@precisa-saude/fhir 0.10.0 → 0.10.1

package/dist/cli.js

@@ -3920,9 +3920,6 @@ import { parseArgs as parseArgs2 } from "util";
 
 // src/reference-ranges.ts
 var biomarkerRangeDefinitions = {
-  // =============================================================================
-  // LIPIDS
-  // =============================================================================
   Albumin_Creatinine_Ratio: {
     default: { max: 30, min: 0, optimalMax: 20, optimalMin: 0, unit: "mg/g" },
     source: "tietz-7ed-2015"
@@ -4051,9 +4048,6 @@ var biomarkerRangeDefinitions = {
   ApoCIII_ApoA1_Ratio: {
     default: { max: 0.15, min: 0, optimalMax: 0.1, optimalMin: 0, unit: "" }
   },
-  // =============================================================================
-  // THYROID
-  // =============================================================================
   Omega6_AA: {
     default: { max: 15, min: 5, optimalMax: 12, optimalMin: 7, unit: "%" },
     source: "simopoulos-omega-ratio-2002"
@@ -4091,9 +4085,6 @@ var biomarkerRangeDefinitions = {
     default: { max: 0.1, min: 0, optimalMax: 0.05, optimalMin: 0, unit: "K/uL" },
     source: "pns-hemograma-2019"
   },
-  // =============================================================================
-  // HEMATOLOGY - CBC
-  // =============================================================================
   Bicarbonate: {
     default: { max: 29, min: 23, optimalMax: 28, optimalMin: 24, unit: "mEq/L" },
     source: "tietz-7ed-2015"
@@ -4228,13 +4219,28 @@ var biomarkerRangeDefinitions = {
     source: "tietz-7ed-2015"
   },
   CPeptide: {
-    default: { max: 3.9, min: 0.8, optimalMax: 3, optimalMin: 1, unit: "ng/mL" },
+    default: {
+      fastingRequired: "strict",
+      max: 3.9,
+      min: 0.8,
+      optimalMax: 3,
+      optimalMin: 1,
+      unit: "ng/mL"
+    },
     source: "tietz-7ed-2015"
   },
   Creatinine: {
     default: { max: 1.2, min: 0.6, optimalMax: 1, optimalMin: 0.7, unit: "mg/dL" },
     source: "pns-bioquimica-2019",
     variants: [
+      // Gestação: hiperfiltração glomerular (↑ 40–50% GFR) reduz a creatinina
+      // sérica. Valores "normais" de não-gestante podem sinalizar disfunção
+      // renal em gestante. Limites tipicamente citados: 0.4–0.8 mg/dL.
+      {
+        pregnant: true,
+        range: { max: 0.8, min: 0.4, optimalMax: 0.7, optimalMin: 0.5, unit: "mg/dL" },
+        sex: "F"
+      },
       {
         ageMin: 18,
         range: { max: 1.3, min: 0.7, optimalMax: 1.1, optimalMin: 0.8, unit: "mg/dL" },
@@ -4261,9 +4267,6 @@ var biomarkerRangeDefinitions = {
     default: { max: 500, min: 0, optimalMax: 250, optimalMin: 0, unit: "ng/mL" },
     source: "wells-ddimer-2003"
   },
-  // =============================================================================
-  // METABOLIC PANEL
-  // =============================================================================
   Omega3_DHA: {
     default: { max: 8, min: 2, optimalMax: 6.5, optimalMin: 3.5, unit: "%" },
     source: "harris-omega3-2004"
@@ -4370,10 +4373,24 @@ var biomarkerRangeDefinitions = {
     default: { max: 86, min: 0, optimalMax: 60, optimalMin: 0, unit: "pg/mL" },
     source: "tietz-7ed-2015"
   },
+  // Ferritina — WHO 2020 é o documento de referência específico para avaliação
+  // do status de ferro via ferritina. Importante: inflamação aguda eleva
+  // ferritina (proteína de fase aguda); WHO 2020 recomenda dosagem concomitante
+  // de PCR para interpretação em contexto inflamatório (fora do escopo deste
+  // tipo de faixa, mas documentado aqui para consumidores).
   Ferritin: {
     default: { max: 150, min: 12, optimalMax: 120, optimalMin: 30, unit: "ng/mL" },
-    source: "tietz-7ed-2015",
+    source: "who-iron-2020",
     variants: [
+      // Gestação: ferritina cai fisiologicamente no 2º/3º trimestre pela expansão
+      // do volume plasmático e maior demanda fetal. WHO 2020: <15 ng/mL sugere
+      // depleção; muitas diretrizes nacionais usam <30 como gatilho mais sensível
+      // na gestação dada a alta prevalência de deficiência subclínica.
+      {
+        pregnant: true,
+        range: { max: 120, min: 15, optimalMax: 80, optimalMin: 30, unit: "ng/mL" },
+        sex: "F"
+      },
       {
         ageMin: 18,
         range: { max: 250, min: 20, optimalMax: 200, optimalMin: 40, unit: "ng/mL" },
@@ -4401,9 +4418,6 @@ var biomarkerRangeDefinitions = {
     default: { max: 20, min: 3, optimalMax: 15, optimalMin: 5, unit: "ng/mL" },
     source: "tietz-7ed-2015"
   },
-  // =============================================================================
-  // LIVER FUNCTION
-  // =============================================================================
   FSH: {
     default: { max: 12.4, min: 1.5, optimalMax: 10, optimalMin: 3, unit: "mIU/mL" },
     source: "tietz-7ed-2015",
@@ -4451,9 +4465,38 @@ var biomarkerRangeDefinitions = {
     default: { max: 3.5, min: 2, optimalMax: 3.2, optimalMin: 2.3, unit: "g/dL" },
     source: "tietz-7ed-2015"
   },
+  // Glicemia de jejum — 70–99 mg/dL é a faixa de normalidade (SBD 2024, ADA);
+  // hipoglicemia clinicamente acionável em não-diabético é <54 mg/dL (Level 2
+  // ADA/SBD), não 70. O corte 70 era Level 1 (alerta em diabético em tratamento)
+  // e gerava falsos "abaixo do normal" em indivíduos saudáveis cuja glicemia
+  // em jejum está fisiologicamente entre 54–70. optimalMin preserva o alvo.
   Glucose: {
-    default: { max: 100, min: 70, optimalMax: 90, optimalMin: 70, unit: "mg/dL" },
-    source: "sbd-diabetes-2024"
+    default: {
+      fastingRequired: "strict",
+      max: 100,
+      min: 54,
+      optimalMax: 90,
+      optimalMin: 70,
+      unit: "mg/dL"
+    },
+    source: "sbd-diabetes-2024",
+    variants: [
