Who is pregnant? Defining real-world data-based pregnancy episodes in the National COVID Cohort Collaborative (N3C)

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

doi:10.1093/jamiaopen/ooad067

Who is pregnant? Defining real-world data-based pregnancy episodes in the National COVID Cohort Collaborative (N3C)

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

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

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.

Original language	English
Article number	ooad067
Journal	JAMIA Open
Volume	6
Issue number	3
DOIs	https://doi.org/10.1093/jamiaopen/ooad067
State	Published - Oct 1 2023

Keywords

COVID-19
algorithms
electronic health records
gestational age
pregnancy

Access to Document

10.1093/jamiaopen/ooad067

Cite this

N3C Consortium, Jones, S. E., Bradwell, K. R., Chan, L. E., McMurry, J. A., Olson-Chen, C., Tarleton, J., Wilkins, K. J., Ly, V., Ljazouli, S., Qin, Q., Faherty, E. G., Lau, Y. K., Xie, C., Kao, Y. H., Liebman, M. N., Mariona, F., Challa, A. P., Li, L., ... Zhang, X. T. (2023). Who is pregnant? Defining real-world data-based pregnancy episodes in the National COVID Cohort Collaborative (N3C). JAMIA Open, 6(3), Article ooad067. https://doi.org/10.1093/jamiaopen/ooad067

@article{758016ad5694400b9242f9d63dd3e390,

title = "Who is pregnant? Defining real-world data-based pregnancy episodes in the National COVID Cohort Collaborative (N3C)",

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.",

keywords = "COVID-19, algorithms, electronic health records, gestational age, pregnancy",

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

note = "Publisher Copyright: {\textcopyright} The Author(s) 2023.",

year = "2023",

month = oct,

day = "1",

doi = "10.1093/jamiaopen/ooad067",

language = "English",

volume = "6",

journal = "JAMIA Open",

issn = "2574-2531",

number = "3",

}

N3C Consortium, Jones, SE, Bradwell, KR, Chan, LE, McMurry, JA, Olson-Chen, C, Tarleton, J, Wilkins, KJ, Ly, V, Ljazouli, S, Qin, Q, Faherty, EG, Lau, YK, Xie, C, Kao, YH, Liebman, MN, Mariona, F, Challa, AP, Li, L, Ratcliffe, SJ, Haendel, MA, Patel, RC, Hill, EL, Wilcox, AB, Lee, AM, Graves, A, Anzalone, A, Manna, A, Saha, A, Olex, A, Zhou, A, Williams, AE, Southerland, A, Girvin, AT, Walden, A, Sharathkumar, AA, Amor, B, Bates, B, Hendricks, B, Patel, B, Alexander, C, Bramante, C, Ward-Caviness, C, Madlock-Brown, C, Suver, C, Chute, C, Dillon, C, Wu, C, Schmitt, C, Takemoto, C, Housman, D, Gabriel, D, Eichmann, DA, Mazzotti, D, Brown, D, Boudreau, E, Zampino, E, Marti, EC, Pfaff, ER, French, E, Koraishy, FM, Prior, F, Sokos, G, Martin, G, Lehmann, H, Spratt, H, Mehta, H, Liu, H, Sidky, H, Awori Hayanga, JW, Pincavitch, J, Clark, J, Harper, JR, Islam, J, Ge, J, Gagnier, J, Saltz, JH, Loomba, J, Buse, J, Mathew, J, Rutter, JL, Starren, J, Crowley, K, Walters, KM, Wilkins, K, Gersing, KR, Cato, KD, Murray, K, Kostka, K, Northington, L, Pyles, LA, Misquitta, L, Cottrell, L, Portilla, L, Deacy, M, Bissell, MM, Clark, M, Emmett, M, Saltz, MM, Palchuk, MB, Adams, M, Temple-O'Connor, M, Kurilla, MG, Morris, M, Qureshi, N, Safdar, N, Garbarini, N, Sharafeldin, N, Sadan, O, Francis, PA, Burgoon, PW, Robinson, P, Payne, PRO, Fuentes, R, Jawa, R, Erwin-Cohen, R, Moffitt, RA, Zhu, RL, Kamaleswaran, R, Hurley, R, Miller, RT, Pyarajan, S, Michael, SG, Bozzette, S, Mallipattu, S, Vedula, S, Chapman, S, O'Neil, ST, Setoguchi, S, Hong, SS, Johnson, S, Bennett, TD, Callahan, T, Topaloglu, U, Sheikh, U, Gordon, V, Subbian, V, Kibbe, WA, Hernandez, W, Beasley, W, Cooper, W, Hillegass, W & Zhang, XT 2023, 'Who is pregnant? Defining real-world data-based pregnancy episodes in the National COVID Cohort Collaborative (N3C)', JAMIA Open, vol. 6, no. 3, ooad067. https://doi.org/10.1093/jamiaopen/ooad067

TY - JOUR

T1 - Who is pregnant? Defining real-world data-based pregnancy episodes in the National COVID Cohort Collaborative (N3C)

AU - N3C Consortium

AU - Jones, Sara E.

AU - Bradwell, Katie R.

AU - Chan, Lauren E.

AU - McMurry, Julie A.

AU - Olson-Chen, Courtney

AU - Tarleton, Jessica

AU - Wilkins, Kenneth J.

