A Simple Regression-based Approach to Account for Survival Bias in Birth Outcomes Research

Tchetgen, Eric J. Tchetgen; Phiri, Kelesitse; Shapiro, Roger

doi:10.1097/ede.0000000000000317

Cited by 23 publications

(40 citation statements)

References 2 publications

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“…In an era of scaling-up in PMTCT option B+ implementation in the entire sub-Saharan Africa, there is need to closely monitor the birth outcomes from pregnant women receiving lifelong, with a wider data safety and monitoring to address potential confounders [ 15 , 31 , 32 ]. Therefore, wherever possible, implementing an interventional trial would provide stronger evidence toward a global translational application.…”

Section: Discussionmentioning

confidence: 99%

Preterm Birth and Low Birth Weight after In Utero Exposure to Antiretrovirals Initiated during Pregnancy in Yaoundé, Cameroon

et al. 2016

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BackgroundEffects of antiretroviral therapy (ART) on birth outcomes remain controversial.ObjectiveTo assess the impact of antenatal exposure to ART on the occurrence of preterm birth (PTB) and low birth weight (LBW).MethodsA cross-sectional study conducted at the Essos Hospital Center in Yaounde from 2008 to 2011 among HIV vertically exposed infants with two distinct maternal antiretroviral experiences: monotherapy group (Zidovudine, ZDV) and the combination ART group (cART). Mothers already receiving cART before pregnancy were ineligible. In both groups, events of PTB (<37 weeks) and LBW (<2,500g) were analyzed using univariate and multivariate logistic regression; with p<0.05 considered statistically significant.ResultsOf the 760 infants, 481 were born from cART-exposed mothers against 279 from maternal-ZDV. Median maternal CD4 count was 378 [interquartile range (IQR): 253–535] cells/mm3. Median duration of ART at onset of delivery was 13 [IQR: 10–17] weeks. In the cART-group, 64.9% (312/481) of mothers were exposed to Zidovudine/Lamuvidine/Nevirapine and only 2% (9/481) were on protease inhibitor-based regimens. Events of PTB were not significantly higher in the cART-group compared to the ZDV-group (10.2% vs. 6.4% respectively, p = 0.08), while onsets of LBW were significantly found in the cART-group compared to ZDV-group (11.6% vs. 7.2% respectively, p = 0.05). Other factors (parity, maternal age at delivery or CD4 cell count) were not associated with PTB.ConclusioncART, initiated during pregnancy, would be an independent factor of LBW. In the era of option B+ (lifelong ART to all HIV-pregnant women), further studies would guide towards measures limiting onsets of LBW.

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Section: Discussionmentioning

confidence: 99%

Preterm Birth and Low Birth Weight after In Utero Exposure to Antiretrovirals Initiated during Pregnancy in Yaoundé, Cameroon

et al. 2016

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“…Competing risks of death and debilitating diseases that might cause differential survivorship in study arms will be considered in the analysis [54,55]. …”

Section: Methodsmentioning

confidence: 99%

“…However, the use of aspirin may affect survivorship itself, which plays a major role in AMD statistics. Therefore, if the follow-up loss of retinal data due to death and disability is found to be unbalanced between the study arms, it will be included in the statistical model as a competing risk [55]. …”

Section: Methodsmentioning

confidence: 99%

Age-related macular degeneration in a randomized controlled trial of low-dose aspirin: Rationale and study design of the ASPREE-AMD study