+      // Gestação: DMG (IADPSG/SBD 2024) usa cortes mais restritivos na glicemia
+      // de jejum — ≥92 mg/dL já indica diabetes mellitus gestacional. Portanto
+      // a faixa "normal" em gestante vai até 91 mg/dL no jejum.
+      {
+        pregnant: true,
+        range: {
+          fastingRequired: "strict",
+          max: 91,
+          min: 54,
+          optimalMax: 85,
+          optimalMin: 70,
+          unit: "mg/dL"
+        },
+        sex: "F"
+      }
+    ]
   },
   GlycoMark: {
     default: { max: 40, min: 10, optimalMax: 35, optimalMin: 15, unit: "mcg/mL" },
@@ -4463,8 +4506,14 @@ var biomarkerRangeDefinitions = {
     default: { max: 5, min: 0, optimalMax: 3, optimalMin: 0, unit: "ng/mL" },
     source: "tietz-7ed-2015"
   },
+  // HbA1c — SBD 2024 não estabelece piso de referência clinicamente acionável.
+  // Valores <4.0% podem refletir anemia hemolítica, perda sanguínea recente ou
+  // hemoglobinopatia, não patologia do metabolismo glicêmico. Usamos min=2 como
+  // piso de sanidade (HbA1c <2% é quase sempre erro instrumental/entrada) sem
+  // criar flag clínico em valores fisiologicamente baixos. optimalMin preserva
+  // o alvo fisiológico da fração glicada.
   HbA1c: {
-    default: { max: 5.7, min: 4, optimalMax: 5.3, optimalMin: 4.5, unit: "%" },
+    default: { max: 5.7, min: 2, optimalMax: 5.3, optimalMin: 4.5, unit: "%" },
     source: "sbd-diabetes-2024"
   },
   Hct: {
@@ -4507,13 +4556,37 @@ var biomarkerRangeDefinitions = {
     direction: "higher-better",
     source: "caulfield-ionmobility-2008"
   },
-  // =============================================================================
-  // INFLAMMATION
-  // =============================================================================
   Hgb: {
     default: { max: 17.5, min: 12, optimalMax: 16, optimalMin: 13.5, unit: "g/dL" },
     source: "pns-hemograma-2019",
     variants: [
+      // Gestação: hemodiluição fisiológica reduz o piso aceitável.
+      // OMS e CDC: anemia gestacional quando Hgb <11 g/dL (1º e 3º tri) ou
+      // <10.5 g/dL (2º tri, dilucional mais acentuada). Catch-all adota a
+      // faixa mais conservadora (2º tri) quando trimestre é desconhecido.
+      {
+        pregnant: true,
+        pregnancyTrimester: 1,
+        range: { max: 14, min: 11, optimalMax: 13, optimalMin: 11.5, unit: "g/dL" },
+        sex: "F"
+      },
+      {
+        pregnant: true,
+        pregnancyTrimester: 2,
+        range: { max: 14, min: 10.5, optimalMax: 13, optimalMin: 11, unit: "g/dL" },
+        sex: "F"
+      },
+      {
+        pregnant: true,
+        pregnancyTrimester: 3,
+        range: { max: 14, min: 11, optimalMax: 13, optimalMin: 11.5, unit: "g/dL" },
+        sex: "F"
+      },
+      {
+        pregnant: true,
+        range: { max: 14, min: 10.5, optimalMax: 13, optimalMin: 11, unit: "g/dL" },
+        sex: "F"
+      },
       {
         ageMin: 18,
         range: { max: 17.5, min: 13.5, optimalMax: 16.5, optimalMin: 14, unit: "g/dL" },
@@ -4526,10 +4599,20 @@ var biomarkerRangeDefinitions = {
       }
     ]
   },
+  // HOMA-IR — corte 2.71 do estudo BRAMS (Geloneze et al., 2009) validado em
+  // população urbana brasileira; Tietz 7ª ed. não publica corte próprio de
+  // HOMA-IR, então a fonte anterior era citação inadequada.
   HOMA_IR: {
-    default: { max: 2.5, min: 0, optimalMax: 1.5, optimalMin: 0, unit: "" },
+    default: {
+      fastingRequired: "strict",
+      max: 2.71,
+      min: 0,
+      optimalMax: 1.5,
+      optimalMin: 0,
+      unit: ""
+    },
     direction: "lower-better",
-    source: "tietz-7ed-2015"
+    source: "geloneze-brams-2009"
   },
   Homocysteine: {
     default: { max: 15, min: 4, optimalMax: 10, optimalMin: 5, unit: "umol/L" },
@@ -4540,15 +4623,19 @@ var biomarkerRangeDefinitions = {
     default: { max: 350, min: 100, optimalMax: 300, optimalMin: 150, unit: "ng/mL" },
     source: "tietz-7ed-2015"
   },
-  // =============================================================================
-  // METABOLIC
-  // =============================================================================
   ImmatureGranulocytes: {
     default: { max: 1, min: 0, optimalMax: 0.5, optimalMin: 0, unit: "%" },
     source: "tietz-7ed-2015"
   },
   Insulin: {
-    default: { max: 25, min: 2, optimalMax: 8, optimalMin: 3, unit: "\xB5IU/mL" },
+    default: {
+      fastingRequired: "strict",
+      max: 25,
+      min: 2,
+      optimalMax: 8,
+      optimalMin: 3,
+      unit: "\xB5IU/mL"
+    },
     source: "tietz-7ed-2015"
   },
   Iron: {
@@ -4597,9 +4684,6 @@ var biomarkerRangeDefinitions = {
     direction: "higher-better",
     source: "caulfield-ionmobility-2008"
   },
-  // =============================================================================
-  // IRON STUDIES
-  // =============================================================================
   LDL_Small: {
     // LDL Small (LDL Pequena): lower is better (small dense LDL is most atherogenic)
     // Quest Ion Mobility reference: Male 123-441, Female 126-382 nmol/L, optimal <142
@@ -4654,9 +4738,6 @@ var biomarkerRangeDefinitions = {
     default: { max: 35, min: 15, optimalMax: 28, optimalMin: 18, unit: "%" },
     source: "simopoulos-omega-ratio-2002"
   },
-  // =============================================================================
-  // VITAMINS
-  // =============================================================================
   Lipoprotein_a: {
     default: { max: 75, min: 0, optimalMax: 30, optimalMin: 0, unit: "nmol/L" },
     direction: "lower-better",
@@ -4698,9 +4779,6 @@ var biomarkerRangeDefinitions = {
     default: { max: 30, min: 0, optimalMax: 20, optimalMin: 0, unit: "mg/L" },
     source: "kdigo-ckd-2024"
   },
-  // =============================================================================
