Natalie Dayan, Marie-Eve Beauchamp, Melia Alcantara, Gabriel D Shapiro, Michal Abrahamowicz
{"title":"加权累积暴露模型评估生殖因素与女性未来心血管疾病之间的关系","authors":"Natalie Dayan, Marie-Eve Beauchamp, Melia Alcantara, Gabriel D Shapiro, Michal Abrahamowicz","doi":"10.1111/ppe.70029","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The occurrence of reproductive or pregnancy events, such as severe maternal morbidity (SMM), may reveal a predisposition to chronic disease and premature mortality. However, most studies have examined these exposures without considering their timing, severity, or recurrence.</p><p><strong>Objectives: </strong>We propose using a weighted cumulative exposure (WCE) modelling approach to flexibly describe the relationship between reproductive events and longer-term health outcomes in a longitudinal cohort of pregnant women.</p><p><strong>Methods: </strong>Application of the WCE modelling approach is accomplished in three steps. First, relative weights are estimated from a multivariable Cox proportional hazards model corresponding to the association of each reproductive risk factor with a given health outcome. Then, a longitudinal dataset is constructed in which all reproductive predictors are recorded at regular intervals (every 3 months), beginning 42 days after each woman's first birth in the cohort and ending at an outcome or censoring event. A new multivariable Cox model applied to this longitudinal dataset, incorporating time-varying WCE-derived reproductive risk scores along with simple time-varying reproductive and non-reproductive predictors, is estimated. Finally, adjusted WCE-based hazard ratios (HR) associated with different reproductive event exposure histories are calculated.</p><p><strong>Results: </strong>In the cohort of 1,992,972 births in Canada (excluding Quebec), 2008-2021, with mean (SD) follow-up time in the longitudinal dataset of 7.3 ± 3.8 years, we propose to use the WCE approach to predict outcomes such as premature cardiovascular disease (16,846 cardiovascular hospitalisations observed, or 1.19 per 1000 person-years).</p><p><strong>Conclusions: </strong>Use of flexible WCE modelling to quantify risks of pregnancy events such as SMM, adjusted for reproductive and non-reproductive CVD risk factors, will account for variation in timing and severity of these events and will capture their cumulative effects across a woman's reproductive trajectory. This approach can refine estimates of etiologic associations and inform novel clinical prediction models with the potential to predict postpartum long-term health outcomes for a given woman based on her unique reproductive history.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Weighted Cumulative Exposure Modelling to Assess the Association Between Reproductive Factors and Future Cardiovascular Disease in Women.\",\"authors\":\"Natalie Dayan, Marie-Eve Beauchamp, Melia Alcantara, Gabriel D Shapiro, Michal Abrahamowicz\",\"doi\":\"10.1111/ppe.70029\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The occurrence of reproductive or pregnancy events, such as severe maternal morbidity (SMM), may reveal a predisposition to chronic disease and premature mortality. However, most studies have examined these exposures without considering their timing, severity, or recurrence.</p><p><strong>Objectives: </strong>We propose using a weighted cumulative exposure (WCE) modelling approach to flexibly describe the relationship between reproductive events and longer-term health outcomes in a longitudinal cohort of pregnant women.</p><p><strong>Methods: </strong>Application of the WCE modelling approach is accomplished in three steps. First, relative weights are estimated from a multivariable Cox proportional hazards model corresponding to the association of each reproductive risk factor with a given health outcome. Then, a longitudinal dataset is constructed in which all reproductive predictors are recorded at regular intervals (every 3 months), beginning 42 days after each woman's first birth in the cohort and ending at an outcome or censoring event. A new multivariable Cox model applied to this longitudinal dataset, incorporating time-varying WCE-derived reproductive risk scores along with simple time-varying reproductive and non-reproductive predictors, is estimated. Finally, adjusted WCE-based hazard ratios (HR) associated with different reproductive event exposure histories are calculated.</p><p><strong>Results: </strong>In the cohort of 1,992,972 births in Canada (excluding Quebec), 2008-2021, with mean (SD) follow-up time in the longitudinal dataset of 7.3 ± 3.8 years, we propose to use the WCE approach to predict outcomes such as premature cardiovascular disease (16,846 cardiovascular hospitalisations observed, or 1.19 per 1000 person-years).</p><p><strong>Conclusions: </strong>Use of flexible WCE modelling to quantify risks of pregnancy events such as SMM, adjusted for reproductive and non-reproductive CVD risk factors, will account for variation in timing and severity of these events and will capture their cumulative effects across a woman's reproductive trajectory. This approach can refine estimates of etiologic associations and inform novel clinical prediction models with the potential to predict postpartum long-term health outcomes for a given woman based on her unique reproductive history.</p>\",\"PeriodicalId\":19698,\"journal\":{\"name\":\"Paediatric and perinatal epidemiology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-05-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Paediatric and perinatal epidemiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/ppe.70029\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Paediatric and perinatal epidemiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/ppe.70029","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
Weighted Cumulative Exposure Modelling to Assess the Association Between Reproductive Factors and Future Cardiovascular Disease in Women.
Background: The occurrence of reproductive or pregnancy events, such as severe maternal morbidity (SMM), may reveal a predisposition to chronic disease and premature mortality. However, most studies have examined these exposures without considering their timing, severity, or recurrence.
Objectives: We propose using a weighted cumulative exposure (WCE) modelling approach to flexibly describe the relationship between reproductive events and longer-term health outcomes in a longitudinal cohort of pregnant women.
Methods: Application of the WCE modelling approach is accomplished in three steps. First, relative weights are estimated from a multivariable Cox proportional hazards model corresponding to the association of each reproductive risk factor with a given health outcome. Then, a longitudinal dataset is constructed in which all reproductive predictors are recorded at regular intervals (every 3 months), beginning 42 days after each woman's first birth in the cohort and ending at an outcome or censoring event. A new multivariable Cox model applied to this longitudinal dataset, incorporating time-varying WCE-derived reproductive risk scores along with simple time-varying reproductive and non-reproductive predictors, is estimated. Finally, adjusted WCE-based hazard ratios (HR) associated with different reproductive event exposure histories are calculated.
Results: In the cohort of 1,992,972 births in Canada (excluding Quebec), 2008-2021, with mean (SD) follow-up time in the longitudinal dataset of 7.3 ± 3.8 years, we propose to use the WCE approach to predict outcomes such as premature cardiovascular disease (16,846 cardiovascular hospitalisations observed, or 1.19 per 1000 person-years).
Conclusions: Use of flexible WCE modelling to quantify risks of pregnancy events such as SMM, adjusted for reproductive and non-reproductive CVD risk factors, will account for variation in timing and severity of these events and will capture their cumulative effects across a woman's reproductive trajectory. This approach can refine estimates of etiologic associations and inform novel clinical prediction models with the potential to predict postpartum long-term health outcomes for a given woman based on her unique reproductive history.
期刊介绍:
Paediatric and Perinatal Epidemiology crosses the boundaries between the epidemiologist and the paediatrician, obstetrician or specialist in child health, ensuring that important paediatric and perinatal studies reach those clinicians for whom the results are especially relevant. In addition to original research articles, the Journal also includes commentaries, book reviews and annotations.