Using Twitter Data for Cohort Studies of Drug Safety in Pregnancy: A Proof-of-Concept with Beta-Blockers

Abstract

AbstractBackgroundDespite that medication is taken during more than 90% of pregnancies, the fetal risk for most medications is unknown, and the majority of medications have no data regarding safety in pregnancy.ObjectiveUsing beta-blockers as a proof-of-concept, the primary objective of this study was to assess the utility of Twitter data for a cohort study design—in particular, whether we could identify (1) Twitter users who have posted tweets reporting that they took a beta-blocker during pregnancy and (2) their associated pregnancy outcomes.MethodsWe searched for mentions of beta-blockers in 2.75 billion tweets posted by 415,690 users who announced their pregnancy on Twitter. We manually reviewed the matching tweets to first determine if the user actually took the beta-blocker mentioned in the tweet. Then, to help determine if the beta-blocker was taken during pregnancy, we used the timestamp of the tweet reporting intake and drew upon an automated natural language processing (NLP) tool that estimates the date of the user’s prenatal time period. For users who posted tweets indicating that they took or may have taken the beta-blocker during pregnancy, we drew upon additional NLP tools to help identify tweets that report their adverse pregnancy outcomes, including miscarriage, stillbirth, preterm birth, low birth weight, birth defects, and neonatal intensive care unit admission.ResultsWe retrieved 5114 tweets, posted by 2339 users, that mention a beta-blocker, and manually identified 2332 (45.6%) tweets, posted by 1195 (51.1%) of the users, that self-report taking the beta-blocker. We were able to estimate the date of the prenatal time period for 356 pregnancies among 334 (27.9%) of these 1195 users. Among these 356 pregnancies, we identified 257 (72.2%) during which the beta-blocker was or may have been taken. We manually verified an adverse pregnancy outcome—preterm birth, neonatal intensive care unit admission, low birth weight, birth defects, or miscarriage—for 38 (14.8%) of these 257 pregnancies.ConclusionsOur ability to detect pregnancy outcomes for Twitter users who posted tweets reporting that they took or may have taken a beta-blocker during pregnancy suggests that Twitter can be a complementary resource for cohort studies of drug safety in pregnancy.