Birthweight, gestational age and familial confounding in sex differences in infant mortality: a matched co-twin control study of Brazilian male-female twin pairs identified by population data linkage

Calais-Ferreira, Lucas; Barreto, Marcos; Mendonça, Everton; Dite, Gillian S.; Hickey, Martha; Ferreira, Paulo H.; Scurrah, Katrina J; Hopper, John L.

doi:10.1093/ije/dyab242

Cited by 11 publications

(10 citation statements)

References 27 publications

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“…Our study's main strength was the application of an innovative design with opposite‐sex twin pairs, which controls for familial factors in the association between sex and LBP. While this design remains underutilized in medical research, it has contributed to evidence for sex differences in a number of different traits and conditions (Calais‐Ferreira et al, 2021; Kendler & Gardner, 2014). The integration of data from twin registries from different countries with diverse genetic backgrounds and societal structural characteristics (i.e., access to healthcare) also allowed for richer analysis and interpretations of findings.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, genetic factors have been implicated in other musculoskeletal traits such as muscle strength, lean mass, and bone density (Seeman et al, 1996). Using a matched co‐twin study design applied to data from opposite‐sex twin pairs allows for the investigation of sex differences in traits and conditions of interest while controlling for such genetic and nongenetic familial confounders, such as factors shared by family members that are associated with both the exposure and the outcome (Calais‐Ferreira et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

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Sex differences in lifetime prevalence of low back pain: A multinational study of opposite‐sex twin pairs

Calais-Ferreira

Pozzobon

Pinheiro

et al. 2023

European Journal of Pain

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BackgroundLow back pain (LBP) is more likely to occur in people with a family history of this condition, highlighting the importance of accounting for familial factors when studying the individual risk of LBP. We conducted a study of opposite‐sex twin pairs investigating sex differences in LBP while accounting for (genetic and shared environmental) familial factors.MethodsWe applied a matched co‐twin control design to study 795 adult opposite‐sex pairs from Australia, Spain, and the United States (US). We used mixed‐effects logistic regression to assess the within‐pair association between female sex and lifetime prevalence of LBP in unadjusted and adjusted models for body‐mass‐index, and depression, as well as interactions between female sex and age (<median age vs. ≥median age) in this association.ResultsThe mean age of the sample was 47.4 years (Standard Deviation = 16.5). The adjusted odds ratio (aOR) of the association between sex and LBP in the merged sample was 1.11 (95% Confidence Interval = 0.88–1.40), with 87.4% of the variance in the studied association explained by between‐site heterogeneity (Q test; p = 0.001). Females had 2.37 (95% CI: 1.48–3.78) higher odds of LBP compared to their male co‐twins in the Spanish sample (adjusted), but a sex association was not found in the Australian nor US samples.ConclusionsWe found no evidence of the association between sex and LBP in our merged sample. Between‐population differences (i.e. cultural background or health system characteristics) are likely to be major factors leading to variation in the sex association with LBP when familial factors are accounted for.SignificanceOur study of adult opposite‐sex twin pairs found no evidence of an association between female sex and lifetime prevalence of low back pain after controlling for familial factors in the merged sample from Australia, Spain and USA, contrary to findings from previous studies of unrelated individuals. Our findings indicate potentially relevant between‐country genetic, cultural and environmental differences which may need to be considered for optimal and individualized strategies for the prevention and management of low back pain across the lifespan.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sex differences in lifetime prevalence of low back pain: A multinational study of opposite‐sex twin pairs

Calais-Ferreira

Pozzobon

Pinheiro

et al. 2023

European Journal of Pain

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“…The χ 2 test was used for categorical variables. The mother’s age, the newborn’s sex and the gestational week can influence maternal and offspring outcomes [40]. These potentially confounding variables were adjusted to gestational week at birth in the multivariate logistic regression models to calculate maternal GWG, and offspring weight, length, and head circumference.…”

Section: Methodsmentioning

confidence: 99%

The Influence of Pregestational Body Mass Index and Physical Activity Patterns on Maternal, Delivery, and Newborn Outcomes in a Sample of Portuguese Pregnant Women: A Retrospective Cohort Study

