Establishing a new UK electronic health data tool for pregnancy research to study the management and consequences of thyroid disease in pregnancy.

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Electronic health record datasets contain a wealth of information on pregnancy, and their large size enables the study of rare outcomes and the risks and benefits of drugs and vaccines given to pregnant women in real-world settings. However, determining the precise timing of pregnancies (the start, end and trimester dates) and their outcomes (live birth, stillbirth or early pregnancy loss) in electronic health records presents challenges. A major advance in this area has recently been achieved through a research collaboration between the London School of Hygiene and Tropical Medicine and the Clinical Practice Research Datalink (CPRD), the UK's foremost electronic health data provider. We developed a new Pregnancy Register identifying more than five million pregnancies recorded in anonymised patient primary care records. This major new data resource offers unprecedented opportunities for research. However, further work is needed to establish the quality of the Pregnancy Register and to identify the best approaches for its use. This fellowship will address this need by bringing together the Pregnancy Register with other high quality linked electronic health data in order to improve it. I will then use these data and cutting edge methods to study a key under-researched area of maternal health: the management and consequences of thyroid disease in pregnancy. Building on an initial CPRD study, in which my clinical collaborators and I identified inadequacies in the management of an underactive thyroid in pregnancy in the UK, I will address three important areas of uncertainty: first, what is the burden of thyroid disease in pregnancy in the UK?; second, how well is an overactive thyroid managed during pregnancy and to what extent are treatment guidelines being followed?; and third, what are the risks of thyroid disease and its treatment to pregnant women and their babies? This work will answer important questions about the management and consequences of thyroid disease in pregnancy in the UK, which will help support the care of pregnant women with thyroid disease. It will also establish the CPRD Pregnancy Register and provide practical guidance for researchers on how best to use this new resource with other linked electronic health data to address key challenges in pregnancy research.