-  // HORMONES
-  // =============================================================================
   MMA: {
     default: { max: 378, min: 0, optimalMax: 270, optimalMin: 0, unit: "nmol/L" },
     source: "tietz-7ed-2015"
@@ -4766,9 +4844,6 @@ var biomarkerRangeDefinitions = {
     direction: "lower-better",
     source: "simopoulos-omega-ratio-2002"
   },
-  // =============================================================================
-  // TUMOR MARKERS
-  // =============================================================================
   OmegaCheck: {
     default: { max: 8, min: 4, optimalMax: 8, optimalMin: 5.5, unit: "%" },
     source: "harris-omega3-2004"
@@ -4789,9 +4864,6 @@ var biomarkerRangeDefinitions = {
     default: { max: 5, min: 3.5, optimalMax: 4.6, optimalMin: 3.8, unit: "mEq/L" },
     source: "tietz-7ed-2015"
   },
-  // =============================================================================
-  // CARDIAC MARKERS
-  // =============================================================================
   Prealbumin: {
     default: { max: 38, min: 18, optimalMax: 35, optimalMin: 20, unit: "mg/dL" },
     source: "tietz-7ed-2015"
@@ -4861,9 +4933,6 @@ var biomarkerRangeDefinitions = {
       }
     ]
   },
-  // =============================================================================
-  // URINALYSIS
-  // =============================================================================
   RDW: {
     default: { max: 14.5, min: 11.5, optimalMax: 14, optimalMin: 12, unit: "%" },
     source: "pns-hemograma-2019"
@@ -4900,9 +4969,6 @@ var biomarkerRangeDefinitions = {
     default: { max: 145, min: 136, optimalMax: 143, optimalMin: 138, unit: "mEq/L" },
     source: "tietz-7ed-2015"
   },
-  // =============================================================================
-  // KIDNEY FUNCTION
-  // =============================================================================
   SpecificGravity_Urine: {
     default: { max: 1.03, min: 1.005, optimalMax: 1.025, optimalMin: 1.01, unit: "SG" },
     source: "tietz-7ed-2015"
@@ -4915,9 +4981,6 @@ var biomarkerRangeDefinitions = {
     default: { max: 4.2, min: 2.3, optimalMax: 3.8, optimalMin: 2.8, unit: "pg/mL" },
     source: "tietz-7ed-2015"
   },
-  // =============================================================================
-  // OMEGA FATTY ACIDS
-  // =============================================================================
   T3Reverse: {
     default: { max: 24, min: 10, optimalMax: 20, optimalMin: 12, unit: "ng/dL" },
     source: "tietz-7ed-2015"
@@ -5012,8 +5075,18 @@ var biomarkerRangeDefinitions = {
       }
     ]
   },
+  // Triglicérides — SBC 2017/2025 permite dosagem não-jejum com corte distinto
+  // (<175 mg/dL pós-prandial). Marcamos `preferred` para indicar que a faixa
+  // padrão é de jejum, mas não bloqueamos interpretação em não-jejum.
   Triglycerides: {
-    default: { max: 150, min: 0, optimalMax: 100, optimalMin: 0, unit: "mg/dL" },
+    default: {
+      fastingRequired: "preferred",
+      max: 150,
+      min: 0,
+      optimalMax: 100,
+      optimalMin: 0,
+      unit: "mg/dL"
+    },
     direction: "lower-better",
     source: "sbc-lipids-2025"
   },
@@ -5027,10 +5100,47 @@ var biomarkerRangeDefinitions = {
     default: { max: 14, min: 0, optimalMax: 10, optimalMin: 0, unit: "ng/L" },
     source: "giannitsis-hstnt-2010"
   },
+  // TSH — 0.4–4.0 é a faixa de referência adulta geral. O alvo 2.5 µIU/mL é
+  // específico do 1º trimestre gestacional (ATA 2017) e não se aplica a
+  // não-gestantes; optimalMax=3.0 reflete o limite superior do tercil "ótimo"
+  // sem invadir a faixa subclínica. Variante ageMin=65 mantém limite superior
+  // expandido (tolerância fisiológica do eixo em idosos, SBEM 2013).
   TSH: {
-    default: { max: 4, min: 0.4, optimalMax: 2.5, optimalMin: 1, unit: "\xB5IU/mL" },
+    default: { max: 4, min: 0.4, optimalMax: 3, optimalMin: 1, unit: "\xB5IU/mL" },
     source: "sbem-thyroid-2013",
     variants: [
+      // Variantes gestacionais (ATA 2017 / SBEM): supressão fisiológica por hCG
+      // no 1º trimestre, recuperação progressiva no 2º/3º. Trimestre-específicas
+      // precedem a catch-all; catch-all cobre contexto gestante sem trimestre
+      // conhecido.
+      // optimalMin/optimalMax definem subfaixa "alvo" mais estreita que o
+      // intervalo de referência — ex.: 1º tri aceita 0.1–2.5, mas o alvo
+      // terapêutico é 0.5–2.5.
+      {
+        pregnant: true,
+        pregnancyTrimester: 1,
+        range: { max: 2.5, min: 0.1, optimalMax: 2, optimalMin: 0.5, unit: "\xB5IU/mL" },
+        sex: "F"
+      },
+      {
+        pregnant: true,
+        pregnancyTrimester: 2,
+        range: { max: 3, min: 0.2, optimalMax: 2.5, optimalMin: 0.5, unit: "\xB5IU/mL" },
+        sex: "F"
+      },
+      {
+        pregnant: true,
+        pregnancyTrimester: 3,
+        range: { max: 3, min: 0.3, optimalMax: 2.5, optimalMin: 0.5, unit: "\xB5IU/mL" },
+        sex: "F"
+      },
+      // Catch-all gestacional — usada quando o trimestre não é informado.
+      // Adota a faixa mais conservadora (2º/3º trimestre: 0.2–3.0).
+      {
+        pregnant: true,
+        range: { max: 3, min: 0.2, optimalMax: 2.5, optimalMin: 0.5, unit: "\xB5IU/mL" },
+        sex: "F"
+      },
       {
         ageMin: 65,
         range: { max: 6, min: 0.4, optimalMax: 4, optimalMin: 1, unit: "\xB5IU/mL" },
@@ -5062,9 +5172,6 @@ var biomarkerRangeDefinitions = {
     default: { max: 1, min: 0.1, optimalMax: 1, optimalMin: 0.1, unit: "mg/dL" },
     source: "tietz-7ed-2015"
   },
-  // =============================================================================
-  // ADVANCED CARDIOVASCULAR
