Original Articles
Maternal Recall of Distant Pregnancy Events

https://doi.org/10.1016/S0895-4356(97)00304-1Get rights and content

Abstract

Women themselves are often the most convenient source of information regarding their pregnancy and birth outcomes such as prematurity. However, the ability of mothers to recall birth information and the accuracy of information they do recall has rarely been assessed. This study used a mail survey of women who delivered either term or preterm infants in Rochester, Minnesota, between 1980 and 1985. Maternal reports of circumstances and outcome of delivery were compared to data abstracted from the medical records. Maternal ability to recall and report events varied from 99.5% for smoking during pregnancy to 85% for infant's gestational age at birth. Agreement between medical record and maternal report was very high for perinatal events such as delivery by cesarean section, preexisting diabetes, and smoking. Percent negative agreement was quite high when comparing information on rare events such as placental abruption. Recall of gestational age was better for women delivering preterm infants but uncommon in all women. Maternal reports of perinatal events in which they directly participated such as cesarean section can be accurately and reliably reported 10 to 15 years after the birth. Gestational age is reported less accurately and with different rates of recall for mothers with term and preterm deliveries.

Introduction

The study of pregnancy outcomes and factors that may be associated with these outcomes usually requires retrospective data collection. Perinatal medical records are often difficult to obtain months or years after the birth. The only readily available source of information may be the woman who was pregnant. While this information may be conveniently available, both its accuracy and reliability must be demonstrated.

Women's ability to remember and accurately report perinatal information may be affected by the pregnancy outcome 1, 2, 3, 4, 5. In case-control studies of disfiguring and disabling birth defects, adverse infant outcomes appeared to enhance maternal recall of exposure to drugs and possible toxins during pregnancy [6]. This type of maternal recall bias in prenatal exposure studies has been confirmed by several others 7, 8, 9, 10, 11, 12. Recall bias has been less thoroughly studied in pregnancies with less adverse outcomes such as mild to moderate prematurity [13].

The accuracy of maternal data has been assessed by comparing the reported data to some factual standard, often the medical record 14, 15. Some aspects of the pregnancy such as birth weight have been found to be accurately reported by women weeks to years after the child's birth 14, 15, 16, 17. Other information on life-style issues such as smoking and complications of pregnancy such as urinary tract infection are much less accurately reported [18]. The quality of maternal recall has not been compared among women with infants of different gestational ages at birth.

Preterm delivery is a common prenatal outcome for which retrospective data are often sought. It is usually important to assess not only whether the pregnancy went to term or was a preterm birth, but also the level of prematurity. A recent report examined the role of maternal recall in collecting data for a study of prematurity or low birth weight [13]. While the investigators evaluated the reliability of maternal reports, they did not specifically assess the ability of the mother to accurately identify her infant as preterm versus term. No studies have systematically estimated the accuracy of self-reported levels of prematurity at any time distant from the delivery.

This article examines the accuracy and reliability of maternal survey data regarding the birth of their children 10 to 15 years after the birth of interest. The data used are from a study investigating family clustering of premature births. We measure the accuracy of maternal reporting of her infant as term or preterm at delivery. In addition, we assess the potential impact of prematurity on mothers' abilities to report their infant's birth weight, gestational age at birth, and maternal complications of labor and delivery. We also assessed the mother's ability to report information regarding her own birth.

Section snippets

Materials and methods

The information reported here is a substudy of a larger study on clustering of preterm births. The selection of patients for the larger study is described first and then the inclusion criteria for this smaller study is described. Computerized birth certificate information from the Minnesota Department of Health, Division of Vital Statistics was used to identify the 500 live born singleton infants reported to be less than 36 weeks gestation or who weighed less than 2500 grams at birth born to

Results

Of the 342 surveys sent to eligible women, 281 (76%) were returned, including 75% of women with term deliveries and 77% of women with preterm deliveries. To assess the potential impact of nonresponse on the study data, medical chart data was compared for the survey responders and nonresponders for a range of information from gestational age at birth and birth weight to the presences of complications of pregnancy. No statistically significant differences were found between responders' and

Discussion

In this study women were able to report accurately and reliably important perinatal outcomes of interest to researchers and clinicians even 10 to 15 years after the birth. Women accurately reported birth weight, presence of cesarean-section delivery, smoking behavior during pregnancy, and the absence of preexisting medical conditions such as diabetes mellitus and uncommon or rare pregnancy complications such as placenta abruption or previa. While women were unable to report exact gestational

Summary

It should be possible to use the information reported by mothers in prenatal studies requiring information about cesarean sections, birth weights, and lack of maternal and infant complications in the perinatal period. However, accurately reported information such as birth weight may be missing 15% of the time. Unfortunately information about the presence and consequences of pregnancy complications and the need for special care of the newborn are less accurately reported by the mother.

Acknowledgements

This work was supported by research grants from the American Academy of Family Physicians Foundation and United States Public Health Services, National Institutes of Health (AR30582). The authors appreciate the secretarial support of Elizabeth Jacobsen.

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