AU - Ly, Victoria

AU - Ljazouli, Saad

AU - Qin, Qiuyuan

AU - Faherty, Emily Groene

AU - Lau, Yan Kwan

AU - Xie, Catherine

AU - Kao, Yu Han

AU - Liebman, Michael N.

AU - Mariona, Federico

AU - Challa, Anup P.

AU - Li, Li

AU - Ratcliffe, Sarah J.

AU - Haendel, Melissa A.

AU - Patel, Rena C.

AU - Hill, Elaine L.

AU - Wilcox, Adam B.

AU - Lee, Adam M.

AU - Graves, Alexis

AU - Anzalone, Alfred

AU - Manna, Amin

AU - Saha, Amit

AU - Olex, Amy

AU - Zhou, Andrea

AU - Williams, Andrew E.

AU - Southerland, Andrew

AU - Girvin, Andrew T.

AU - Walden, Anita

AU - Sharathkumar, Anjali A.

AU - Amor, Benjamin

AU - Bates, Benjamin

AU - Hendricks, Brian

AU - Patel, Brijesh

AU - Alexander, Caleb

AU - Bramante, Carolyn

AU - Ward-Caviness, Cavin

AU - Madlock-Brown, Charisse

AU - Suver, Christine

AU - Chute, Christopher

AU - Dillon, Christopher

AU - Wu, Chunlei

AU - Schmitt, Clare

AU - Takemoto, Cliff

AU - Housman, Dan

AU - Gabriel, Davera

AU - Eichmann, David A.

AU - Mazzotti, Diego

AU - Brown, Don

AU - Boudreau, Eilis

AU - Zampino, Elizabeth

AU - Marti, Emily Carlson

AU - Pfaff, Emily R.

AU - French, Evan

AU - Koraishy, Farrukh M.

AU - Prior, Fred

AU - Sokos, George

AU - Martin, Greg

AU - Lehmann, Harold

AU - Spratt, Heidi

AU - Mehta, Hemalkumar

AU - Liu, Hongfang

AU - Sidky, Hythem

AU - Awori Hayanga, J. W.

AU - Pincavitch, Jami

AU - Clark, Jaylyn

AU - Harper, Jeremy Richard

AU - Islam, Jessica

AU - Ge, Jin

AU - Gagnier, Joel

AU - Saltz, Joel H.

AU - Loomba, Johanna

AU - Buse, John

AU - Mathew, Jomol

AU - Rutter, Joni L.

AU - Starren, Justin

AU - Crowley, Karen

AU - Walters, Kellie M.

AU - Wilkins, Ken

AU - Gersing, Kenneth R.

AU - Cato, Kenrick Dwain

AU - Murray, Kimberly

AU - Kostka, Kristin

AU - Northington, Lavance

AU - Pyles, Lee Allan

AU - Misquitta, Leonie

AU - Cottrell, Lesley

AU - Portilla, Lili

AU - Deacy, Mariam

AU - Bissell, Mark M.

AU - Clark, Marshall

AU - Emmett, Mary

AU - Saltz, Mary Morrison

AU - Palchuk, Matvey B.

AU - Adams, Meredith

AU - Temple-O'Connor, Meredith

AU - Kurilla, Michael G.

AU - Morris, Michele

AU - Qureshi, Nabeel

AU - Safdar, Nasia

AU - Garbarini, Nicole

AU - Sharafeldin, Noha

AU - Sadan, Ofer

AU - Francis, Patricia A.

AU - Burgoon, Penny Wung

AU - Robinson, Peter

AU - Payne, Philip R.O.

AU - Fuentes, Rafael

AU - Jawa, Randeep

AU - Erwin-Cohen, Rebecca

AU - Moffitt, Richard A.

AU - Zhu, Richard L.

AU - Kamaleswaran, Rishi

AU - Hurley, Robert

AU - Miller, Robert T.

AU - Pyarajan, Saiju

AU - Michael, Sam G.

AU - Bozzette, Samuel

AU - Mallipattu, Sandeep

AU - Vedula, Satyanarayana

AU - Chapman, Scott

AU - O'Neil, Shawn T.

AU - Setoguchi, Soko

AU - Hong, Stephanie S.

AU - Johnson, Steve

AU - Bennett, Tellen D.

AU - Callahan, Tiffany

AU - Topaloglu, Umit

AU - Sheikh, Usman

AU - Gordon, Valery

AU - Subbian, Vignesh

AU - Kibbe, Warren A.

AU - Hernandez, Wenndy

AU - Beasley, Will

AU - Cooper, Will

AU - Hillegass, William

AU - Zhang, Xiaohan Tanner

PY - 2023/10/1

Y1 - 2023/10/1

N2 - 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.

AB - 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.

KW - COVID-19

KW - algorithms

KW - electronic health records

KW - gestational age

KW - pregnancy

UR - http://www.scopus.com/inward/record.url?scp=85169507173&partnerID=8YFLogxK

U2 - 10.1093/jamiaopen/ooad067

DO - 10.1093/jamiaopen/ooad067

M3 - Article

C2 - 37600074

AN - SCOPUS:85169507173

SN - 2574-2531

VL - 6

JO - JAMIA Open

JF - JAMIA Open

IS - 3

M1 - ooad067

ER -

Who is pregnant? Defining real-world data-based pregnancy episodes in the National COVID Cohort Collaborative (N3C)

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Keywords

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