Sarah E Forrest, Lauren M Rossen, Katherine A Ahrens
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Statistically stable estimates of the risk of pregnancy loss are limited for nonmetropolitan populations due to small sample sizes.</p><p><strong>Objectives: </strong>This study evaluated the utility of the enhanced Modified Kalman Filter (eMKF) in producing estimates of the risk of pregnancy loss for subgroups of US women with small sample sizes to examine recent trends.</p><p><strong>Methods: </strong>Data from the National Survey of Family Growth (NSFG; 2006-2019) were used to estimate trends in the risk of self-reported pregnancy loss (miscarriage, stillbirth, ectopic pregnancy) among US women (15-44 years) who reported at least one completed pregnancy (excluding induced abortions) conceived during 2000-2018 (n = 17,314 women, 35,988 pregnancies) by metropolitan status and maternal age. The eMKF was used to smooth estimates over groups and time. We compared the relative 95% confidence intervals (95% CIs) of model-based estimates to direct estimates to assess improvements in precision.</p><p><strong>Results: </strong>Among completed pregnancies conceived during 2000-2018, 21.6% ended in pregnancy loss. Relative 95% CIs for model-based estimates were 33.0% and 53.0% smaller for metropolitan and nonmetropolitan groups, respectively, than direct estimates. After adjustment, the risk of pregnancy loss for women ages 15-44 increased by a relative 1% annually for both metropolitan (risk ratio [RR] 1.01, 95% CI 1.01, 1.02) and nonmetropolitan (RR 1.01, 95% CI 1.00, 1.01) women. The risk of pregnancy loss increased for metropolitan women ages 15-19 (RR 1.01, 95% CI 1.00, 1.01), 20-24 (RR 1.01, 95% CI 1.00, 1.01), 25-29 (RR 1.02, 95% CI 1.01, 1.02), and 30-34 (RR 1.02, 95% CI 1.01, 1.03).</p><p><strong>Conclusions: </strong>Risk of pregnancy loss increased by a relative 1% annually for women overall, and by 1%-2% annually among subgroups of women ages 15-34 in metropolitan areas. The eMKF provided improvements in estimate precision relative to direct estimates.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477614/pdf/","citationCount":"0","resultStr":"{\"title\":\"Trends in Risk of Pregnancy Loss Among US Women by Metropolitan Status, 2000-2018.\",\"authors\":\"Sarah E Forrest, Lauren M Rossen, Katherine A Ahrens\",\"doi\":\"10.1111/ppe.70066\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Approximately 20% of pregnancies end in spontaneous loss, an outcome associated with adverse health consequences. Statistically stable estimates of the risk of pregnancy loss are limited for nonmetropolitan populations due to small sample sizes.</p><p><strong>Objectives: </strong>This study evaluated the utility of the enhanced Modified Kalman Filter (eMKF) in producing estimates of the risk of pregnancy loss for subgroups of US women with small sample sizes to examine recent trends.</p><p><strong>Methods: </strong>Data from the National Survey of Family Growth (NSFG; 2006-2019) were used to estimate trends in the risk of self-reported pregnancy loss (miscarriage, stillbirth, ectopic pregnancy) among US women (15-44 years) who reported at least one completed pregnancy (excluding induced abortions) conceived during 2000-2018 (n = 17,314 women, 35,988 pregnancies) by metropolitan status and maternal age. The eMKF was used to smooth estimates over groups and time. We compared the relative 95% confidence intervals (95% CIs) of model-based estimates to direct estimates to assess improvements in precision.