Paediatric and perinatal epidemiology最新文献

{"title":"Good, Better, Best, Never Let It Rest: Lowering Perinatal Morbidity and Mortality.","authors":"Fausto Negri, Michael L Eisenberg","doi":"10.1111/ppe.70045","DOIUrl":"https://doi.org/10.1111/ppe.70045","url":null,"abstract":"","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causal Inference and Survey Data in Paediatric Epidemiology: Generalising Treatment Effects From Observational Data.","authors":"Lizbeth Burgos-Ochoa, Felix J Clouth","doi":"10.1111/ppe.70042","DOIUrl":"https://doi.org/10.1111/ppe.70042","url":null,"abstract":"<p><strong>Background: </strong>Survey data are essential in paediatric epidemiology, providing valuable insights into child health outcomes. The potential outcomes framework has advanced causal inference using observational data. However, traditional design-based adjustments, especially sample weights, are often overlooked. This omission limits the ability to generalise findings to the broader population.</p><p><strong>Objective: </strong>This study demonstrates three approaches for estimating the population average treatment effect (PATE) in a practical example, examining the impact of household second-hand smoke (SHS) exposure on blood pressure in school-aged children.</p><p><strong>Methods: </strong>Using data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020, we assessed the effect of household SHS exposure, a non-randomised treatment, on blood pressure in school-aged children. We applied estimators based on Inverse Probability of Treatment Weighting (IPTW), G-computation, Targeted Maximum Likelihood Estimation (TMLE), and regression adjustment. Models without adjustments were run for comparison. We examined point estimates and the efficiency of the estimates obtained from these methods.</p><p><strong>Results: </strong>The largest differences were observed between the unadjusted regression models and the fully adjusted methods (IPTW, G-computation, and TMLE), which account for both confounding and survey weights. While the inclusion of the sample weights leads to wider confidence intervals for all methods, G-computation and TMLE showed comparatively narrower confidence intervals. Confidence intervals for the models not adjusted for sample weights were likely underestimated.</p><p><strong>Conclusions: </strong>This study highlights the important role of sample weights in causal inference. Generalisability of the average treatment effect as estimated on data sampled using common survey designs to a defined population requires the use of sample weights. The estimators described provide a framework for incorporating sample weights, and their use in health research is recommended.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression and Infertile Women: Sick Individuals, Sick Populations, or Neither?","authors":"Luigi Gagliardi, Franca Rusconi","doi":"10.1111/ppe.70047","DOIUrl":"https://doi.org/10.1111/ppe.70047","url":null,"abstract":"","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case-Crossover Study of Extreme Heat and Psychiatric Emergency Encounters Among Vulnerable Pregnant People.","authors":"Kaylin A Vrkljan, Rachel Oblath, Flannery Black-Ingersoll, Stephanie T Grady, Kate Burrows, M Patricia Fabian, Samantha E Parker, Amruta Nori-Sarma, Mary D Willis","doi":"10.1111/ppe.70044","DOIUrl":"https://doi.org/10.1111/ppe.70044","url":null,"abstract":"<p><strong>Background: </strong>Extreme ambient heat has been linked to maternal and neonatal mortality and morbidity. However, less is known regarding the impact of extreme ambient heat on mental health outcomes, particularly among socially vulnerable pregnant people.</p><p><strong>Objectives: </strong>We aimed to estimate the effect of ambient heat exposure on psychiatric emergency services encounters among pregnant people served by a public program in the metropolitan Boston area. We hypothesised that days of extreme heat would have higher odds of an encounter with psychiatric emergency services when compared to normal temperature days.</p><p><strong>Methods: </strong>Using electronic health records from the Boston Emergency Services Team program, we identified 861 geocodable encounters for pregnant people who utilised psychiatric emergency services between 2005-2009 and 2017-2021. Using a time-stratified case-crossover design, we matched each case (psychiatric emergency services encounter) with 3-5 control dates (matched by day-of-week and month). We obtained daily temperature (degrees Celsius) measures (mean, minimum, maximum) at an 800 m gridded resolution for cases/controls. Extreme heat exposure was defined at the 95th percentile, and exposure-response relationships were analysed using distributed lag nonlinear models with a 5-day lag period. We used conditional logistic regression models to estimate the association between ambient temperature exposure and odds of psychiatric emergency services encounters, controlling for U.S. federal holidays, relative humidity, and week of case/control date. Effect measure modification by time was examined (e.g., 2005-2009, 2017-2021).</p><p><strong>Results: </strong>Among socially vulnerable pregnant people, we found no evidence of an association between days of extreme heat and the odds of psychiatric emergency services encounters, compared to normal temperature days.</p><p><strong>Conclusions: </strong>This study does not support our a priori hypothesis. Future research is needed to confirm to what extent this association is truly null, as opposed to being obscured by selection bias into psychiatric emergency services, among socially vulnerable pregnant people.