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. 2016 Nov;106(11):927-934.
doi: 10.1002/bdra.23573.

Using insurance claims data to identify and estimate critical periods in pregnancy: An application to antidepressants

Elizabeth C Ailes  1 , Regina M Simeone  1 , April L Dawson  1 , Emily E Petersen  2 , Suzanne M Gilboa  1
Affiliations

Using insurance claims data to identify and estimate critical periods in pregnancy: An application to antidepressants

Elizabeth C Ailes et al. Birth Defects Res A Clin Mol Teratol. 2016 Nov.

Abstract

Background: Health insurance claims are a rich data source to examine medication use in pregnancy. Our objective was to identify pregnant women, their pregnancy outcomes, and date of their last menstrual period (LMP), and to estimate antidepressant dispensations in pregnancy.

Methods: From a literature search, we identified diagnosis and procedure codes indicating the end of a pregnancy. Using Truven Health MarketScan® Commercial Claims and Encounters Databases, we identified all inpatient admissions and outpatient service claims with these codes. We developed an algorithm to assign: (1) pregnancy outcome (ectopic pregnancy, induced or spontaneous abortion, live birth, or stillbirth), and (2) estimated gestational age, to each inpatient or outpatient visit. For each pregnancy outcome, we estimated the LMP as the admission (for inpatient visits) or service (for outpatient visits) date minus the gestational age. To differentiate visits associated with separate pregnancies, we required ≥ 2 months between one pregnancy outcomes and the LMP of the next pregnancy. We used this algorithm to identify pregnancies in 2013 and to estimate the proportion of women who filled a prescription for an antidepressant from an outpatient pharmacy at various time points in pregnancy.

Results: We identified 488,887 pregnancies in 2013; 79% resulted in a live birth. A prescription for an antidepressant was filled in 6.2% of pregnancies. Dispensations varied throughout pregnancy and were lowest (3.1%) during the second trimester.

Conclusion: This work will inform future efforts to estimate medication dispensations during critical periods of preconception, interconception, and pregnancy using health insurance claims data. Birth Defects Research (Part A) 106:927-934, 2016. © 2016 Wiley Periodicals, Inc.

Keywords: MarketScan; SSRI; antidepressant; claims data; medication; pregnancy.

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Figures

FIGURE 1
FIGURE 1
Identification of Analytic Sample of Pregnancies, 2013 Truven Health MarketScan® Commercial Claims and Encounters Database. aNo end of pregnancy related visit or estimated date of last menstrual period occurring in 2013. bWomen 15 to 44 years of age at “end of pregnancy”-related visit. cWomen enrolled from the 90 days before the estimated date of last menstrual period to 90 days after the end of pregnancy or only missing one month of enrollment during that time period were considered sufficiently enrolled; all others were considered to be “under-enrolled.”
FIGURE 2
FIGURE 2
Pattern of dispensation(s) of antide-pressant prescriptions from outpatient pharmacies, among pregnancies with at least 37 weeks estimated gestation (N = 41,552 pregnancies). Notes: X = filled a prescription for an antidepressant during this time period; LMP = Date of last menstrual period. aIncludes all other possible exposure combinations, each of which accounted for less than 2.8% of pregnancies.
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