Fetuses-at-risk, to avoid paradoxical associations at early gestational ages: extension to preterm infant mortality.

Item request has been placed! ×
Item request cannot be made. ×
  Processing Request
  • Additional Information
    • Source:
      Publisher: Oxford University Press Country of Publication: England NLM ID: 7802871 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1464-3685 (Electronic) Linking ISSN: 03005771 NLM ISO Abbreviation: Int J Epidemiol Subsets: MEDLINE
    • Publication Information:
      Original Publication: [London] Oxford University Press.
    • Subject Terms:
    • Abstract:
      Background: Fetuses-at-risk denominators are commonly used in research on preterm stillbirth, but applications to postnatal outcomes such as preterm infant mortality are controversial. We evaluated whether biased associations between maternal risk factors and preterm infant mortality caused by stratification by preterm birth could be avoided using fetuses-at-risk risk ratios.
      Methods: Data included 3 277 570 births drawn from the linked live birth-death file for Canada from 1990 through 2005. We used maternal age as the risk factor, and estimated the association with stillbirth, early neonatal, late neonatal and postneonatal mortality by gestational interval (22-24, 25-27, 28-31, 32-36, ≥37 weeks). Models were run using (i) log-binomial regression stratified by preterm gestational age, and (ii) unstratified log-binomial regression using fetuses-at-risk denominators.
      Results: Extremes of maternal age were associated with higher mortality among term births. Among preterm births, the stratified model suggested a protective, null or attenuated association of extremes of maternal age with stillbirth, early, late and post neonatal mortality. The unstratified fetuses-at-risk model, however, resulted in the expected higher risk of mortality at extremes of maternal age for all outcomes.
      Conclusions: Fetuses-at-risk regression can avoid paradoxical associations between maternal exposures and mortality of infants born early in gestation, caused by preterm birth stratification bias. The fetuses-at-risk approach can be extended through the first year of life, or potentially beyond, depending on the outcome and presence of unmeasured confounders associated with preterm birth.
      (© The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)
    • References:
      BJOG. 2006 May;113(5):544-51. (PMID: 16579801)
      Ann Epidemiol. 2012 Mar;22(3):160-7. (PMID: 22285866)
      Epidemiology. 2012 Jan;23(1):1-9. (PMID: 22157298)
      Am J Epidemiol. 2004 Aug 1;160(3):213-4; discussion 215-6. (PMID: 15257992)
      J Pediatr. 2013 Jul;163(1):67-72. (PMID: 23351601)
      J Pediatr. 2011 Mar;158(3):372-6. (PMID: 20888573)
      Epidemiology. 2009 Jul;20(4):488-95. (PMID: 19525685)
      BMC Pregnancy Childbirth. 2004 Apr 16;4(1):7. (PMID: 15090071)
      Am J Epidemiol. 2008 Apr 1;167(7):793-6; author reply 797-8. (PMID: 18343876)
      Epidemiology. 2011 May;22(3):320-7. (PMID: 21372718)
      Paediatr Perinat Epidemiol. 2011 Mar;25(2):111-5. (PMID: 21281323)
      J Pediatr Adolesc Gynecol. 2012 Apr;25(2):98-102. (PMID: 22088316)
      Obstet Gynecol. 1992 Apr;79(4):547-53. (PMID: 1553174)
      Epidemiology. 2012 Mar;23(2):247-54. (PMID: 22266894)
      Obstet Gynecol. 2011 Oct;118(4):872-7. (PMID: 21934451)
      Am J Epidemiol. 2006 Dec 1;164(11):1115-20. (PMID: 16931543)
      Obstet Gynecol Surv. 2010 Jan;65(1):53-65. (PMID: 20040130)
      Pharmacoepidemiol Drug Saf. 2005 Jul;14(7):477-91. (PMID: 15660442)
      Am J Epidemiol. 2011 Jul 1;174(1):99-108. (PMID: 21430195)
      Paediatr Perinat Epidemiol. 2011 Mar;25(2):100-10. (PMID: 21281322)
      Am J Obstet Gynecol. 2012 Apr;206(4):309.e1-7. (PMID: 22464068)
      BMJ. 2003 Jan 25;326(7382):219. (PMID: 12543843)
      Am J Epidemiol. 2011 Nov 1;174(9):1062-8. (PMID: 21946386)
      Lancet. 1987 May 23;1(8543):1192-4. (PMID: 2883499)
      Clin Lab Med. 2010 Sep;30(3):709-20. (PMID: 20638583)
      N Engl J Med. 2008 Jul 17;359(3):262-73. (PMID: 18635431)
      Lancet. 2008 Jan 19;371(9608):261-9. (PMID: 18207020)
      Epidemiology. 2012 Mar;23(2):255-6. (PMID: 22317808)
      Am J Epidemiol. 2010 Dec 15;172(12):1339-48. (PMID: 21036955)
