This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Savitz, D. A Articles by Herring, A. H Search for Related Content PubMed PubMed Citation Articles by Savitz, D. A Articles by Herring, A. H Social Bookmarking                         What's this?

Methodologic issues in the design and analysis of epidemiologic studies of pregnancy outcome

Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, USA

Nancy Dole

Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA

Amy H Herring

Department of Biostatistics, University of North Carolina School of Public Health, Chapel Hill, North Carolina, USA

Using epidemiology to elucidate the causes of adverse pregnancy outcomes offers unique opportunities and poses distinctive challenges. The context of pregnancy includes contraception and planning, medical interventions altering the natural history, and the tendency for selective participation in demanding research protocols. Several key pervasive issues are considered in detail: 1) the close temporal proximity of determinants and outcomes, which makes separation of causes and effects difficult and introduces the real possibility of reverse causality; 2) non-random allocation of exposure, often done consciously in response to concerns about having a healthy pregnancy or to the health of the pregnancy itself, making confounding a major concern; 3) heterogeneity of pregnancy outcomes, with endpoints such as pregnancy loss and preterm birth arising through diverse pathways that are not easily identified and if grouped, could diminish the magnitude of observed associations; and 4) racial and ethnic disparities, which pose a public health challenge in the USA and offer a potentially important opportunity for identifying preventable causes of adverse pregnancy outcome. Sophisticated biological and statistical methods are needed to advance epidemiologic research in this area.

Statistical Methods in Medical Research, Vol. 15, No. 2, 93-102 (2006)
DOI: 10.1191/0962280206sm433oa


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				T. B. Gage, F. Fang, E. O'Neill, and H. Stratton Maternal Age and Infant Mortality: A Test of the Wilcox-Russell Hypothesis Am. J. Epidemiol., February 1, 2009; 169(3): 294 - 303. [Abstract] [Full Text] [PDF]