Environmental hazards, social inequality, and fetal loss: Implications of live-birth bias for estimation of disparities in birth outcomes

Goin, Dana E.; Casey, Joan A.; Kioumourtzoglou, Marianthi-Anna; Cushing, Lara; Morello‐Frosch, Rachel

doi:10.1097/ee9.0000000000000131

Cited by 16 publications

(15 citation statements)

References 57 publications

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“…[17][18][19] Goin et al demonstrated an underestimation of preterm birth when only live births are considered, suggesting our findings may be attenuated. 18 It is well known that apart from complications at the time of birth, untreated STIs also increase the risk of transmission directly to the baby during birth, predisposing the child to potential longterm complications. 20 We would have also liked to examine additional maternal outcomes which were not available in the data.…”

Section: Limitations Of the Datamentioning

confidence: 59%

Comparing adverse neonatal and maternal outcomes of chlamydia, gonorrhoea, and syphilis infections and co‐infections in pregnancy

Felske

Castillo

Kuret

et al. 2022

Paediatric Perinatal Epid

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Background While maternal sexually transmitted infections (STIs) during pregnancy have been extensively studied, fewer studies have directly compared the associations of different infections and co‐infections or investigated the association between STIs in pregnancy and maternal outcomes. Objectives We examine associations between STIs and co‐infections in pregnancy on risks of adverse neonatal and maternal outcomes. Methods Data from the 2019 US natality files (n = 3,747,882) were used to assess the associations between STIs in pregnancy on adverse pregnancy outcomes. Five mutually exclusive STI groups were examined: a single chlamydia, syphilis, or gonorrhoeal infection, chlamydia and gonorrhoea co‐infection, and syphilis co‐infection (with chlamydia, gonorrhoea, or both). Demographic and obstetric characteristics among each STI group were compared to those of an uninfected comparison group. Prevalence ratios (PR) of adverse neonatal outcomes (preterm birth, small for gestational age [SGA] births, and 5‐min APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score < 7) and maternal outcomes (gestational hypertension) by STI status were examined using log‐binomial regression. Results Increased prevalence of preterm birth was apparent, especially among those with a syphilis infection (PR 1.19, 95% confidence intreval [CI] 1.10, 1.30 for single infections and PR 1.31, 95% CI 1.10, 1.57 for co‐infections). All STI groups, except gonorrhoea and chlamydia co‐infections, were associated with an increased prevalence of gestational hypertension, with the strongest association among those with syphilis co‐infections (PR 1.41, 95% CI 1.13, 1.76). Conclusions An increased prevalence was of preterm birth and low APGAR scores were associated with syphilis infection. Increased prevalence of GH among those with STIs warrants further investigation into the relationships and corresponding mechanisms of STIs in pregnancy on adverse maternal outcomes.

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Section: Limitations Of the Datamentioning

confidence: 59%

Comparing adverse neonatal and maternal outcomes of chlamydia, gonorrhoea, and syphilis infections and co‐infections in pregnancy

Felske

Castillo

Kuret

et al. 2022

Paediatric Perinatal Epid

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“…Similarly, another form of collider stratification bias, resulting from the necessity of conditioning ASD assessments on live births, could induce a falsely protective association of smoking among preterm cohorts, given that tobacco smoke exposure in pregnancy is a risk factor for both premature birth and fetal loss (Liew et al, 2015;Pineles et al, 2014). The bias can occur if exposed children who are born preterm and do not survive were otherwise at a higher risk for ASD than those who did survive, potentially leading to a paradoxical protective association with smoking if it preferentially leads to fetal loss among fetuses susceptible to ASD (Goin et al, 2021), as described previously for air pollution (Leung et al, 2021;Raz et al, 2018). However, a key question with regard to 'live-birth bias' is whether the interest lies in all conceptions or just among live births who reach the age when a diagnosis is possible, in which case, such bias is less likely or may be entirely moot.…”

Section: Discussionmentioning

confidence: 99%

Maternal tobacco smoking and offspring autism spectrum disorder or traits in ECHO cohorts