      Am J Epidemiol. 2004 Aug 1;160(3):199-206. (PMID: 15257989)
      Paediatr Perinat Epidemiol. 2009 Sep;23(5):394-402. (PMID: 19689488)
      N Engl J Med. 2004 Nov 4;351(19):1927-9. (PMID: 15525717)
      Epidemiology. 2010 Jul;21(4):540-51. (PMID: 20479643)
      CMAJ. 2008 Jan 15;178(2):165-72. (PMID: 18195290)
      Int J Epidemiol. 2010 Apr;39(2):417-20. (PMID: 19926667)
      Paediatr Perinat Epidemiol. 2012 Mar;26(2):109-16. (PMID: 22324496)
      Obstet Gynecol. 1996 Feb;87(2):163-8. (PMID: 8559516)
      Am J Epidemiol. 2004 Aug 1;160(3):207-10. (PMID: 15257990)
      Am J Epidemiol. 2009 Apr 1;169(7):798-801. (PMID: 19240223)
      BJOG. 2012 Jun;119(7):874-9. (PMID: 22530987)
    • Grant Information:
      MOP-130452 Canada Canadian Institutes of Health Research
    • Contributed Indexing:
      Keywords: Bias (epidemiology); gestational age; infant mortality; maternal age; premature birth
    • Publication Date:
      Date Created: 20140212 Date Completed: 20150709 Latest Revision: 20181113
    • Publication Date:
      20181211
    • Accession Number:
      10.1093/ije/dyu011
    • Accession Number:
      24513685
  • Citations
    • ABNT:
      AUGER, N. et al. Fetuses-at-risk, to avoid paradoxical associations at early gestational ages: extension to preterm infant mortality. International Journal Of Epidemiology, [s. l.], v. 43, n. 4, p. 1154–1162, 2014. DOI 10.1093/ije/dyu011. Disponível em: http://widgets.ebscohost.com/prod/customlink/proxify/proxify.php?count=1&encode=0&proxy=&find_1=&replace_1=&target=http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=mdc&AN=24513685&authtype=sso&custid=s5834912. Acesso em: 26 jan. 2020.
    • AMA:
      Auger N, Gilbert NL, Naimi AI, Kaufman JS. Fetuses-at-risk, to avoid paradoxical associations at early gestational ages: extension to preterm infant mortality. International Journal Of Epidemiology. 2014;43(4):1154-1162. doi:10.1093/ije/dyu011.
    • APA:
      Auger, N., Gilbert, N. L., Naimi, A. I., & Kaufman, J. S. (2014). Fetuses-at-risk, to avoid paradoxical associations at early gestational ages: extension to preterm infant mortality. International Journal Of Epidemiology, 43(4), 1154–1162. https://doi.org/10.1093/ije/dyu011
    • Chicago/Turabian: Author-Date:
      Auger, Nathalie, Nicolas L Gilbert, Ashley I Naimi, and Jay S Kaufman. 2014. “Fetuses-at-Risk, to Avoid Paradoxical Associations at Early Gestational Ages: Extension to Preterm Infant Mortality.” International Journal Of Epidemiology 43 (4): 1154–62. doi:10.1093/ije/dyu011.
    • Harvard:
      Auger, N. et al. (2014) ‘Fetuses-at-risk, to avoid paradoxical associations at early gestational ages: extension to preterm infant mortality’, International Journal Of Epidemiology, 43(4), pp. 1154–1162. doi: 10.1093/ije/dyu011.
    • Harvard: Australian:
      Auger, N, Gilbert, NL, Naimi, AI & Kaufman, JS 2014, ‘Fetuses-at-risk, to avoid paradoxical associations at early gestational ages: extension to preterm infant mortality’, International Journal Of Epidemiology, vol. 43, no. 4, pp. 1154–1162, viewed 26 January 2020, .
    • MLA:
      Auger, Nathalie, et al. “Fetuses-at-Risk, to Avoid Paradoxical Associations at Early Gestational Ages: Extension to Preterm Infant Mortality.” International Journal Of Epidemiology, vol. 43, no. 4, Aug. 2014, pp. 1154–1162. EBSCOhost, doi:10.1093/ije/dyu011.
    • Chicago/Turabian: Humanities:
      Auger, Nathalie, Nicolas L Gilbert, Ashley I Naimi, and Jay S Kaufman. “Fetuses-at-Risk, to Avoid Paradoxical Associations at Early Gestational Ages: Extension to Preterm Infant Mortality.” International Journal Of Epidemiology 43, no. 4 (August 2014): 1154–62. doi:10.1093/ije/dyu011.
    • Vancouver/ICMJE:
      Auger N, Gilbert NL, Naimi AI, Kaufman JS. Fetuses-at-risk, to avoid paradoxical associations at early gestational ages: extension to preterm infant mortality. International Journal Of Epidemiology [Internet]. 2014 Aug [cited 2020 Jan 26];43(4):1154–62. Available from: http://widgets.ebscohost.com/prod/customlink/proxify/proxify.php?count=1&encode=0&proxy=&find_1=&replace_1=&target=http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=mdc&AN=24513685&authtype=sso&custid=s5834912