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Implausible birth weight for gestational age.

K S Joseph1, M S Kramer, A C Allen

  • 1Bureau of Reproductive and Child Health, Laboratory Centre for Disease Control, Ottawa, Ontario, Canada. ks.joseph@np.iwkgrace.ns.ca

American Journal of Epidemiology
|February 13, 2001
PubMed
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Exclusion rules for implausible birth weight for gestational age data disproportionately remove high-risk infants. This may distort trends in infant mortality and perinatal outcomes.

Area of Science:

  • Perinatal epidemiology
  • Biostatistics

Background:

  • Accurate perinatal data is crucial for public health research.
  • Established rules aim to exclude implausible birth weight for gestational age (BW/GA) data.
  • Potential biases from these exclusions are not fully understood.

Purpose of the Study:

  • To evaluate common rules for excluding implausible BW/GA.
  • To assess the characteristics and infant mortality of excluded live births in Canada.

Main Methods:

  • Analysis of Canadian live births (1992-1994), excluding Ontario.
  • Comparison of four exclusion rules: median BW/GA +/-4 SD, +/-5 SD, expert opinion, and modified Tukey's rule.
  • Examination of exclusion frequencies and infant mortality rates.

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Main Results:

  • Exclusion rates varied significantly by rule (0.02% to 0.40%).
  • Tukey's rule excluded a higher proportion of high-birth-weight infants compared to expert opinion.
  • Infant mortality rates among excluded infants were 8-13 times higher than the general live birth population.

Conclusions:

  • Current exclusion rules for implausible BW/GA identify high-risk infants.
  • These rules may lead to an underestimation of adverse perinatal trends.
  • Revising exclusion criteria is necessary to avoid data attrition bias.