-  // =============================================================================
   pH_Urine: {
     default: { max: 8, min: 4.5, optimalMax: 7, optimalMin: 5.5, unit: "pH" },
     source: "tietz-7ed-2015"
@@ -5093,9 +5200,6 @@ var biomarkerRangeDefinitions = {
     default: { max: 100, min: 20, optimalMax: 80, optimalMin: 30, unit: "mcg/dL" },
     source: "tietz-7ed-2015"
   },
-  // =============================================================================
-  // MINERALS
-  // =============================================================================
   VitaminB1: {
     default: { max: 180, min: 70, optimalMax: 150, optimalMin: 80, unit: "nmol/L" },
     source: "tietz-7ed-2015"
@@ -5112,12 +5216,28 @@ var biomarkerRangeDefinitions = {
     default: { max: 2, min: 0.4, optimalMax: 1.5, optimalMin: 0.6, unit: "mg/dL" },
     source: "tietz-7ed-2015"
   },
-  // =============================================================================
-  // HEAVY METALS
-  // =============================================================================
+  // Vitamina D — posicionamento conjunto SBEM/SBPC-ML 2017:
+  // ≥20 ng/mL é desejável para população saudável <60 anos
+  // ≥30 ng/mL é recomendado para grupos de risco (idosos, gestantes, DRC,
+  // osteoporose, hiperparatireoidismo secundário).
+  // A variante ageMin=60 cobre idosos. Gestação, doença renal crônica,
+  // osteoporose e hiperparatireoidismo secundário também exigem min=30;
+  // o tipo `BiomarkerReferenceRange` atual não expressa esses contextos
+  // clínicos além de gestação e idade, portanto consumidores devem aplicar
+  // o limiar ≥30 nessas populações quando souberem a comorbidade. Gestação
+  // será modelada quando `pregnant: true` — aceita-se TODO até lá.
+  // TODO(PR-vitd-pregnancy): adicionar variante `pregnant: true` com min=30
+  // quando a modelagem de comorbidades chegar ao schema.
   VitaminD: {
-    default: { max: 100, min: 30, optimalMax: 70, optimalMin: 40, unit: "ng/mL" },
-    source: "sbem-vitamind-2014"
+    default: { max: 100, min: 20, optimalMax: 70, optimalMin: 40, unit: "ng/mL" },
+    source: "ferreira-vitd-2017",
+    variants: [
+      {
+        ageMin: 60,
+        range: { max: 100, min: 30, optimalMax: 70, optimalMin: 40, unit: "ng/mL" },
+        sex: "all"
+      }
+    ]
   },
   VitaminD_1_25: {
     default: { max: 72, min: 18, optimalMax: 60, optimalMin: 25, unit: "pg/mL" },
@@ -5127,14 +5247,15 @@ var biomarkerRangeDefinitions = {
     default: { max: 17, min: 5.5, optimalMax: 14, optimalMin: 7, unit: "mg/L" },
     source: "tietz-7ed-2015"
   },
-  // VLDL: estimado via fórmula de Friedewald (TG/5)
+  // VLDL — estimado clinicamente via TG/5 (método Friedewald). O corte de
+  // referência deriva de triglicérides <150 mg/dL (SBC 2025, dislipidemias),
+  // portanto VLDL <30. Friedewald-1972 permanece registrada como fonte do
+  // método de cálculo, mas a faixa de referência tem respaldo na diretriz
+  // SBC 2025.
   VLDL: {
     default: { max: 30, min: 2, optimalMax: 20, optimalMin: 5, unit: "mg/dL" },
-    source: "friedewald-1972"
+    source: "sbc-lipids-2025"
   },
-  // =============================================================================
-  // OTHER
-  // =============================================================================
   WBC: {
     default: { max: 11, min: 4, optimalMax: 8, optimalMin: 5, unit: "K/uL" },
     source: "pns-hemograma-2019"
@@ -5143,9 +5264,6 @@ var biomarkerRangeDefinitions = {
     default: { max: 120, min: 60, optimalMax: 100, optimalMin: 70, unit: "mcg/dL" },
     source: "tietz-7ed-2015"
   },
-  // =============================================================================
-  // BODY COMPOSITION (DXA)
-  // =============================================================================
   AndroidFatPct: {
     default: { max: 35, min: 10, optimalMax: 25, optimalMin: 15, unit: "%" },
     direction: "lower-better",
@@ -5384,9 +5502,6 @@ var biomarkerRangeDefinitions = {
       }
     ]
   },
-  // =============================================================================
-  // BONE DENSITOMETRY (DXA)
-  // =============================================================================
   BMD_Total: {
     default: { max: 1.4, min: 0.9, optimalMax: 1.3, optimalMin: 1, unit: "g/cm\xB2" },
     direction: "higher-better",
@@ -5402,9 +5517,6 @@ var biomarkerRangeDefinitions = {
     direction: "higher-better",
     source: "who-osteoporosis-1994"
   },
-  // =============================================================================
-  // MISSING LAB RANGES
-  // =============================================================================
   Amylase: {
     default: { max: 100, min: 28, optimalMax: 90, optimalMin: 35, unit: "U/L" },
     source: "tietz-7ed-2015"
@@ -5515,8 +5627,17 @@ function getReferenceRange(testCode, context) {
   if (!context || !definition.variants || definition.variants.length === 0) {
     return definition.default;
   }
-  const { age, biologicalSex } = context;
+  const { age, biologicalSex, pregnancyTrimester, pregnant } = context;
+  const hasPregnancyVariant = definition.variants.some((v) => v.pregnant === true);
   for (const variant of definition.variants) {
+    if (variant.pregnant === true) {
+      if (!pregnant) continue;
+      if (variant.pregnancyTrimester !== void 0 && variant.pregnancyTrimester !== pregnancyTrimester) {
+        continue;
+      }
+    } else if (pregnant && hasPregnancyVariant) {
+      continue;
+    }
     if (variant.sex !== "all" && variant.sex !== biologicalSex) {
       continue;
     }
@@ -5677,7 +5798,7 @@ async function main() {
     strict: false
   });
   if (values.version) {
-    process.stdout.write(`${"0.10.0"}
+    process.stdout.write(`${"0.10.1"}
 `);
     return;
   }