et al. 2022

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Given inconsistent evidence on preconception or prenatal tobacco use and offspring autism spectrum disorder (ASD), this study assessed associations of maternal smoking with ASD and ASD-related traits. Among 72 cohorts in the Environmental Influences on Child Health Outcomes consortium, 11 had ASD diagnosis and prenatal tobaccosmoking (n = 8648). and 7 had Social Responsiveness Scale (SRS) scores of ASD traits (n = 2399). Cohorts had diagnoses alone (6), traits alone (2), or both (5). Diagnoses drew from parent/caregiver report, review of records, or standardized instruments. Regression models estimated smoking-related odds ratios (ORs) for diagnoses and standardized mean differences for SRS scores. Cohort-specific ORs were meta-analyzed. Overall, maternal smoking was unassociated with child ASD (adjusted OR, 1.08; 95% confidence interval [CI], 0.72-1.61). However, heterogeneity across studies was strong: preterm cohorts showed reduced ASD risk for exposed children. After excluding preterm cohorts (biased by restrictions on causal intermediate and exposure opportunity) and small cohorts (very few ASD cases in either smoking category), the adjusted OR for ASD from maternal smoking was 1.44 (95% CI, 1.02-2.03). Children of smoking (versus non-smoking) mothers had more ASD traits (SRS Tscore + 2.37 points, 95% CI, 0.73-4.01 points), with results homogeneous across cohorts. Maternal preconception/prenatal smoking was consistently associated with quantitative ASD traits and modestly associated with ASD diagnosis among sufficiently powered United States cohorts of non-preterm children. Limitations resulting from self-reported smoking and unmeasured confounders preclude definitive conclusions. Nevertheless, counseling on potential and known risks to the child from maternal smoking is warranted for pregnant women and pregnancy planners.Lay Summary: Evidence on the association between maternal prenatal smoking and the child's risk for autism spectrum disorder has been conflicting, with some studies reporting harmful effects, and others finding reduced risks. Our analysis of children in the ECHO consortium found that maternal prenatal tobacco smoking is consistently associated with an increase in autism-related symptoms in the general population and modestly associated with elevated risk for a diagnosis of autism spectrum disorder when looking at a combined analysis from multiple studies that each included both pre-and full-term births. However, this study is not proof of a causal connection. Future studies to clarify the role of smoking in autism-like behaviors or autism diagnoses should collect more reliable data on smoking and measure other exposures or lifestyle factors that might have confounded our results.

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“…However, residential mobility and time–activity patterns during pregnancy were likely nondifferential conditional on the covariates included, with the magnitude of the bias being contingent on the degree of misclassification in our sample. Furthermore, our analyses were restricted to live-born children and so our estimates may be biased upward ( Goin et al. 2021 ; Leung et al.…”

Section: Discussionmentioning

confidence: 99%

Exposure to PM2.5 during Pregnancy and Fetal Growth in Eastern Massachusetts, USA

Leung

Weisskopf

Laden

et al. 2022

Environ Health Perspect

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Background: Prior studies have examined the association between fine particulate matter [PM in aerodynamic diameter ( )] and fetal growth with either limited spatial or temporal resolution. Objectives: In this study, we examined the association between exposure during pregnancy and fetal growth measures (ultrasound parameters and birth weight) in a pregnancy cohort using spatiotemporally resolved in Eastern Massachusetts, USA. Methods: We used ultrasound measures of biparietal diameter (BPD), head circumference, femur length, and abdominal circumference (AC), in addition to birth weight, from 9,446 pregnancies that were delivered at the Beth Israel Deaconess Medical Center from 2011–2016. We used linear mixed-effects models to examine the associations of in two exposure windows (the first 16 wk of pregnancy and the cumulative exposure up until the assessment of fetal growth) with anatomic scans (ultrasound ), growth scans (ultrasound ), and birth weight. All models were adjusted for sociodemographic characteristics, long-term trends, and temperature. Results: Higher exposure in the first 16 wk was associated with smaller fetal growth measures, where associations were particularly strong for BPD, AC, and birth weight. For example, a increase in was associated with a lower mean BPD -score of (95% CI: , ) before 24 wk, a lower mean AC -score of (95% CI: , ) after 24 wk, and a lower mean birth weight -score of (95% CI: , ). Analyses examining the associations with cumulative exposure up until the assessment of fetal growth produced attenuated associations. Conclusions: Higher gestational exposure to was associated with smaller fetal growth measures at levels below the current national standards. https://doi.org/10.1289/EHP9824

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Environmental hazards, social inequality, and fetal loss: Implications of live-birth bias for estimation of disparities in birth outcomes

Abstract: Supplemental Digital Content is available in the text.

Cited by 16 publications

References 57 publications

Comparing adverse neonatal and maternal outcomes of chlamydia, gonorrhoea, and syphilis infections and co‐infections in pregnancy

Comparing adverse neonatal and maternal outcomes of chlamydia, gonorrhoea, and syphilis infections and co‐infections in pregnancy

Maternal tobacco smoking and offspring autism spectrum disorder or traits in ECHO cohorts

Exposure to PM2.5 during Pregnancy and Fetal Growth in Eastern Massachusetts, USA

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