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Nationwide Impact of Guidelines for Prophylactic Aspirin Treatment for Preeclampsia.","authors":"Julie Hauer Vendelbo, Mette Østergaard Thunbo, Tine Brink Henriksen, Zeyan Liew, Agnete Larsen, Lars Henning Pedersen","doi":"10.1111/ppe.70046","DOIUrl":"https://doi.org/10.1111/ppe.70046","url":null,"abstract":"<p><strong>Background: </strong>Preeclampsia is a common pregnancy complication associated with maternal and neonatal mortality. Early aspirin treatment lowers the risk of preeclampsia in high-risk pregnancies. However, knowledge of aspirin's effects and possible side effects outside clinical trials is sparse, and the evaluation of maternal and foetal safety regarding aspirin treatment is hindered by the inherent risk of confounding by indication.</p><p><strong>Objectives: </strong>To study if the introduction of national guidelines recommending aspirin as preeclampsia prophylaxis affects clinical practice in Denmark, measured by aspirin use and investigate if the guideline change was related to the proportion of preeclampsia, preterm delivery, postpartum haemorrhage (PPH), placental abruption or neonatal intracranial haemorrhage.</p><p><strong>Methods: </strong>All singleton pregnancies (1997-2016) identified in the nationwide Danish registries (gestational age ≥ 10 weeks) were included. The population was divided into persons at high or low risk of preeclampsia, according to the 2012 Danish National Guideline for Prevention and Treatment of Preeclampsia. Aspirin use was estimated based on redeemed prescriptions. The proportion of outcomes was compared using interrupted time series analyses.</p><p><strong>Results: </strong>Of 1,323,750 pregnant persons, 2.0% (n = 25,826) were considered at high risk of preeclampsia. After the 2012 guideline change, aspirin use in high-risk pregnancies increased from 2.2% to 12.4% in 4 years, a 0.88 (95% confidence interval [CI] 0.83, 0.93) percentage point change for every half year. Severe preeclampsia slightly decreased from 6.0% to 5.2% after the guideline change, with a -0.22 (95% CI -0.43, -0.01) percentage point change for every half year, while preterm delivery rates remained unchanged. PPH increased in high-risk pregnancies. There was no difference in the risks of placental abruption or neonatal intracranial haemorrhage.</p><p><strong>Conclusions: </strong>After the introduction of preventive aspirin treatment, aspirin use in high-risk pregnancies increased, and severe preeclampsia decreased. However, PPH increased, while rates of preterm delivery, placental abruption and neonatal intracranial haemorrhage remained unchanged.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthy Live Births as Censoring Versus Competing Events in Studies of Prenatal Medication Use.","authors":"Chase D Latour, Mark Klose, Jessie K Edwards, Zoey Song, Michele Jonsson Funk, Mollie E Wood","doi":"10.1111/ppe.70043","DOIUrl":"https://doi.org/10.1111/ppe.70043","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy loss is recognised as a competing event in studies of prenatal medication use. A healthy live birth also precludes subsequent pregnancy outcomes, yet is often censored in time-to-event analyses.</p><p><strong>Objectives: </strong>Using a Monte Carlo simulation, we examined bias resulting from censoring versus accounting for healthy live birth as a competing event in estimates of the total effect of prenatal medication use on pregnancy outcomes.</p><p><strong>Methods: </strong>We simulated 2000 cohorts of 7500 conceptions with chronic hypertension under 12 treatment profiles. Ongoing pregnancies were indexed into the trial and randomly assigned to initiate or not initiate antihypertensives. Using time-to-event methods, we estimated absolute risks, risk differences (RD) per 100 pregnancies, and risk ratios (RR) for two outcomes, mirroring a prior trial: (i) composite fetal death or severe prenatal preeclampsia and (ii) small for gestational age (SGA) live birth. For the composite outcome, we conducted analyses where non-preeclamptic live birth was: (1) a censoring event and (2) a competing event. For SGA live birth, we conducted analyses where fetal death and non-SGA live birth were: (1) censoring events; (2) a competing event and censoring event, respectively; and (3) competing events.</p><p><strong>Results: </strong>For the composite outcome, censoring non-preeclamptic live births overestimated the absolute risk by 42.3 to 49.1 percentage points; RD and RR estimates were biased (e.g., RD bias range -6.18 to 0.46). For SGA live birth, analyses censoring non-SGA live births (with or without fetal death as a competing event) overestimated absolute risk by 30.0 to 37.7 and 40.9 to 52.4 percentage points on average; RD and RR estimates were biased (e.g., RD bias range -7.45 to 0.79 and -9.62 to 1.81, respectively). Analyses in which healthy live births were modelled as competing events produced unbiased risks, RDs and RRs.</p><p><strong>Conclusions: </strong>Censoring healthy live births resulted in overestimated risks as well as biased and imprecise total treatment effect estimates. Such inaccuracies about risks undermine informed patient-provider decision-making.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Invisible Burden: Examining the Impact of Exposure Misclassification in Epidemiologic Analyses of Uterine Fibroids.","authors":"Julia D DiTosto, Naria R Z Sealy, Stefanie N Hinkle, Enrique F Schisterman, Anuja Dokras, Sunni L Mumford, Ellen C Caniglia","doi":"10.1111/ppe.70027","DOIUrl":"https://doi.org/10.1111/ppe.70027","url":null,"abstract":"<p><strong>Background: </strong>Uterine fibroids, a common gynaecologic condition, are often underdiagnosed, potentially biasing results in epidemiologic studies due to measurement error.