Invited Commentary: The Causal Association Between Obesity and Stillbirth-Strengths and Limitations of the Consecutive-Pregnancies Approach.
Invited Commentary: The Causal Association Between Obesity and Stillbirth-Strengths and Limitations of the Consecutive-Pregnancies Approach.
复制标题
特邀评论：肥胖与死产之间的因果关系——连续妊娠方法的优势和局限性。
DOI：
10.1093/aje/kwz079
复制
发表时间：
2019
影响因子：
5
通讯作者：
Leonard,StephanieA
中科院分区：
文献类型：
--
作者：
Snowden,JonathanM;Leonard,StephanieA
在围产期和儿科流行病学中，对连续妊娠（或类似的同胞设计）的分析已经复苏。这些方法对于估计与复杂的多因素暴露（如肥胖）的关联具有吸引力。在这期杂志上发表的一篇文章中，Yu等人（Am J Epidemiol.二〇一九年; 188（7）：1328-1336）应用召唤怀孕方法来表征在怀孕之间发展肥胖（“偶发性肥胖”）的妇女中的死胎风险。在因果框架内工作，并使用参数和非参数估计技术，作者发现死产风险增加与事件肥胖有关。风险差异介于每1，000例出生0.4例（95%置信区间（CI）：0.1，0.7）和每1，000例出生6.9例（95% CI：3.7，10.0）之间，风险比范围为1.12（95% CI：1.02，1.23）至2.99（95% CI：2.19，4.08）。这种方法的优势包括从一个明确定义的因果被估量开始，并探索模型选择的参数估计的敏感性。在这篇评论中，我们将这些发现放在肥胖和出生结局研究的更广泛背景下，并强调了对来自家庭内设计的结果的普遍性的担忧。我们的结论是，虽然因果推理是一个重要的目标，在某些情况下，专注于制定一个因果问题驱动器的结果远离广泛的适用性。
There has been a resurgence in analyses of consecutive pregnancies (or similarly, sibling designs) in perinatal and pediatric epidemiology. These approaches have attractive qualities for estimating associations with complex multifactorial exposures like obesity. In an article appearing in this issue of theJournal, Yu et al. (Am J Epidemiol. 2019;188(7):1328–1336) apply a consecutive-pregnancies approach to characterize the risk of stillbirth among women who develop obesity between pregnancies (“incident obesity”). Working within a causal framework and using parametric and nonparametric estimation techniques, the authors find an increase in stillbirth risk associated with incident obesity. Risk differences varied between 0.4 per 1,000 births (95% confidence interval (CI): 0.1, 0.7) and 6.9 per 1,000 births (95% CI: 3.7, 10.0), and risk ratios ranged from 1.12 (95% CI: 1.02, 1.23) to 2.99 (95% CI: 2.19, 4.08). The strengths of this approach include starting from a clearly defined causal estimand and exploring the sensitivity of parameter estimates to model selection. In this commentary, we put these findings in the broader context of research on obesity and birth outcomes and highlight concerns regarding the generalizability of results derived from within-family designs. We conclude that while causal inference is an important goal, in some instances focusing on formulation of a causal question drives results away from broad applicability.