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The Impact of Different Case Ascertainment Definitions on the Prevalence of Major Congenital Malformations and their Association with Asthma During Pregnancy

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Abstract

Objectives To compare the prevalence of major malformations using different case ascertainment definitions and to evaluate their impact on maternal asthma-major malformations association. Methods A cohort of pregnancies with and without asthma between 1990 and 2010 was formed. We used two classification methods: the Two step Congenital Malformation Classification (TCMC) and the Canadian Congenital Anomalies Surveillance System (CCASS). Within each method, three case definitions were compared: (1) ≥1 diagnosis in the hospital database; (2) ≥1 diagnosis in the hospital database or ≥2 in the medical claims; and (3) ≥1 diagnosis in the hospital database or ≥1 in the medical claims. We calculated the prevalence of major malformations and adjusted odds ratios (aORs) for maternal asthma association. Results Of 467,946 pregnancies, 12.3 % were with active asthma. The prevalence estimates were: TCMC 5.10–7.08 % and CCASS 7.03–10.57 %. Asthma-major malformations association was weaker with the CCASS (aOR 1.14–1.20) versus TCMC (aOR 1.22–1.26). Discussion The case ascertainment definitions with ≥1 hospitalization are likely to be the most reliable in similar administrative databases. The case ascertainment definition had a considerable impact on the prevalence of major malformations, but hardly influenced the aORs. Future studies should formally assess the validity of the case ascertainment definitions and allow generalizability to other maternal exposures.

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Acknowledgments

This study was funded by the Canadian Institutes for Health Research, Grant Number: MOP-97731. We are grateful to the Commission d’accès à l’information du Québec for authorising the study and to the Régie de l’assurance-mladie du Québec for providing the data.

Financial Diclosure

L. Blais reports grants from CIHR during the conduct of the study; S.Eltonsy is the recipient of The Fonds de recherche du Québec – Santé (FRQS) doctoral grant. A.Forget has nothing to disclose. This study was funded the Canadian Institutes for Health Research, grant number: MOP-97731.

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Authors and Affiliations

  1. Faculté de pharmacie, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, QC, H3C 3J7, Canada

    Sherif Eltonsy, Amelie Forget & Lucie Blais

  2. Hôpital du Sacré-Cœur de Montréal, 5400, boul. Gouin Ouest, Montréal, QC, H4J 1C5, Canada

    Sherif Eltonsy, Amelie Forget & Lucie Blais

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  1. Sherif Eltonsy
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  2. Amelie Forget
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Correspondence to Lucie Blais.

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Ethical Statement

This research project was approved by the Ethics Committee of the Hôpital du Sacré-Cœur de Montréal. Authorization was obtained from the Commission d’Accès à l’Information du Québec to access and link the RAMQ and MED-ECHO databases.

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Eltonsy, S., Forget, A. & Blais, L. The Impact of Different Case Ascertainment Definitions on the Prevalence of Major Congenital Malformations and their Association with Asthma During Pregnancy. Matern Child Health J 21, 616–625 (2017). https://doi.org/10.1007/s10995-016-2147-1

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