scholarly journals Reporting of gestational diabetes and other maternal medical conditions

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Heather J Baldwin ◽  
Tanya A Nippita ◽  
Kristen Rickard ◽  
Siranda Torvaldsen ◽  
Therese M McGee ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Gestational Diabetes ◽  
Gestational Hypertension ◽  
New South ◽  
Health Planning ◽  
New South Wales ◽  
Chronic Hypertension ◽  
Medical Conditions ◽  
Predictive Values ◽  
South Wales

IntroductionHospital datasets are a valuable resource for examining prevalence and outcomes of medical conditions during pregnancy. To enable effective research and health planning, it is important to determine whether variables are reliably captured. ObjectiveTo examine the reliability of reporting of gestational and pre-existing diabetes, hypertension, thyroid conditions, and morbid obesity in coded hospital records that inform the population-level New South Wales Admitted Patient Data Collection. MethodsCoded hospital admission data from two large tertiary hospitals in New South Wales, from 2011 to 2015, were compared with obstetric data, collected by midwives at outpatient pregnancy booking and in hospital after birth, as the reference standard. Records were deterministically linked and sensitivity, specificity, positive predictive values and negative predictive values for the conditions of interest were obtained. ResultsThere were 36,051 births included in the analysis. Sensitivity was high for gestational diabetes (83.6%, 95% CI 82.4–84.7%), pre-existing diabetes (88.2%, 95% CI 84.1–91.6%), and gestational hypertension (80.1%, 95% CI 78.2–81.9%), moderate for chronic hypertension (53.5%, 95% CI 47.8–59.1%), and low for thyroid conditions (12.9%, 95% CI 11.7–14.2%) and morbid obesity (9.8%, 95% CI 7.6–12.4%). Specificity was high for all conditions (≥97.8%, 95% CI 97.7–98.0) and positive predictive value ranged from 53.2% for chronic hypertension (95% CI 47.5–58.8%) to 92.7% for gestational diabetes (95% CI 91.8–93.5%). ConclusionOur findings suggest that coded hospital data are a reliable source of information for gestational and pre-existing diabetes and gestational hypertension. Chronic hypertension is less consistently reported, which may be remedied by grouping hypertension types. Data on thyroid conditions and morbid obesity should be used with caution, and if possible, other sources of data for those conditions should be sought.

scholarly journals 638Reporting of gestational diabetes and chronic conditions of pregnancy: validation of routinely collected hospital data

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Heather Baldwin ◽  
Siranda Torvaldsen ◽  
Kristen Rickard ◽  
Tanya Nippita ◽  
Jillian Patterson
Keyword(s):  
Morbid Obesity ◽  
Gestational Diabetes ◽  
Gestational Hypertension ◽  
High Sensitivity ◽  
Clinical Situation ◽  
Adverse Outcomes ◽  
Chronic Hypertension ◽  
Hospital Data ◽  
Predictive Values ◽  
Low Sensitivity

Abstract Background Gestational diabetes, hypertension, thyroid conditions and morbid obesity in pregnancy are associated with increased risks of adverse outcomes. Hospital data are important for research on these conditions, however, up-to-date validation of reporting is needed to understand the extent to which the data reflect the clinical situation. Methods Women giving birth to singleton infants in two tertiary hospitals in New South Wales, Australia, between 2011 and 2015 were included. Obstetric data, from the ObstetriX system, was used as the gold standard to which linked hospital data, from the Electronic Medical Record, were compared. Results There were 35,928 births included. Gestational and pre-existing diabetes had high sensitivity (83.6% and 88.2%) and positive predictive values (PPV, 92.7% and 86.0%). Pre-eclampsia and eclampsia, gestational hypertension and any hypertension had good sensitivity (80.0%, 80.1%, 81.5%), but moderate PPVs (59.7%, 65.6%, 70.4%), while for chronic hypertension sensitivity (53.5%) and PPV (53.2%) were lower. Obesity and thyroid conditions showed low sensitivity (9.8%, 12.9%; PPV 65.6%, 82.3%). Specificity and NPV were high for all conditions. Conclusions We found reliable reporting of gestational diabetes, pre-existing diabetes and all types hypertension, except for chronic hypertension which was moderately well reported. Thyroid conditions and morbid obesity were very poorly reported. Key messages Diabetes appears well reported in the hospital data, and sensitivity for hypertension may be improved by using a grouped category. Hospital data on thyroid conditions and obesity should be used with caution.

