: Among 15,041 (6.6%) pregnancies exposed to an antidepressant, the following trajectory groups were identified: A-low exposure, starting pregnancy at ~10mg/day, with 1(st) trimester reduction/discontinuation, B-low sustained exposure of ~20 mg/day, C-moderate exposure (~40mg/day) with 1(st) trimester reduction/discontinuation, D-moderate sustained exposure of ~40 mg/day, and E-high sustained exposure of ~75mg/day. In the low exposure with reduction/discontinuation trajectory, risks were 8.2% for preeclampsia and 2.7% for PPH. Compared with this group, low, moderate, and high sustained trajectories were associated with preeclampsia [adjusted (a)RR: 1.17 (95% CI: 1.01, 1.34), aRR: 1.31 (95% CI: 1.12, 1.54), aRR: 1.41 (95% CI: 1.05, 1.90), respectively] and PPH [aRR: 1.32 (1.05, 1.66), aRR: 1.35 (95% CI: 1.03,1.78), aRR: 2.51 (95% CI: 1.69, 3.71), respectively]; p

Background 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. Methods 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. Results 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. Conclusions 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.

BACKGROUND: Pre-existing conditions are imperfectly recorded in healthcare databases. We assessed whether pre-existing neurologic conditions (epilepsy, multiple sclerosis [MS]) were differentially recorded in the presence of major obstetric outcomes (Caesarean delivery, preterm delivery, preeclampsia) in delivery records. We also evaluated the impact of differential recording on measures of frequency and association between the conditions and outcomes. METHODS: The 2011-2014 Truven Health MarketScan® Commercial Claims Dataset was used to identify deliveries. We calculated the relative recording of epilepsy and MS at delivery compared with a 270-day pre-delivery interval, both overall and by the presence of major obstetric outcomes. We estimated risk ratios of the association between epilepsy and MS with the outcomes for each ascertainment window. RESULTS: We identified 909,065 deliveries in women continuously enrolled from 270-days before the delivery date. Of women with epilepsy identified in the pre-delivery interval, 73% had the condition coded at delivery. For MS, the proportion was 60%. MS recording at delivery did not vary by obstetric outcomes, however delivery-coded epilepsy was less likely confirmed in the pre-delivery interval in the presence of preeclampsia. Generally, the period of ascertainment did not meaningfully impact risk ratios, however the risk ratio for preeclampsia associated with epilepsy was 1.67 [95% CI: 1.47, 1.90] when epilepsy was ascertained at delivery and 1.26 [95% CI: 1.07, 1.48] when epilepsy was ascertained in the pre-delivery interval (heterogeneity, p=0.007). CONCLUSIONS: Ascertainment of epilepsy and MS in delivery records underestimated prevalence. However the window of recording generally did not impact associations with obstetric outcomes.

Background A "Table Fallacy," as coined by Westreich and Greenland, reports multiple adjusted effect estimates from a single model. This practice, which remains common in published literature, can be problematic when different types of effect estimates are presented together in a single table. The purpose of this paper is to quantitatively illustrate this potential for misinterpretation with an example estimating the effects of preeclampsia on preterm birth. Methods We analysed a retrospective population-based cohort of 2 963 888 singleton births in California between 2007 and 2012. We performed a modified Poisson regression to calculate the total effect of preeclampsia on the risk of PTB, adjusting for previous preterm birth. pregnancy alcohol abuse, maternal education, and maternal socio-demographic factors (Model 1). In subsequent models, we report the total effects of previous preterm birth, alcohol abuse, and education on the risk of PTB, comparing and contrasting the controlled direct effects, total effects, and confounded effect estimates, resulting from Model 1. Results The effect estimate for previous preterm birth (a controlled direct effect in Model 1) increased 10% when estimated as a total effect. The risk ratio for alcohol abuse, biased due to an uncontrolled confounder in Model 1, was reduced by 23% when adjusted for drug abuse. The risk ratio for maternal education, solely a predictor of the outcome, was essentially unchanged. Conclusions Reporting multiple effect estimates from a single model may lead to misinterpretation and lack of reproducibility. This example highlights the need for careful consideration of the types of effects estimated in statistical models.