Timing and patterns of exposures during pregnancy and their implications for study methods.
Timing and patterns of exposures during pregnancy and their implications for study methods.
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怀孕期间暴露的时间和模式及其对研究方法的影响。
DOI：
10.1093/oxfordjournals.aje.a008790
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发表时间：
1996
影响因子：
5
通讯作者：
Beaumont,JJ
中科院分区：
文献类型：
--
作者：
Hertz-Picciotto,I;Pastore,LM;Beaumont,JJ
从加州10个农村县的357例活产婴儿中，对妊娠期间的医疗、生活方式、居住和职业暴露的暴露变异模式进行了研究。引入了一种新的变异性测量方法，即总患病率与特定时间窗患病率的比率。整体越高：时间窗（OTW）比率越高，当使用妊娠期间任何时间的患病率作为在较小时间窗内发挥作用的药物时，错误分类的可能性就越大。暴露于香烟、大麻、桑拿/热水浴缸、与居住地点有关的因素以及某些工作场所物质的时间往往较长。妊娠中期的一致性对于吸烟、住宅接近农作物和使用视频显示终端来说是高的（κ's> 0.8）;对于许多职业暴露来说是中等高的（κ's在0.4和0.8之间）;对于疾病来说是低的（κ's < 0.4），这些疾病往往持续时间很短。OTW比率最低的是吸烟和某些住宅暴露（1.1-1.3），而油漆应用、流感、阴道感染和超声波的OTW比率要高得多（达到，例如，4-6）。使用怀孕期间任何时间的暴露指数可能会使风险因素和不良妊娠结局之间的相关性测量产生偏差，特别是当OTW比率很高时。如果存在暴露发挥其影响的脆弱时间窗口，则会发生误分类偏倚。当病例组的平均妊娠时间短于对照组时，这种错误分类可能是有区别的。对于不同的暴露，妊娠结局的调查应收集尽可能多的关于时间的细节。
Patterns of exposure variability across pregnancy were examined for medical, lifestyle, residential, and occupational exposures in a population-based sample of 357 livebirths from 10 rural California counties. A new measure of variability, the ratio of overall prevalence to time-window-specific prevalence, is introduced. The higher the overall: time window (OTW) ratio, the greater the potential for misclassification when using anytime-during-pregnancy prevalence for an agent that exerts its effect in a smaller time window. Exposures to cigarettes, marijuana, saunas/hot tubs, factors related to location of residence, and some workplace substances tended to be of longer duration. Intertrimester concordance was high (κ's > 0.8) for smoking, residential proximity to crops, and use of video display terminals; moderately high (κ's between 0.4 and 0.8) for many occupational exposures; and low (κ's < 0.4) for illnesses, which tended to be of short duration. The lowest OTW ratios were for smoking and some residential exposures (1.1–1.3), while OTW ratios were much higher for paint applications, influenza, vaginal infections, and ultrasound (reaching, e.g., 4–6). Use of anytime-during-pregnancy exposure indices can bias measures of association between risk factors and adverse pregnancy outcomes, particularly if the OTW ratio is high. Misclassification bias occurs if there is a vulnerable time window during which the exposure exerts its effect. The misclassification can be differential when the average length of gestation of cases is shorter than that of controls. For exposures that vary, investigations of pregnancy outcome should collect as much detail as feasible regarding timing.