scholarly journals Are newly introduced criteria for the diagnosis of gestational diabetes mellitus associated with improved pregnancy outcomes and/or increased interventions in New South Wales, Australia? A population-based data linkage study

2021 ◽  
Vol 9 (1) ◽  
pp. e002277
Author(s):  
Deborah A Randall ◽  
Jonathan M Morris ◽  
Patrick Kelly ◽  
Sarah J Glastras
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Diagnostic Criteria ◽  
New South ◽  
New South Wales ◽  
Neonatal Morbidity ◽  
Adverse Outcomes ◽  
Newly Diagnosed ◽  
South Wales

IntroductionThe incidence of gestational diabetes mellitus (GDM) is increasing in Australia, influenced by changed diagnostic criteria. We aimed to identify whether the diagnostic change was associated with improved outcomes and/or increased obstetric interventions using state-wide data in New South Wales (NSW), Australia.Research design and methodsPerinatal and hospital data were linked for singleton births, 33–41 weeks’ gestation, 2006–2015, NSW. An adjusted Poisson model was used to split pregnancies from 2011 onwards into those that would have been diagnosed under the old criteria (‘previous GDM’) and newly diagnosed cases (‘additional GDM’). We compared actual rates of total and early (<39 weeks) planned births, cesareans, and maternal and neonatal adverse outcomes for GDM-diagnosed pregnancies using three predicted scenarios, where the ‘additional GDM’ group was assumed to have the same rates as: the ‘previous GDM’ group <2011 (scenario A); the ‘non-GDM’ group <2011 (scenario B); or the ‘non-GDM’ group ≥2011 (scenario C).ResultsGDM incidence more than doubled over the study period, with an inflection point observed at 2011. For those diagnosed with GDM since 2011, the actual incidence of interventions (planned births and cesareans) and macrosomia was consistent with scenario A, which meant higher intervention rates, but lower rates of macrosomia, than those with no GDM. Incidence of neonatal hypoglycemia was lower than scenario A and closer to the other scenarios. There was a reduction in perinatal deaths among those with GDM, lower than that predicted by all scenarios, indicating an improvement for all with GDM, not only women newly diagnosed. Incidence of maternal and neonatal morbidity indicators was within the confidence bounds for all three predicted scenarios.ConclusionsOur study suggests that the widely adopted new diagnostic criteria for GDM are associated with increased obstetric intervention rates and lower rates of macrosomic babies, but with no clear impacts on maternal or neonatal morbidity.

scholarly journals Gestational age as a predictor for subsequent preterm birth in New South Wales, Australia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gavin Pereira ◽  
Annette K. Regan ◽  
Kingsley Wong ◽  
Gizachew A. Tessema
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
New South ◽  
Absolute Risk ◽  
New South Wales ◽  
Predictive Ability ◽  
Evidence Base ◽  
First Birth ◽  
Predictive Values ◽  
South Wales

Abstract Background There is no validated evidence base on predictive ability and absolute risk of preterm birth by gestational age of the previous pregnancy. Methods We conducted a retrospective cohort study of mothers who gave birth to their first two children in New South Wales, 1994–2016 (N = 517,558 mothers). For each week of final gestational age of the first birth, we calculated relative and absolute risks of subsequent preterm birth. Results For mothers whose first birth had a gestational age of 22 to 30 weeks the absolute risks of clinically significant preterm second birth (before 28, 32, and 34 weeks) were all less than 14%. For all gestational ages of the first child the median gestational ages of the second child were all at least 38 weeks. Sensitivity and positive predictive values were all below 30%. Conclusion Previous gestational age alone is a poor predictor of subsequent risk of preterm birth.

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