Defining, Measuring, and Evaluating Prenatal Care in Insurance Claims Data

The objective of this paper is to discuss the complexities of identifying prenatal care visits in insurance claims databases, review existing methods to identify prenatal care encounters, and explore how different study goals should inform the definition of prenatal care employed by investigators.

Insurance claims data are routinely used to conduct perinatal epidemiology studies focused on the effects of medical interventions. Prenatal care, an important medical intervention and an indicator of ongoing pregnancy, lacks a consistent definition among clinical and research-based sources.

We have categorized definitions of prenatal care in three groups: all healthcare received while pregnant, pregnancy-specific healthcare, and guideline-concordant healthcare. In studies using insurance claims data, we found five common methods to identify prenatal care encounters. Using example study goals, we outline important considerations investigators must make when applying different methods to identify prenatal care visits in studies using insurance claims data.