</p><p><strong>Objectives: </strong>To examine how varying sensitivity in detecting uterine fibroids impacts effect estimates, using the association with hypertension onset as an example.</p><p><strong>Methods: </strong>Three simulation studies were conducted (N = 100,000), considering true population prevalences of uterine fibroids of 5%, 20% and 60%. The first study varied detection sensitivity between 0% and 100%. The second examined differential sensitivity by symptom status (asymptomatic vs. symptomatic). The third assessed differential sensitivity by racialised groups. Specificity remained fixed at 90%, and true risk ratios (RRs) for the association with hypertension were set at 1.3 and 1.8.</p><p><strong>Results: </strong>Decreasing sensitivity biased results towards the null, with low-sensitivity methods (e.g., self-report) showing the largest bias and high-sensitivity methods (e.g., transvaginal ultrasonography) the least bias. At low fibroid prevalence (5%), even gold-standard ascertainment introduced bias due to imperfect specificity, whereas this concern diminished at higher prevalence. Assuming a dose-response relationship between fibroids and hypertension based on symptom status, results remained biased towards the null unless sensitivity was 100% and prevalence was high (60%); bias was most pronounced at low prevalence. When only symptomatic fibroids were associated with hypertension, increasing sensitivity biased results away from the null by capturing more asymptomatic cases. Studies using low-sensitivity methods may fail to identify a true effect among Black females while identifying it among White females, potentially exacerbating disparities. Detection bias, where those with fibroids are more likely to have hypertension detected, could result in bias away from the null.</p><p><strong>Conclusions: </strong>Underdiagnosis of uterine fibroids can bias results towards the null, particularly with self-report or modest effect estimates, potentially obscuring true effects. When only symptomatic fibroids were associated with the outcome, the bias was away from the null. Results varied by symptom status and race, highlighting the need to prioritise sensitive ascertainment methods, employ sensitivity analyses and improve reliability across diverse gynecologic conditions and health disparities.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging Knowledge Gaps in Understanding SARS-CoV-2 Infection During Pregnancy.","authors":"Anne K Örtqvist, Maria C Magnus, Stine Kjaer Urhoj","doi":"10.1111/ppe.70050","DOIUrl":"https://doi.org/10.1111/ppe.70050","url":null,"abstract":"","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy and ADHD Medications: Is It Time for Clinical Guidelines?","authors":"Julie Werenberg Dreier, Kathrine Bang Madsen","doi":"10.1111/ppe.70048","DOIUrl":"https://doi.org/10.1111/ppe.70048","url":null,"abstract":"","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Methods Versus Multiple Imputation to Infer Missing Maternal Data in Registry-Based Pregnancy Studies.","authors":"Takamasa Sakai, Hedvig Nordeng, Marleen M H J van Gelder","doi":"10.1111/ppe.70011","DOIUrl":"https://doi.org/10.1111/ppe.70011","url":null,"abstract":"<p><strong>Background: </strong>In birth registries, incomplete recording of information leads to missing values. Multiple imputation (MI) by chained equations is a widely used method for analysing datasets with missing data. It is unknown whether using registry records from multiple pregnancies contributed by the same woman could potentially give more accurate values when resolving missing data.</p><p><strong>Objectives: </strong>To investigate the relative performance of five methods to infer missing data on maternal characteristics using data from a medical birth registry, comparing longitudinal methods and MI with data from previous and future pregnancies.</p><p><strong>Methods: </strong>We used data from the Medical Birth Registry of Norway (MBRN), selecting records among mothers with more than one pregnancy between 2004 and 2018. Longitudinal methods used reference pregnancies in three time directions: past, future and closest pregnancy record. MI was conducted with only index pregnancy records (single-pregnancy MI) and with both index and closest reference pregnancy records (multiple-pregnancy MI). Validity was assessed by comparing the actual values with inferred/imputed values. For continuous variables, we calculated the proportion of inferred values within predefined increments. For binary variables, we calculated five parameters: agreement rate, sensitivity, specificity, positive predictive value and negative predictive value.</p><p><strong>Results: </strong>We included 578,670 pregnancies among 256,658 women. For continuous variables, the longitudinal methods showed the highest proportion within predefined increments, followed by multiple-pregnancy MI, and single-pregnancy MI showed the lowest value. For binary variables, longitudinal methods generally showed higher values among the five validity parameters than MI. Single-pregnancy MI had substantially lower agreement, while multiple-pregnancy MI performed similarly to longitudinal methods.</p><p><strong>Conclusions: </strong>The longitudinal method outperformed MI in inferring missing data on maternal characteristics in a medical birth registry.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}