Use of an automated database to evaluate markers for early detection of pregnancy

The objective of this study was to develop and validate algorithms to detec t pregnancies from the time of first clinical recognition by using Kaiser P ermanente automated databases from Portland, Oregon. In 1993-1994, the auth ors evaluated these databases retrospectively to identify markers indicativ e of initial clinical detection of pregnancy and pregnancy outcomes. Pregna ncy markers were found for 99% of the women for whom pregnancy outcomes wer e included in the automated databases, and pregnancy outcomes were identifi ed for 77% of the women for whom there were pregnancy markers. The earliest marker most predictive of a pregnancy outcome was a positive human chorion ic gonadotropin test; least predictive was an obstetric outpatient visit. M edical record review indicated that in a sample of women with pregnancy mar kers in the database, an estimated 6% of pregnancy outcomes (primarily earl y fetal deaths and elective terminations) were lost. Pregnancies were first captured in automated databases 6-8 weeks after the last menstrual period, and a combination of a positive human chorionic gonadotropin test and an o utpatient obstetric visit was the most sensitive and specific early marker of pregnancy. When combined with automated pharmacy records, these database s may be valuable tools for evaluating prescription drug effects on all maj or outcomes of clinically recognized pregnancies.