package/dist/index.cjs

@@ -51,7 +51,7 @@ var _chunk2EVQ2ESBcjs = require('./chunk-2EVQ2ESB.cjs');
 
 
 
-var _chunkD6XKCRS2cjs = require('./chunk-D6XKCRS2.cjs');
+var _chunkT22Q6ML7cjs = require('./chunk-T22Q6ML7.cjs');
 
 
 
@@ -612,5 +612,5 @@ function cnsToFHIRIdentifier(cns) {
 
 
 
-exports.AGE_BRACKETS = AGE_BRACKETS; exports.BIOMARKER_DEFAULT_UNIT = _chunkMJ254F5Kcjs.BIOMARKER_DEFAULT_UNIT; exports.BIOMARKER_DEFINITIONS = _chunk2EVQ2ESBcjs.BIOMARKER_DEFINITIONS; exports.BIOMARKER_UNITS = _chunkMJ254F5Kcjs.BIOMARKER_UNITS; exports.BODY_FAT_ZONES = BODY_FAT_ZONES; exports.CAC_INDICATOR_CODES = _chunk2EVQ2ESBcjs.CAC_INDICATOR_CODES; exports.CATEGORY_SCREENING_INTERVALS = CATEGORY_SCREENING_INTERVALS; exports.DEXA_CATEGORIES = _chunk2EVQ2ESBcjs.DEXA_CATEGORIES; exports.DEXA_INDICATOR_CODES = _chunk2EVQ2ESBcjs.DEXA_INDICATOR_CODES; exports.MAX_FILE_SIZE = _chunkO25F6G3Kcjs.MAX_FILE_SIZE; exports.MAX_OBSERVATIONS = _chunkO25F6G3Kcjs.MAX_OBSERVATIONS; exports.T_SCORE_ZONES = T_SCORE_ZONES; exports.UNIT_TO_UCUM = _chunkMJ254F5Kcjs.UNIT_TO_UCUM; exports.ZONE_DEFS = ZONE_DEFS; exports.applyFallbackReferenceRanges = _chunkD6XKCRS2cjs.applyFallbackReferenceRanges; exports.biomarkerRangeDefinitions = _chunkD6XKCRS2cjs.biomarkerRangeDefinitions; exports.calculateNextScreeningDate = calculateNextScreeningDate; exports.cnsToFHIRIdentifier = cnsToFHIRIdentifier; exports.codeToLoinc = _chunk2EVQ2ESBcjs.codeToLoinc; exports.convertUnit = _chunkMJ254F5Kcjs.convertUnit; exports.cpfToFHIRIdentifier = cpfToFHIRIdentifier; exports.defaultReferenceRanges = _chunkD6XKCRS2cjs.defaultReferenceRanges; exports.extractObservationsFromBundle = _chunkO25F6G3Kcjs.extractObservationsFromBundle; exports.filterVisibleBiomarkers = _chunk2EVQ2ESBcjs.filterVisibleBiomarkers; exports.findCodeByName = _chunk2EVQ2ESBcjs.findCodeByName; exports.formatCNS = formatCNS; exports.formatCPF = formatCPF; exports.generateCacFullReference = _chunk2EVQ2ESBcjs.generateCacFullReference; exports.generateDexaFullReference = _chunk2EVQ2ESBcjs.generateDexaFullReference; exports.generateFilteredLLMReference = _chunk2EVQ2ESBcjs.generateFilteredLLMReference; exports.generateLLMReference = _chunk2EVQ2ESBcjs.generateLLMReference; exports.getAllCodes = _chunk2EVQ2ESBcjs.getAllCodes; exports.getAllDefinitions = _chunk2EVQ2ESBcjs.getAllDefinitions; exports.getAllLoincCodes = _chunk2EVQ2ESBcjs.getAllLoincCodes; exports.getAllSearchPatterns = _chunk2EVQ2ESBcjs.getAllSearchPatterns; exports.getBiomarkersByCategory = _chunk2EVQ2ESBcjs.getBiomarkersByCategory; exports.getBiomarkersForCategories = _chunk2EVQ2ESBcjs.getBiomarkersForCategories; exports.getCanonicalUnit = _chunkMJ254F5Kcjs.getCanonicalUnit; exports.getCategoriesByInterval = getCategoriesByInterval; exports.getDaysUntilScreening = getDaysUntilScreening; exports.getDefaultUnit = _chunkMJ254F5Kcjs.getDefaultUnit; exports.getDefinitionByCode = _chunk2EVQ2ESBcjs.getDefinitionByCode; exports.getDefinitionByLoinc = _chunk2EVQ2ESBcjs.getDefinitionByLoinc; exports.getDefinitionsBySex = _chunk2EVQ2ESBcjs.getDefinitionsBySex; exports.getDueCategories = getDueCategories; exports.getFallbackReferenceRange = _chunkD6XKCRS2cjs.getFallbackReferenceRange; exports.getRangeDirection = _chunkD6XKCRS2cjs.getRangeDirection; exports.getReferenceRange = _chunkD6XKCRS2cjs.getReferenceRange; exports.getSIUnit = _chunkMJ254F5Kcjs.getSIUnit; exports.getScreeningInterval = getScreeningInterval; exports.getSexForCode = _chunk2EVQ2ESBcjs.getSexForCode; exports.getVisibleDefinitions = _chunk2EVQ2ESBcjs.getVisibleDefinitions; exports.interventionToFHIRMedicationStatement = interventionToFHIRMedicationStatement; exports.interventionToFHIRObservation = interventionToFHIRObservation; exports.interventionsToFHIRBundle = interventionsToFHIRBundle; exports.isBiomarkerVisible = _chunk2EVQ2ESBcjs.isBiomarkerVisible; exports.isCacDocument = _chunk2EVQ2ESBcjs.isCacDocument; exports.isDexaDocument = _chunk2EVQ2ESBcjs.isDexaDocument; exports.isScreeningDue = isScreeningDue; exports.isValidCode = _chunk2EVQ2ESBcjs.isValidCode; exports.isValidLoinc = _chunk2EVQ2ESBcjs.isValidLoinc; exports.labObservationToFHIR = _chunkPJJVDGX4cjs.labObservationToFHIR; exports.labReportToFHIR = _chunkPJJVDGX4cjs.labReportToFHIR; exports.labResultToFHIRBundle = _chunkPJJVDGX4cjs.labResultToFHIRBundle; exports.loincToCode = _chunk2EVQ2ESBcjs.loincToCode; exports.mapFHIRObservationToInternal = _chunkO25F6G3Kcjs.mapFHIRObservationToInternal; exports.normalizeCode = _chunk2EVQ2ESBcjs.normalizeCode; exports.plural = plural; exports.pluralCount = pluralCount; exports.pluralPhrase = pluralPhrase; exports.pluralPhraseCount = pluralPhraseCount; exports.processImportBundle = _chunkO25F6G3Kcjs.processImportBundle; exports.toBiomarkerTests = _chunk2EVQ2ESBcjs.toBiomarkerTests; exports.unitToUCUM = _chunkMJ254F5Kcjs.unitToUCUM; exports.userProfileToFHIR = _chunkPJJVDGX4cjs.userProfileToFHIR; exports.validateCNS = validateCNS; exports.validateCPF = validateCPF; exports.validateFHIRDiagnosticReport = _chunk3ILBFLVQcjs.validateFHIRDiagnosticReport; exports.validateFHIRImportBundle = _chunk3ILBFLVQcjs.validateFHIRImportBundle; exports.validateFHIRObservation = _chunk3ILBFLVQcjs.validateFHIRObservation; exports.validateLoincNameMatch = _chunk2EVQ2ESBcjs.validateLoincNameMatch;
+exports.AGE_BRACKETS = AGE_BRACKETS; exports.BIOMARKER_DEFAULT_UNIT = _chunkMJ254F5Kcjs.BIOMARKER_DEFAULT_UNIT; exports.BIOMARKER_DEFINITIONS = _chunk2EVQ2ESBcjs.BIOMARKER_DEFINITIONS; exports.BIOMARKER_UNITS = _chunkMJ254F5Kcjs.BIOMARKER_UNITS; exports.BODY_FAT_ZONES = BODY_FAT_ZONES; exports.CAC_INDICATOR_CODES = _chunk2EVQ2ESBcjs.CAC_INDICATOR_CODES; exports.CATEGORY_SCREENING_INTERVALS = CATEGORY_SCREENING_INTERVALS; exports.DEXA_CATEGORIES = _chunk2EVQ2ESBcjs.DEXA_CATEGORIES; exports.DEXA_INDICATOR_CODES = _chunk2EVQ2ESBcjs.DEXA_INDICATOR_CODES; exports.MAX_FILE_SIZE = _chunkO25F6G3Kcjs.MAX_FILE_SIZE; exports.MAX_OBSERVATIONS = _chunkO25F6G3Kcjs.MAX_OBSERVATIONS; exports.T_SCORE_ZONES = T_SCORE_ZONES; exports.UNIT_TO_UCUM = _chunkMJ254F5Kcjs.UNIT_TO_UCUM; exports.ZONE_DEFS = ZONE_DEFS; exports.applyFallbackReferenceRanges = _chunkT22Q6ML7cjs.applyFallbackReferenceRanges; exports.biomarkerRangeDefinitions = _chunkT22Q6ML7cjs.biomarkerRangeDefinitions; exports.calculateNextScreeningDate = calculateNextScreeningDate; exports.cnsToFHIRIdentifier = cnsToFHIRIdentifier; exports.codeToLoinc = _chunk2EVQ2ESBcjs.codeToLoinc; exports.convertUnit = _chunkMJ254F5Kcjs.convertUnit; exports.cpfToFHIRIdentifier = cpfToFHIRIdentifier; exports.defaultReferenceRanges = _chunkT22Q6ML7cjs.defaultReferenceRanges; exports.extractObservationsFromBundle = _chunkO25F6G3Kcjs.extractObservationsFromBundle; exports.filterVisibleBiomarkers = _chunk2EVQ2ESBcjs.filterVisibleBiomarkers; exports.findCodeByName = _chunk2EVQ2ESBcjs.findCodeByName; exports.formatCNS = formatCNS; exports.formatCPF = formatCPF; exports.generateCacFullReference = _chunk2EVQ2ESBcjs.generateCacFullReference; exports.generateDexaFullReference = _chunk2EVQ2ESBcjs.generateDexaFullReference; exports.generateFilteredLLMReference = _chunk2EVQ2ESBcjs.generateFilteredLLMReference; exports.generateLLMReference = _chunk2EVQ2ESBcjs.generateLLMReference; exports.getAllCodes = _chunk2EVQ2ESBcjs.getAllCodes; exports.getAllDefinitions = _chunk2EVQ2ESBcjs.getAllDefinitions; exports.getAllLoincCodes = _chunk2EVQ2ESBcjs.getAllLoincCodes; exports.getAllSearchPatterns = _chunk2EVQ2ESBcjs.getAllSearchPatterns; exports.getBiomarkersByCategory = _chunk2EVQ2ESBcjs.getBiomarkersByCategory; exports.getBiomarkersForCategories = _chunk2EVQ2ESBcjs.getBiomarkersForCategories; exports.getCanonicalUnit = _chunkMJ254F5Kcjs.getCanonicalUnit; exports.getCategoriesByInterval = getCategoriesByInterval; exports.getDaysUntilScreening = getDaysUntilScreening; exports.getDefaultUnit = _chunkMJ254F5Kcjs.getDefaultUnit; exports.getDefinitionByCode = _chunk2EVQ2ESBcjs.getDefinitionByCode; exports.getDefinitionByLoinc = _chunk2EVQ2ESBcjs.getDefinitionByLoinc; exports.getDefinitionsBySex = _chunk2EVQ2ESBcjs.getDefinitionsBySex; exports.getDueCategories = getDueCategories; exports.getFallbackReferenceRange = _chunkT22Q6ML7cjs.getFallbackReferenceRange; exports.getRangeDirection = _chunkT22Q6ML7cjs.getRangeDirection; exports.getReferenceRange = _chunkT22Q6ML7cjs.getReferenceRange; exports.getSIUnit = _chunkMJ254F5Kcjs.getSIUnit; exports.getScreeningInterval = getScreeningInterval; exports.getSexForCode = _chunk2EVQ2ESBcjs.getSexForCode; exports.getVisibleDefinitions = _chunk2EVQ2ESBcjs.getVisibleDefinitions; exports.interventionToFHIRMedicationStatement = interventionToFHIRMedicationStatement; exports.interventionToFHIRObservation = interventionToFHIRObservation; exports.interventionsToFHIRBundle = interventionsToFHIRBundle; exports.isBiomarkerVisible = _chunk2EVQ2ESBcjs.isBiomarkerVisible; exports.isCacDocument = _chunk2EVQ2ESBcjs.isCacDocument; exports.isDexaDocument = _chunk2EVQ2ESBcjs.isDexaDocument; exports.isScreeningDue = isScreeningDue; exports.isValidCode = _chunk2EVQ2ESBcjs.isValidCode; exports.isValidLoinc = _chunk2EVQ2ESBcjs.isValidLoinc; exports.labObservationToFHIR = _chunkPJJVDGX4cjs.labObservationToFHIR; exports.labReportToFHIR = _chunkPJJVDGX4cjs.labReportToFHIR; exports.labResultToFHIRBundle = _chunkPJJVDGX4cjs.labResultToFHIRBundle; exports.loincToCode = _chunk2EVQ2ESBcjs.loincToCode; exports.mapFHIRObservationToInternal = _chunkO25F6G3Kcjs.mapFHIRObservationToInternal; exports.normalizeCode = _chunk2EVQ2ESBcjs.normalizeCode; exports.plural = plural; exports.pluralCount = pluralCount; exports.pluralPhrase = pluralPhrase; exports.pluralPhraseCount = pluralPhraseCount; exports.processImportBundle = _chunkO25F6G3Kcjs.processImportBundle; exports.toBiomarkerTests = _chunk2EVQ2ESBcjs.toBiomarkerTests; exports.unitToUCUM = _chunkMJ254F5Kcjs.unitToUCUM; exports.userProfileToFHIR = _chunkPJJVDGX4cjs.userProfileToFHIR; exports.validateCNS = validateCNS; exports.validateCPF = validateCPF; exports.validateFHIRDiagnosticReport = _chunk3ILBFLVQcjs.validateFHIRDiagnosticReport; exports.validateFHIRImportBundle = _chunk3ILBFLVQcjs.validateFHIRImportBundle; exports.validateFHIRObservation = _chunk3ILBFLVQcjs.validateFHIRObservation; exports.validateLoincNameMatch = _chunk2EVQ2ESBcjs.validateLoincNameMatch;
 //# sourceMappingURL=index.cjs.map

