Maternal age is an important and independent risk factor for adverse pregnancy outcome.

SUMMARY. When regression models adjust for mediators on the causal path from exposure to outcome, the regression coefficient of exposure is commonly viewed as a measure of the direct exposure effect. This interpretation can be misleading, even with a randomly assigned exposure. This is because adjustment for post-exposure measurements introduces bias whenever their association with outcome is confounded by more than just the exposure. By the same token, adjustment for such confounders stays problematic when these are themselves affected by the exposure. Robins (1999) accommodated this by introducing structural nested direct-effect models with direct effect parameters that can be estimated using inverse probability weighting by a conditional distribution of the mediator. The resulting estimators are consistent, but inefficient and can be extremely unstable when the intermediate variable is absolutely continuous. In this paper, we develop direct effect estimators which are not only more efficient, but also consistent under a less demanding model for a conditional expectation of the outcome. We find the one estimator which avoids inverse probability weighting altoghether to perform best. This estimator is intuitive, computationally straightforward and, as

A common and important problem in clustered sampling designs is that the effect of within-cluster exposures (i.e., exposures that vary within clusters) on outcome may be confounded by both measured and unmeasured cluster-level factors (i.e., measurements that do not vary within clusters). When some of these are ill/not accounted for, estimation of this effect through population-averaged models or random-effects models may introduce bias. We accommodate this by developing a general theory for the analysis of clustered data, which enables consistent and asymptotically normal estimation of the effects of within-cluster exposures in the presence of cluster-level confounders. Semiparametric efficient estimators are obtained by solving so-called conditional generalized estimating equations. We compare this approach with a popular proposal by Neuhaus and Kalbfleisch (1998, Biometrics 54, 638-645) who separate the exposure effect into a within- and a between-cluster component within a random intercept model. We find that the latter approach yields consistent and efficient estimators when the model is linear, but is less flexible in terms of model specification. Under nonlinear models, this approach may yield inconsistent and inefficient estimators, though with little bias in most practical settings.

In genetic association studies, different complex phenotypes are often associated with the same marker. Such associations can be indicative of pleiotropy (i.e. common genetic causes), of indirect genetic effects via one of these phenotypes, or can be solely attributable to non-genetic/environmental links between the traits. To identify the phenotypes with the inducing genetic association, statistical methodology is needed that is able to distinguish between the different causes of the genetic associations. Here, we propose a simple, general adjustment principle that can be incorporated into many standard genetic association tests which are then able to infer whether an SNP has a direct biological influence on a given trait other than through the SNP’s influence on another correlated phenotype. Using simulation studies, we show that, in the presence of a non-marker related link between phenotypes, standard association tests without the proposed adjustment can be biased. In contrast to that, the proposed methodology remains unbiased. Its achieved power levels are identical to those of standard adjustment methods, making the adjustment principle universally applicable in genetic association studies. The principle is illustrated by an application to three genome-wide association analyses.

Objectives To assess gestational length and prevalence of preterm birth among medically and naturally conceived twins; to establish the role of zygosity and chorionicity in assessing gestational length in twins born after subfertility treatment.