Lu Chen1, Susan M Shortreed2, Thomas Easterling3, T Craig Cheetham4, Kristi Reynolds5, Lyndsay A Avalos6, Aruna Kamineni7, Victoria Holt3, Romain Neugebauer6, Mary Akosile7, Nerissa Nance6, Zoe Bider-Canfield5, Rod L Walker7, Sylvia E Badon6, Sascha Dublin2. 1. Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States. Electronic address: lu.chen@kp.org. 2. Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States; University of Washington, Seattle, WA, United States. 3. University of Washington, Seattle, WA, United States. 4. Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, United States; Chapman University, School of Pharmacy, Irvine, CA, United States. 5. Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, United States. 6. Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States. 7. Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States.
Abstract
OBJECTIVE: To incorporate blood pressure (BP), diagnoses codes, and medication fills from electronic medical records (EMR) to identify pregnant women with hypertension. STUDY DESIGN: A retrospective cohort study of singleton pregnancies at three US integrated health delivery systems during 2005-2014. MAIN OUTCOME MEASURES: Women were considered hypertensive if they had any of the following: (1) ≥2 high BPs (≥140/90 mmHg) within 30 days during pregnancy (High BP); (2) an antihypertensive medication fill in the 120 days before pregnancy and a hypertension diagnosis from 1 year prior to pregnancy through 20 weeks gestation (Treated Chronic Hypertension); or (3) a high BP, a hypertension diagnosis, and a prescription fill within 7 days during pregnancy (Rapid Treatment). We described characteristics of these pregnancies and conducted medical record review to understand hypertension presence and severity. RESULTS: Of 566,624 pregnancies, 27,049 (4.8%) met our hypertension case definition: 24,140 (89.2%) with High BP, 5,409 (20.0%) with Treated Chronic Hypertension, and 5,363 (19.8%) with Rapid Treatment (not mutually exclusive). Of hypertensive pregnancies, 19,298 (71.3%) received a diagnosis, 9,762 (36.1%) received treatment and 11,226 (41.5%) had a BP ≥ 160/110. In a random sample (n = 55) of the 7,559 pregnancies meeting the High BP criterion with no hypertension diagnosis, clinical statements about hypertension were found in medical records for 58% of them. CONCLUSION: Incorporating EMR BP identified many pregnant women with hypertension who would have been missed by using diagnosis codes alone. Future studies should seek to incorporate BP to study treatment and outcomes of hypertension in pregnancy.
OBJECTIVE: To incorporate blood pressure (BP), diagnoses codes, and medication fills from electronic medical records (EMR) to identify pregnant women with hypertension. STUDY DESIGN: A retrospective cohort study of singleton pregnancies at three US integrated health delivery systems during 2005-2014. MAIN OUTCOME MEASURES: Women were considered hypertensive if they had any of the following: (1) ≥2 high BPs (≥140/90 mmHg) within 30 days during pregnancy (High BP); (2) an antihypertensive medication fill in the 120 days before pregnancy and a hypertension diagnosis from 1 year prior to pregnancy through 20 weeks gestation (Treated Chronic Hypertension); or (3) a high BP, a hypertension diagnosis, and a prescription fill within 7 days during pregnancy (Rapid Treatment). We described characteristics of these pregnancies and conducted medical record review to understand hypertension presence and severity. RESULTS: Of 566,624 pregnancies, 27,049 (4.8%) met our hypertension case definition: 24,140 (89.2%) with High BP, 5,409 (20.0%) with Treated Chronic Hypertension, and 5,363 (19.8%) with Rapid Treatment (not mutually exclusive). Of hypertensive pregnancies, 19,298 (71.3%) received a diagnosis, 9,762 (36.1%) received treatment and 11,226 (41.5%) had a BP ≥ 160/110. In a random sample (n = 55) of the 7,559 pregnancies meeting the High BP criterion with no hypertension diagnosis, clinical statements about hypertension were found in medical records for 58% of them. CONCLUSION: Incorporating EMR BP identified many pregnant women with hypertension who would have been missed by using diagnosis codes alone. Future studies should seek to incorporate BP to study treatment and outcomes of hypertension in pregnancy.
Authors: Mark A Brown; Laura A Magee; Louise C Kenny; S Ananth Karumanchi; Fergus P McCarthy; Shigeru Saito; David R Hall; Charlotte E Warren; Gloria Adoyi; Salisu Ishaku Journal: Hypertension Date: 2018-07 Impact factor: 10.190
Authors: Pedro L Teixeira; Wei-Qi Wei; Robert M Cronin; Huan Mo; Jacob P VanHouten; Robert J Carroll; Eric LaRose; Lisa A Bastarache; S Trent Rosenbloom; Todd L Edwards; Dan M Roden; Thomas A Lasko; Richard A Dart; Anne M Nikolai; Peggy L Peissig; Joshua C Denny Journal: J Am Med Inform Assoc Date: 2016-08-07 Impact factor: 4.497
Authors: Susan E Spratt; Katherine Pereira; Bradi B Granger; Bryan C Batch; Matthew Phelan; Michael Pencina; Marie Lynn Miranda; Ebony Boulware; Joseph E Lucas; Charlotte L Nelson; Benjamin Neely; Benjamin A Goldstein; Pamela Barth; Rachel L Richesson; Isaretta L Riley; Leonor Corsino; Eugenia R McPeek Hinz; Shelley Rusincovitch; Jennifer Green; Anna Beth Barton; Carly Kelley; Kristen Hyland; Monica Tang; Amanda Elliott; Ewa Ruel; Alexander Clark; Melanie Mabrey; Kay Lyn Morrissey; Jyothi Rao; Beatrice Hong; Marjorie Pierre-Louis; Katherine Kelly; Nicole Jelesoff Journal: J Am Med Inform Assoc Date: 2017-04-01 Impact factor: 4.497
Authors: Sascha Dublin; Abisola Idu; Lyndsay A Avalos; T Craig Cheetham; Thomas R Easterling; Lu Chen; Victoria L Holt; Nerissa Nance; Zoe Bider-Canfield; Romain S Neugebauer; Kristi Reynolds; Sylvia E Badon; Susan M Shortreed Journal: PLoS One Date: 2022-05-16 Impact factor: 3.752
Authors: Sylvia E Badon; Sascha Dublin; Nerissa Nance; Monique M Hedderson; Romain Neugebauer; Thomas Easterling; T Craig Cheetham; Lu Chen; Victoria L Holt; Lyndsay A Avalos Journal: Pregnancy Hypertens Date: 2020-10-24 Impact factor: 2.899
Authors: Natalie A Bello; Hui Zhou; T Craig Cheetham; Eliza Miller; Darios T Getahun; Michael J Fassett; Kristi Reynolds Journal: JAMA Netw Open Date: 2021-03-01