package/dist/index.d.cts

@@ -6,7 +6,7 @@ import { F as FHIRMedicationStatement, a as FHIRObservation, b as FHIRBundle, c
 export { d as FHIRAddress, e as FHIRAnnotation, f as FHIRAttachment, g as FHIRBundleEntry, h as FHIRCodeableConcept, i as FHIRCoding, j as FHIRContactPoint, k as FHIRDiagnosticReport, l as FHIRHumanName, m as FHIRPatient, n as FHIRPeriod, o as FHIRQuantity, p as FHIRReference, q as FHIRReferenceRange } from './fhir-types-jTJayiwn.cjs';
 export { FHIRImportResult, ImportError, ImportedObservation, MAX_FILE_SIZE, MAX_OBSERVATIONS, SkippedEntry, extractObservationsFromBundle, mapFHIRObservationToInternal, processImportBundle } from './importer.cjs';
 export { validateFHIRDiagnosticReport, validateFHIRImportBundle, validateFHIRObservation } from './validators.cjs';
-export { BiomarkerRangeDefinition, BiomarkerReferenceRange, RangeDirection, RangeVariant, ReferenceRangeContext, SexKey, applyFallbackReferenceRanges, biomarkerRangeDefinitions, defaultReferenceRanges, getFallbackReferenceRange, getRangeDirection, getReferenceRange } from './reference-ranges.cjs';
+export { BiomarkerRangeDefinition, BiomarkerReferenceRange, FastingRequirement, PregnancyTrimester, RangeDirection, RangeVariant, ReferenceRangeContext, SexKey, applyFallbackReferenceRanges, biomarkerRangeDefinitions, defaultReferenceRanges, getFallbackReferenceRange, getRangeDirection, getReferenceRange } from './reference-ranges.cjs';
 
 /**
  * FHIR Intervention Converter

package/dist/index.d.ts

@@ -6,7 +6,7 @@ import { F as FHIRMedicationStatement, a as FHIRObservation, b as FHIRBundle, c
 export { d as FHIRAddress, e as FHIRAnnotation, f as FHIRAttachment, g as FHIRBundleEntry, h as FHIRCodeableConcept, i as FHIRCoding, j as FHIRContactPoint, k as FHIRDiagnosticReport, l as FHIRHumanName, m as FHIRPatient, n as FHIRPeriod, o as FHIRQuantity, p as FHIRReference, q as FHIRReferenceRange } from './fhir-types-jTJayiwn.js';
 export { FHIRImportResult, ImportError, ImportedObservation, MAX_FILE_SIZE, MAX_OBSERVATIONS, SkippedEntry, extractObservationsFromBundle, mapFHIRObservationToInternal, processImportBundle } from './importer.js';
 export { validateFHIRDiagnosticReport, validateFHIRImportBundle, validateFHIRObservation } from './validators.js';
-export { BiomarkerRangeDefinition, BiomarkerReferenceRange, RangeDirection, RangeVariant, ReferenceRangeContext, SexKey, applyFallbackReferenceRanges, biomarkerRangeDefinitions, defaultReferenceRanges, getFallbackReferenceRange, getRangeDirection, getReferenceRange } from './reference-ranges.js';
+export { BiomarkerRangeDefinition, BiomarkerReferenceRange, FastingRequirement, PregnancyTrimester, RangeDirection, RangeVariant, ReferenceRangeContext, SexKey, applyFallbackReferenceRanges, biomarkerRangeDefinitions, defaultReferenceRanges, getFallbackReferenceRange, getRangeDirection, getReferenceRange } from './reference-ranges.js';
 
 /**
  * FHIR Intervention Converter

package/dist/index.js

@@ -51,7 +51,7 @@ import {
   getFallbackReferenceRange,
   getRangeDirection,
   getReferenceRange
-} from "./chunk-GTKRPCZB.js";
+} from "./chunk-WTAXN4BF.js";
 import {
   BIOMARKER_DEFAULT_UNIT,
   BIOMARKER_UNITS,

package/dist/reference-ranges.cjs

@@ -5,7 +5,7 @@
 
 
 
-var _chunkD6XKCRS2cjs = require('./chunk-D6XKCRS2.cjs');
+var _chunkT22Q6ML7cjs = require('./chunk-T22Q6ML7.cjs');
 require('./chunk-MJ254F5K.cjs');
 
 
@@ -14,5 +14,5 @@ require('./chunk-MJ254F5K.cjs');
 
 
 
-exports.applyFallbackReferenceRanges = _chunkD6XKCRS2cjs.applyFallbackReferenceRanges; exports.biomarkerRangeDefinitions = _chunkD6XKCRS2cjs.biomarkerRangeDefinitions; exports.defaultReferenceRanges = _chunkD6XKCRS2cjs.defaultReferenceRanges; exports.getFallbackReferenceRange = _chunkD6XKCRS2cjs.getFallbackReferenceRange; exports.getRangeDirection = _chunkD6XKCRS2cjs.getRangeDirection; exports.getReferenceRange = _chunkD6XKCRS2cjs.getReferenceRange;
+exports.applyFallbackReferenceRanges = _chunkT22Q6ML7cjs.applyFallbackReferenceRanges; exports.biomarkerRangeDefinitions = _chunkT22Q6ML7cjs.biomarkerRangeDefinitions; exports.defaultReferenceRanges = _chunkT22Q6ML7cjs.defaultReferenceRanges; exports.getFallbackReferenceRange = _chunkT22Q6ML7cjs.getFallbackReferenceRange; exports.getRangeDirection = _chunkT22Q6ML7cjs.getRangeDirection; exports.getReferenceRange = _chunkT22Q6ML7cjs.getReferenceRange;
 //# sourceMappingURL=reference-ranges.cjs.map