Harnessing the Medicaid Analytic eXtract (MAX) to Evaluate Medications in Pregnancy: Design Considerations
Autor: | Kristin Palmsten, Mary K. Kowal, Krista F. Huybrechts, Soko Setoguchi, Karin B. Michels, Paige L. Williams, Sonia Hernandez-Diaz, Helen Mogun |
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Jazyk: | angličtina |
Rok vydání: | 2013 |
Předmět: |
Pediatrics
Non-Clinical Medicine Epidemiology lcsh:Medicine Cohort Studies 0302 clinical medicine Pregnancy Medicine 030212 general & internal medicine lcsh:Science Child education.field_of_study 030219 obstetrics & reproductive medicine Multidisciplinary Obstetrics and Gynecology Middle Aged 3. Good health Cohort Female Live birth Cohort study Research Article Adult medicine.medical_specialty Drugs and Devices Adolescent Clinical Research Design Population 03 medical and health sciences Young Adult Product Surveillance Postmarketing Humans education Biology Health Care Policy Population Biology business.industry Medicaid Pharmacoepidemiology lcsh:R Infant medicine.disease United States Pregnancy Complications Family medicine Observational study lcsh:Q business Delivery of Health Care |
Zdroj: | PLoS ONE PLoS ONE, Vol 8, Iss 6, p e67405 (2013) |
ISSN: | 1932-6203 |
Popis: | BACKGROUNDIn the absence of clinical trial data, large post-marketing observational studies are essential to evaluate the safety and effectiveness of medications during pregnancy. We identified a cohort of pregnancies ending in live birth within the 2000-2007 Medicaid Analytic eXtract (MAX). Herein, we provide a blueprint to guide investigators who wish to create similar cohorts from healthcare utilization data and we describe the limitations in detail.METHODSAmong females ages 12-55, we identified pregnancies using delivery-related codes from healthcare utilization claims. We linked women with pregnancies to their offspring by state, Medicaid Case Number (family identifier) and delivery/birth dates. Then we removed inaccurate linkages and duplicate records and implemented cohort eligibility criteria (i.e., continuous and appropriate enrollment type, no private insurance, no restricted benefits) for claim information completeness.RESULTSFrom 13,460,273 deliveries and 22,408,810 child observations, 6,107,572 pregnancies ending in live birth were available after linkage, cleaning, and removal of duplicate records. The percentage of linked deliveries varied greatly by state, from 0 to 96%. The cohort size was reduced to 1,248,875 pregnancies after requiring maternal eligibility criteria throughout pregnancy and to 1,173,280 pregnancies after further applying infant eligibility criteria. Ninety-one percent of women were dispensed at least one medication during pregnancy.CONCLUSIONSMother-infant linkage is feasible and yields a large pregnancy cohort, although the size decreases with increasing eligibility requirements. MAX is a useful resource for studying medications in pregnancy and a spectrum of maternal and infant outcomes within the indigent population of women and their infants enrolled in Medicaid. It may also be used to study maternal characteristics, the impact of Medicaid policy, and healthcare utilization during pregnancy. However, careful attention to the limitations of these data is necessary to reduce biases. |
Databáze: | OpenAIRE |
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