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

电子健康记录数据集包含大量关于怀孕的信息，其庞大的规模使得能够研究罕见的结果以及在现实世界环境中给予孕妇的药物和疫苗的风险和好处。然而，在电子健康记录中确定怀孕的准确时间(开始、结束和三个月的日期)及其结局(活产、死产或早孕丢失)是一项挑战。最近，通过伦敦卫生和热带医学院与英国最大的电子健康数据提供商临床实践研究数据链(CPRD)之间的研究合作，这一领域取得了重大进展。我们开发了一种新的怀孕登记簿，识别匿名患者初级保健记录中记录的500多万次怀孕。这一重大的新数据资源为研究提供了前所未有的机会。然而，还需要进一步的工作来确定妊娠登记簿的质量，并确定使用它的最佳方法。这项研究金将通过将怀孕登记簿与其他高质量的链接电子健康数据结合起来，以改进它，从而满足这一需要。然后，我将使用这些数据和尖端方法来研究产妇健康中一个研究不足的关键领域：妊娠期间甲状腺疾病的管理和后果。在CPRD的一项初步研究的基础上，我和我的临床合作者发现了英国在管理怀孕期间甲状腺功能低下方面的不足，我将解决三个重要的不确定性领域：第一，英国怀孕期间甲状腺疾病的负担是什么？第二，怀孕期间甲状腺功能过度的管理情况如何，治疗指南得到了多大程度的遵守？第三，甲状腺疾病及其治疗对孕妇及其婴儿的风险有多大？这项工作将回答有关英国怀孕期间甲状腺疾病的管理和后果的重要问题，这将有助于支持对患有甲状腺疾病的孕妇的护理。它还将建立CPRD怀孕登记簿，并为研究人员提供实用指导，指导他们如何最好地将这一新资源与其他相关的电子健康数据结合起来，以应对怀孕研究中的关键挑战。

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.