# Presentation: 599649

## Comparison of PRAMS Self-report of Selected Pregnancy Morbidities With Birth Certificate Records

- Laurie Baksh, MPH
- Shaheen Hossain, PhD
- Ayanna Harrison, BS
- Lois Bloebaum, BSN
- Nan Streeter, MS RN
- Utah Department of Health, Maternal Child Health Bureau

## Background

- Many studies have been conducted to validate the information contained on birth certificates
- Literature review shows validation of medical records done in New York, Georgia, Florida, Alabama, Tennessee, and North Carolina

## Literature Review

- Roohan et al. showed a wide range of sensitivity for maternal risk factors, ranging from 100% for Rh sensitization to 3% for reporting of a previous pre-term infant.  Positive predictive values also had a wide range.
- Piper et al. found low sensitivity for maternal medical risk factors, complications of labor and delivery, abnormal conditions of the newborn, and congenital anomalies.

- Roohan, P. Josberger R. Acar J. Dabir P, Feder H, Gagliano P. Validation of Birth Certificate Data in New York State.  Journal of Community Health, 28(5); 335-345
- Piper J, Mitchel E, Snowden M, Hall C, Adams M, Taylor P. Validation of 1989 Tennessee Birth Certificates using Maternal and Newborn Hospital Records. American Journal of Epidemiology, 137(7); 758-768

## Literature Review (Cont.)

- Melissa Adams found that sensitivities for the history of poor pregnancy outcomes (previous preterm, previous SGA or LGA) were low.
- Buescher et al. found poor accuracy for medical history but high accuracy for method of delivery, prenatal care, and events of labor and delivery.

- Adams, M. Validiy of Birth Certificate Data for the Outcome of the Previous Pregnancy, Georgia, 1980 – 1995.  American Journal of Epidemiology: 154(10); 883-887.
- Buescher P, Taylor K, Davis M, Bowling M. The Quality of the New Birth Certificate Data: A Validation Study in North Carolina. American Journal of Public Health: 83(8); 1163-1165.

## Utah’s Vital Records Process

- Pregnancy risk factors are abstracted from the medical record by the birth certificate clerks at each hospital.  This data comes from the prenatal care record
- Birth complications are abstracted from the labor and delivery records by the birth certificate clerk
- The physician must have authenticated the condition on the medical record for it to be included on the birth certificate
- Yearly quality checks are conducted by the state for each hospital

## Methodology

- 2000 Utah PRAMS file linked to Birth file using the birth certificate number
- Looked at agreement between self report of morbidity on PRAMS survey and equivalent category on birth certificate
- Kappa Coefficient analysis run to determine reliability between the two reports
- Analysis run using SAS and SUDAAN

## Kappa Coefficient

- Measures inter-rater reliability
- Measures the extent of exact agreement, adjusting for chance agreement
- Interpretation
- < .20 poor agreement above chance
- .20 - .40 fair agreement above chance
- .40 to .60 moderate agreement above chance
- .60 to .80 good agreement above chance
- .80 to 1.0 very good agreement above chance

## Not a Validation Study

- Without individual chart review, a validation study was not plausible
- Sensitivity and specificity cannot be calculated

## Comparisons Made

| PRAMS Survey | Birth Certificate |
| --- | --- |
| Cervix had to be sewn shut (Incompetent cervix, cerclage) | Incompetent Cervix |
| High blood sugar (diabetes) | Pre-Existing diabetes
Gestational Diabetes |
| Water broke more than three weeks before baby due (PROM) | Premature rupture of membranes |
| Problems with the placenta (such as abruptio placentae, placenta previa) | Abruptio placenta
Placenta previa |

**PRAMS Question: Did you have any of these problems during your pregnancy?**

## Comparisons Made (Cont.)

**PRAMS Survey**
- Did the baby born just before your new one weigh less than 5lbs 8 oz or less at birth?
- Was the baby just before your new one born more than three weeks before its due date?

**Birth Certificate**
- Previous SFGA infant
- Previous preterm infant

## Excluded

- High blood pressure
- PRAMS survey includes edema with high blood pressure – no equivalent on birth certificate
- Nausea, vomiting or dehydration, kidney or bladder infection, or car accident are not included on the birth certificate

## Results

|  |  % Agree | Kappa |
| --- | --- | --- |
| Placental abruption/previa | 93.6 | 0.32 |
| PROM | 92.4 | 0.44 |
| Incompetent Cervix | 98.0 | 0.32 |
| Diabetes/Gestational Diabetes | 95.1 | 0.48 |
| Previous Preterm | 86.1 | 0.26 |
| Previous SGA | 85.9 | 0.06 |

## Interpretation

- Moderate agreement for PROM and diabetes
- Fair agreement for placental problems, incompetent cervix, and previous preterm infant
- Poor agreement for previous SGA infant

## Reporting Disagreements

- For disagreements in reporting, which way are they attributable?
- For all conditions, the majority (80% – 100%) of discrepancies occurred when a woman reported the condition on PRAMS, but it was not reported on the birth certificate.

## Characteristics of Women With Disagreement

- Characteristics examined:
- Race
- Hispanic ethnic group
- Maternal age
- Maternal education
- Marital status
- Income categories
- Prenatal care payer
- Previous live births
- Statistical method: Chi-square tests

## Characteristics of Women With Disagreement (Cont.)

| Risk Factor | Demographic | P Value |
| --- | --- | --- |
| Placental Abruption/
Previa | Non-Hispanic women
Women <17 years old
Women with parity less than five | 0.01
0.002
0.05 |
| Incompetent Cervix | Hispanic women
Other than white women
Primiparous women | 0.05
0.04
0.01 |
| Previous Low Birth Weight | Women with <HS education
Other than white women | 0.03
0.01 |
| Diabetes/Gestational Diabetes | Married women | 0.05 |

## Discussions

- Low prevalence of certain conditions, such as (less than 100 for each), affecting results
- Women may be over reporting
- Vital records data may be in error as supported by literature
- Definitions of conditions could be beneficial to PRAMS respondents
- Some conditions not exactly the same (e.g. all incompetent cervices are not sewn shut)

## Conclusions

- Continued education of providers on the importance of accurate reporting for providing sound public health data
- Pending national certification of birth certificate clerks will be beneficial in improving quality of vital records data
- Study should be repeated when additional years of PRAMS data become available