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Validation of International Classification of Diseases Diagnosis Codes for Anaemia During Pregnancy

Anna Booman1, Brian T Bateman1, Sara Siadat1

  • 1Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA.

Paediatric and Perinatal Epidemiology
|October 30, 2025
PubMed

Insights

International Classification of Diseases, 10th Revision (ICD-10) codes for pregnancy anemia show low sensitivity but high specificity. Researchers should use caution and consider bias analysis when relying solely on these codes for antepartum anemia identification.

Area of Science:

  • Obstetrics and Gynecology
  • Hematology
  • Health Informatics

Background:

  • Pregnancy anemia is a common condition linked to adverse perinatal outcomes.
  • Epidemiological studies frequently use International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes to identify anemia in pregnancy.
  • The diagnostic accuracy of these ICD-10 codes is not well-established.

Purpose of the Study:

  • To evaluate the validity of ICD-10 diagnosis codes for identifying anemia during pregnancy.
  • To compare ICD-10 code diagnoses against laboratory-measured hemoglobin and hematocrit values.

Main Methods:

  • Utilized the Merative™ MarketScan® Commercial Database (2018-2022) containing insurance claims and laboratory values.
  • Included pregnancies with recorded hemoglobin or hematocrit values, excluding those with hereditary anemia diagnosis codes.
  • Calculated Cohen's kappa, sensitivity, specificity, and predictive values to assess code validity against established anemia criteria.

Main Results:

  • Analysis included 71,160 pregnancies.
  • Concordance between laboratory-identified anemia and ICD-10 codes was 0.258.
  • Sensitivity was low at 0.300, while specificity was high at 0.918.
  • Positive predictive value was 0.551 and negative predictive value was 0.797.

Conclusions:

  • ICD-10 codes for antepartum anemia demonstrate low sensitivity and high specificity in a large commercial claims database.
  • Caution is advised when using ICD-10 codes alone for identifying antepartum anemia in research.
  • Researchers should incorporate bias analyses to mitigate misclassification errors when using these codes.
Abstract

Keywords:
anaemiahemoglobinsinternational classification of diseasesiron‐deficiency anaemiasensitivity and specificityvalidation study

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