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\begin{document}

\title{Detecting and dating early non-live pregnancy outcomes: generation of a
novel pregnancy algorithm from Norwegian linked health registries}



\author[1]{Hedvig Nordeng}%
\author[1]{Angela Lupattelli}%
\author[2]{Hilde M. Engjom}%
\author[1]{Marleen van Gelder}%
\affil[1]{Universitetet i Oslo Farmasoytisk institutt}%
\affil[2]{UIB Research Centre for Health Promotion}%


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  \date{May 15, 2024}


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\begin{abstract}
\textbf{Purpose} Pregnancies ending before gestational week 12 are
common but not notified to the Medical Birth Registry of Norway. Our
goal was to develop an algorithm that more completely detects and dates
pregnancy outcomes by using diagnostic codes from primary and secondary
care registries to complement information from the birth registry.
\textbf{Methods} We used nationwide linked registry data between 2008
and 2018 in a hierarchical manner: We developed an algorithm to arrive
at unique pregnancy outcomes, considering codes within 56 days as the
same event. To infer gestational age of pregnancy outcomes before
gestational week 12, we used the median gestational week of pregnancy
markers (45 ICD-10 codes and 9 ICPC-2 codes). When no pregnancy markers
were available, we assigned outcome-specific gestational age estimates.
The performance of the algorithm was assessed by blinded clinicians.
\textbf{Results} Using only the medical birth registry, we identified
649,703 pregnancies, including 1,369 (0.2\%) miscarriages and 3,058
(0.5\%) elective terminations. With the new algorithm, we detected
859,449 pregnancies, including 642,712 live-births (74.8\%), 112,257
miscarriages (13.1\%), 94,664 elective terminations (11.0\%), 6,429
ectopic pregnancies (0.7\%), 2,564 stillbirths (0.3\%), and 823 molar
pregnancies (0.1\%). The median gestational age was 10
\textsuperscript{+0} weeks (IQR 10 \textsuperscript{+0}-11
\textsuperscript{+3}) for miscarriages and 8 \textsuperscript{+0} weeks
(IQR 8 \textsuperscript{+0}-9 \textsuperscript{+6}) for elective
terminations. Gestational age could be inferred using pregnancy markers
for 66.3\% of miscarriages and 47.2\% of elective terminations.
\textbf{Conclusion} The pregnancy algorithm improved the detection and
dating of early non-live pregnancy outcomes that would have gone
unnoticed if relying solely on the medical birth registry information.%
\end{abstract}%



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