Bernardo,

Carvalho,

Mota

et al. 2023

Port J Public Health

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Introduction: There is a linear association between pregestational body mass index (BMI) and almost all adverse pregnancy outcomes. Pregnancy is “a window of opportunities” in terms of changing behavior and improving awareness of healthy living. The proper assessment of physical activity levels, during pregnancy, determines trends, health benefits, and their effects over time. This study aims to describe maternal physical activity levels, stratified by pregestational BMI, verify the accomplishment of physical activity recommendations in pregnant women, and correlate pregestational BMI and physical activity accomplishment with maternal, delivery, and neonatal parameters. Methods: A retrospective cohort study was carried out with 103 pregnant women. Physical activity levels were evaluated using a questionnaire and accelerometry. Pregestational BMI was obtained through the Quetelet formula and used the American College of Sports Medicine’s guidelines were used to determine physical activity accomplishment levels. Continuous data were presented as mean and standard deviation and categorical data as numbers and percentages. The F test was used to examine the differences between groups. Results: Pregnant women in the sample spent 42.9% of their time on household activities, and for pregnant women with obesity, 91.5% of the time was spent on sedentary activities. Women with normative BMI had higher levels of moderate-intensity activities. Only 15.8% of participants with obesity reached the international recommendations for physical activity practice and women who accomplished physical activity recommendations gained less weight during pregnancy. A high percentage of pre-obesity and obese pregnant women exceeded the recommendations for gestational weight gain and the gestational diabetes prevalence was higher in the obesity group (p = 0.03 between groups). Regarding delivery and neonatal parameters (Apgar score 1st, Apgar score 5th, birth weight, length and head circumference), no statistical differences were found when adjusted to a gestational week at birth, between BMI (p = 0.58; p = 0.18; p = 0.60; p = 0.34; p = 0.34, respectively) or physical activity (p = 0.12; p = 0.15; p = 0.83; p = 0.70; p = 0.70, respectively) groups. Conclusion: Pregnant women with obesity, exhibit high levels of sedentary behavior, a high prevalence of gestational diabetes, and exceed recommended gestational weight gain. Healthcare professionals have a crucial role in promoting regular physical activity and lifestyle changes before and during pregnancy.

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“…This approach has been used to investigate if associations between exposures and outcomes are, at least partially, due to unmeasured familial confounders shared by twin pairs. 25,26 To study the within-individual association of mental disorder and discrimination (aim 1), we fitted univariable and multivariable logistic regression models with random effects applying maximum likelihood estimation of odds ratios (OR). This allowed us to study within-individual associations between exposure and outcome (including covariates) while accounting for the paired structure of the data to make inferences about individual differences.…”

Section: Statistical Analysesmentioning

confidence: 99%

Mental disorders and discrimination: a prospective cohort study of young twin pairs in Germany

Calais-Ferreira,

Armstrong,

Hahn

et al. 2023

Preprint

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BackgroundMental disorders and discrimination share common risk factors. The association between having a mental disorder and experiencing discrimination is well-known, but the extent to which familial factors, such as genetic and shared environmental factors, might confound this association, including gender differences in familial confounding, remains unexplored.AimsWe investigated potential unmeasured familial confounding in the relationship between mental disorders and discrimination.MethodWe examined 2,044 same-sex twin pairs aged 16–25 years from the German population-based study’TwinLife’. We used a matched design and random-effects regression applied to within-individual and within-and-between pair models for the association between mental disorder and discrimination, and used likelihood ratio tests (LRTs) to compare these models. Multivariable models were adjusted for body-mass-index, educational attainment, and global life satisfaction.ResultsMental disorder and discrimination were associated in the adjusted within-individual model (adjusted odds ratio=2.19, 95% Confidence Interval:1.42–3.39,P<0.001). However, the within-and-between pair model showed that this association was explained by the within-pair mean (aOR=4.24, 95%CI:2.17–8.29,P<0.001) and not the within-pair difference (aOR=1.26, 95%CI:0.70–2.28,P=0.4) of mental disorder. Therefore, this association was mostly explained by familial confounding, which is also supported by the LRTs for the unadjusted and adjusted models (P<0.001 andP=0.03, respectively). This familial confounding was more prominent for males than females.ConclusionsOur findings show that the association between mental disorder and discrimination is almost fully explained by unmeasured familial factors. Incorporating family members in interventions targeted at ameliorating mental ill-health and experiences of discrimination among adolescents may improve efficacy.

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Birthweight, gestational age and familial confounding in sex differences in infant mortality: a matched co-twin control study of Brazilian male-female twin pairs identified by population data linkage

Cited by 11 publications

References 27 publications

Sex differences in lifetime prevalence of low back pain: A multinational study of opposite‐sex twin pairs

Sex differences in lifetime prevalence of low back pain: A multinational study of opposite‐sex twin pairs

The Influence of Pregestational Body Mass Index and Physical Activity Patterns on Maternal, Delivery, and Newborn Outcomes in a Sample of Portuguese Pregnant Women: A Retrospective Cohort Study

Mental disorders and discrimination: a prospective cohort study of young twin pairs in Germany

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