Robman

Guymer

Woods

et al. 2017

Contemporary Clinical Trials Communications

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Purpose Although aspirin therapy is used widely in older adults for prevention of cardiovascular disease, its impact on the incidence, progression and severity of age-related macular degeneration (AMD) is uncertain. The effect of low-dose aspirin on the course of AMD will be evaluated in this clinical trial. Design A sub-study of the ‘ASPirin in Reducing Events in the Elderly’ (ASPREE) trial, ASPREE-AMD is a 5-year follow-up double-blind, placebo-controlled, randomized trial of the effect of 100 mg daily aspirin on the course of AMD in 5000 subjects aged 70 years or older, with normal cognitive function and without cardiovascular disease at baseline. Non-mydriatic fundus photography will be performed at baseline, 3-year and 5-year follow-up to determine AMD status. Primary outcome measures The incidence and progression of AMD. Exploratory analyses will determine whether aspirin affects the risk of retinal hemorrhage in late AMD, and whether other factors, such as genotype, systemic disease, inflammatory biomarkers, influence the effect of aspirin on AMD. Conclusion The study findings will be of significant clinical and public interest due to a potential to identify a possible low cost therapy for preventing AMD worldwide and to determine risk/benefit balance of the aspirin usage by the AMD-affected elderly. The ASPREE-AMD study provides a unique opportunity to determine the effect of aspirin on AMD incidence and progression, by adding retinal imaging to an ongoing, large-scale primary prevention randomized clinical trial.

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“…Antepartum suicidal behaviour is associated with substantially higher risk of miscarriages and abortions, 8,9,13 resulting in the truncation of birth outcomes defined only for livebirths. 28,29 Future studies quantifying this "livebirth bias" arising from conditioning on fetuses' survival to livebirths in the context of antepartum suicidal behaviour are warranted. Third, due to the small number of suicidal behaviour in our study, we did not perform separate analyses for suicide attempt and suicidal ideation.…”

Section: Limitations Of the Datamentioning

confidence: 99%

Associations of antepartum suicidal behaviour with adverse infant and obstetric outcomes

Zhong

Gelaye

Karlson

et al. 2019

Paediatric Perinatal Epid

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Background Relatively little is known about antepartum suicidal behaviour and pregnancy outcomes. We examined associations of antepartum suicidal behaviour, alone and in combination with psychiatric disorders, with adverse infant and obstetric outcomes. Methods We included 188 925 singleton livebirths from a retrospective cohort (1996‐2016). Suicidal behaviour, psychiatric disorders, and outcomes were derived from electronic medical records. We performed multivariable logistic regressions with generalised estimating equations to estimate adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). Results The prevalence of antepartum suicidal behaviour was 152.44 per 100 000 singleton livebirths. Nearly two‐thirds (64.24%) of women with suicidal behaviour also had psychiatric disorders. Compared to women without psychiatric disorders and suicidal behaviour, women with psychiatric disorders alone had 1.3‐fold to 1.4‐fold increased odds of delivering low birthweight or preterm infants and 1.2‐fold increased odds of experiencing obstetric complications. Women with suicidal behaviour alone had increased odds of preterm labour (aOR 2.05, 95% CI 1.16, 3.62). Women with both suicidal behaviour and psychiatric disorders had > twofold increased odds of delivering low birthweight (aOR 2.52, 95% CI 1.40, 4.54), preterm birth (aOR 2.44, 95% CI 1.63, 3.66), and low birthweight/preterm birth (aOR 2.30, 95% CI 1.54, 3.44) infants; the odds of preterm labour (aOR 1.62, 95% CI 1.06, 2.47), placental abruption (aOR 2.33, 95% CI 1.20, 4.51), preterm rupture of membranes (aOR 1.63, 95% CI 1.08, 2.46), and postpartum haemorrhage (aOR 1.93, 95%CI 1.09, 3.40) were elevated. Conclusions Antepartum suicidal behaviour, when co‐occurring with psychiatric disorders, is associated with increased odds of adverse infant and obstetric outcomes. Future studies are warranted to understand the causal roles of suicidal behaviour and psychiatric disorders in pregnancy.

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A Simple Regression-based Approach to Account for Survival Bias in Birth Outcomes Research

Cited by 23 publications

References 2 publications

Preterm Birth and Low Birth Weight after In Utero Exposure to Antiretrovirals Initiated during Pregnancy in Yaoundé, Cameroon

Preterm Birth and Low Birth Weight after In Utero Exposure to Antiretrovirals Initiated during Pregnancy in Yaoundé, Cameroon

Age-related macular degeneration in a randomized controlled trial of low-dose aspirin: Rationale and study design of the ASPREE-AMD study

Associations of antepartum suicidal behaviour with adverse infant and obstetric outcomes

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