</p><p><strong>Results: </strong>Among completed pregnancies conceived during 2000-2018, 21.6% ended in pregnancy loss. Relative 95% CIs for model-based estimates were 33.0% and 53.0% smaller for metropolitan and nonmetropolitan groups, respectively, than direct estimates. After adjustment, the risk of pregnancy loss for women ages 15-44 increased by a relative 1% annually for both metropolitan (risk ratio [RR] 1.01, 95% CI 1.01, 1.02) and nonmetropolitan (RR 1.01, 95% CI 1.00, 1.01) women. The risk of pregnancy loss increased for metropolitan women ages 15-19 (RR 1.01, 95% CI 1.00, 1.01), 20-24 (RR 1.01, 95% CI 1.00, 1.01), 25-29 (RR 1.02, 95% CI 1.01, 1.02), and 30-34 (RR 1.02, 95% CI 1.01, 1.03).</p><p><strong>Conclusions: </strong>Risk of pregnancy loss increased by a relative 1% annually for women overall, and by 1%-2% annually among subgroups of women ages 15-34 in metropolitan areas. 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引用次数: 0
摘要
背景：大约20%的妊娠以自然流产告终，这一结局与不良的健康后果有关。由于样本量小，对非大都市人群妊娠丢失风险的统计稳定估计是有限的。目的：本研究评估了增强型修正卡尔曼滤波器（eMKF）在小样本量的美国妇女亚组中产生妊娠丢失风险估计的效用，以检查最近的趋势。方法：使用全国家庭增长调查（NSFG; 2006-2019）的数据来估计2000-2018年期间报告至少一次完成妊娠（不包括人工流产）的美国妇女（15-44岁）自我报告妊娠丢失（流产、死胎、异位妊娠）的风险趋势（n = 17,314名妇女，35,988例妊娠），按城市地位和母亲年龄划分。eMKF被用来平滑对群体和时间的估计。我们比较了基于模型的估计与直接估计的相对95%置信区间（95% ci），以评估精度的提高。结果：在2000年至2018年期间完成的妊娠中，21.6%以流产告终。与直接估算相比，基于模型估算的95% ci在大都市和非大都市群体中分别小33.0%和53.0%。调整后，大城市（风险比[RR] 1.01, 95% CI 1.01, 1.02）和非大城市（RR 1.01, 95% CI 1.00, 1.01）妇女15-44岁妇女的妊娠丢失风险每年相对增加1%。都市女性15-19岁（RR 1.01, 95% CI 1.00, 1.01）、20-24岁（RR 1.01, 95% CI 1.00, 1.01）、25-29岁（RR 1.02, 95% CI 1.01, 1.02）和30-34岁（RR 1.02, 95% CI 1.01, 1.03）的流产风险增加。结论：总体而言，妊娠流产的风险每年增加1%，在大城市15-34岁的女性亚组中，每年增加1%-2%。相对于直接估计，eMKF提供了估计精度的改进。
Trends in Risk of Pregnancy Loss Among US Women by Metropolitan Status, 2000-2018.
Background: Approximately 20% of pregnancies end in spontaneous loss, an outcome associated with adverse health consequences. Statistically stable estimates of the risk of pregnancy loss are limited for nonmetropolitan populations due to small sample sizes.
Objectives: This study evaluated the utility of the enhanced Modified Kalman Filter (eMKF) in producing estimates of the risk of pregnancy loss for subgroups of US women with small sample sizes to examine recent trends.
Methods: Data from the National Survey of Family Growth (NSFG; 2006-2019) were used to estimate trends in the risk of self-reported pregnancy loss (miscarriage, stillbirth, ectopic pregnancy) among US women (15-44 years) who reported at least one completed pregnancy (excluding induced abortions) conceived during 2000-2018 (n = 17,314 women, 35,988 pregnancies) by metropolitan status and maternal age. The eMKF was used to smooth estimates over groups and time. We compared the relative 95% confidence intervals (95% CIs) of model-based estimates to direct estimates to assess improvements in precision.
Results: Among completed pregnancies conceived during 2000-2018, 21.6% ended in pregnancy loss. Relative 95% CIs for model-based estimates were 33.0% and 53.0% smaller for metropolitan and nonmetropolitan groups, respectively, than direct estimates. After adjustment, the risk of pregnancy loss for women ages 15-44 increased by a relative 1% annually for both metropolitan (risk ratio [RR] 1.01, 95% CI 1.01, 1.02) and nonmetropolitan (RR 1.01, 95% CI 1.00, 1.01) women. The risk of pregnancy loss increased for metropolitan women ages 15-19 (RR 1.01, 95% CI 1.00, 1.01), 20-24 (RR 1.01, 95% CI 1.00, 1.01), 25-29 (RR 1.02, 95% CI 1.01, 1.02), and 30-34 (RR 1.02, 95% CI 1.01, 1.03).
Conclusions: Risk of pregnancy loss increased by a relative 1% annually for women overall, and by 1%-2% annually among subgroups of women ages 15-34 in metropolitan areas. The eMKF provided improvements in estimate precision relative to direct estimates.
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.
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