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Pregnancy, Injury, and Birth Outcomes: Linking birth/fetal death certificates to hospital data

Pregnancy, Injury, and Birth Outcomes: Linking birth/fetal death certificates to hospital data. Melissa Schiff, MD, MPH Victoria Holt, PhD Janet Daling, PhD. Injury during Pregnancy. A leading cause of morbidity and mortality during pregnancy Occurs in 1 out of 12 pregnancies

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Pregnancy, Injury, and Birth Outcomes: Linking birth/fetal death certificates to hospital data

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  1. Pregnancy, Injury, and Birth Outcomes:Linking birth/fetal death certificates to hospital data Melissa Schiff, MD, MPH Victoria Holt, PhD Janet Daling, PhD

  2. Injury during Pregnancy • A leading cause of morbidity and mortality during pregnancy • Occurs in 1 out of 12 pregnancies • Injury during pregnancy assessed in studies of maternal mortality • Few population-based studies of adverse outcomes after non-fatal injuries during pregnancy

  3. Pregnancy Outcomes Following Injury • Case series – trauma registries, obstetric services (N=27-476) • Purpose – appropriate clinical management, prediction of pregnancy outcomes • Outcomes assessed – maternal and fetal death, abruption, preterm labor and delivery

  4. Study Aims • Describe mechanisms of injury during pregnancy • Evaluate the risk of adverse maternal and infant outcomes following injury during pregnancy

  5. Methods • Retrospective cohort study of pregnant women hospitalized for injury in Washington State 1989-2001 • Hospital discharge data linked to birth and fetal death certificates using personal identifiers

  6. Subjects • Exposed group - injury hospitalization during pregnancy in hospital discharge data, ICD-9CM codes 800 - 959.99 or external causation codes (E codes) • ICD codes identified 73.6% • E codes identified 90.1% • Unexposed comparison group - randomly chosen pregnant women with singleton birth/fetal death, no injury hospitalization

  7. Pregnancy Outcomes • Ascertained using birth/fetal death certificate and ICD codes • Maternal outcomes • preterm labor (<37 weeks gestation) • placental abruption • labor induction • Cesarean delivery • maternal death

  8. Pregnancy Outcomes (cont’d) • Infant outcomes • prematurity (<37 weeks gestation) • low birth weight (<2500 grams) • fetal distress • fetal death

  9. Analysis • Demographic, obstetric characteristics comparing uninjured to injured • Mechanism of injury • Poisson regression - relative risks and 95% confidence intervals • Confounders - education, smoking, trimester of initiation of prenatal care

  10. Demographic and Obstetric Characteristics

  11. Mechanisms and Intent of Injury

  12. Maternal Outcomes *Adjusted for smoking, education, PNC initiation

  13. Infant Outcomes *Adjusted for smoking, education, PNC initiation

  14. Limitations • Misclassification of injury mechanism - possible over-reporting falls, under-reporting assaults - legal and social acceptability • Limitations of hospital discharge data coding for exposure and outcome information • minimized by using multiple sources

  15. Limitations (cont’d) • Differential misclassification of outcomes - increased awareness of potential adverse outcomes after injury resulting in differential reporting of subjective diagnoses (abruption, fetal distress)

  16. Conclusions • Falls and motor vehicle crashes - most common mechanisms of injuries during pregnancy • Injury during pregnancy can result in adverse maternal and infant outcomes

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