{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T02:05:17Z","timestamp":1789005917158,"version":"build-2803163510"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01HD110107"],"award-info":[{"award-number":["R01HD110107"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Composite major congenital malformation (MCM) outcomes are commonly used to assess teratogenic effects of prenatal medication exposure, but this approach dilutes effect estimates when the risk is confined to a specific MCM. Tree-based scan statistics address this by screening outcomes using a hierarchical tree, enabling detection of specific risks without predefined hypotheses. To apply this method across ICD-9-CM and ICD-10-CM eras, we developed a unified hierarchical outcomes tree for MCM. We selected ICD-9-CM and ICD-10-CM codes classified as congenital anomalies, removing minor malformations, chromosomal anomalies, and single-gene conditions. A multilevel tree was built based on the Multi-level Clinical Classification Software, General Equivalence Mappings, and expert review. We validated the tree using birth cohorts from MarketScan and Medicaid databases (2011-2013; 2016-2018), assessing the balance of MCM prevalences within 1 year of birth via standardized mean differences (SMDs). The final tree included 1023 codes, organized into 244 clinical MCM groups at the most granular level. We identified 572\u2009107 (2011-2013) and 360\u2009167 infants (2016-2018) in MarketScan and 362\u2009820 and 3\u2009500\u2009589 infants in Medicaid. All SMDs were below 0.1, indicating consistency across coding eras. This hierarchical MCM tree bridges ICD-9-CM and ICD-10-CM, enabling consistent outcome definitions and enhancing the detection of specific teratogenic risks.<\/jats:p>","DOI":"10.1093\/aje\/kwag060","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T11:54:04Z","timestamp":1773834844000},"page":"2244-2252","source":"Crossref","is-referenced-by-count":2,"title":["A new tool for pregnancy research: a unified definition for major congenital malformation across ICD eras"],"prefix":"10.1093","volume":"195","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4544-1160","authenticated-orcid":false,"given":"Thuy N","family":"Thai","sequence":"first","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0866-4579","authenticated-orcid":false,"given":"Nicole 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,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0264-9604","authenticated-orcid":false,"given":"Thorben","family":"Kurzbach","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, University of Florida , Gainesville, FL ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4263-3944","authenticated-orcid":false,"given":"Yanning","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, University of Florida , Gainesville, FL ,","place":["United States"]},{"name":"Center for Drug Evaluation and Safety, University of Florida , Gainesville, FL ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6518-5961","authenticated-orcid":false,"given":"Almut 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