为因果中间混因素进行调整是否解决了围产交叉悖论?
Wen Wei Loh1, Cande V Ananth2,3,4,5,6
1From the Department of Methodology and Statistics, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands.
Epidemiology (Cambridge, Mass.)
|February 25, 2025
概括
尽管调整了诸如早产 (PTB) 等中介因素,但孕前-周产期结果悖论仍然存在. 没有测量的混仍然是理解孕前的一个重要问题.
科学领域:
- 围产期流行病学 围产期流行病学
- 孕产妇与胎儿的医学
- 在健康研究中的因果推理.
背景情况:
- 孕前症与产前期结局的关联显示出矛盾的发现,在孕前性早产中,不良结局较低.
- 之前的解释涉及到不计时的混,将早产 (PTB) 视为唯一的调解者.
- 中间变量,如胎盘断裂,对于妊娠年龄来说很小 (SGA),以及胆炎通常被排除在外,因为它们的时机是孕前后.
研究的目的:
- 调查因果中间因素的调整是否解决了孕前与产前期结局关联中的混偏差.
- 为了比较处理中间混的不同方法,当PTB是焦点调解器时.
- 评估未测量的混对干预效应的影响.
主要方法:
- 利用了安全劳动联盟 (2002-2008) 的数据.
- 采用干预间接效应来研究调解.
- 将治疗中间体作为暴露诱导混剂与多个调解剂进行比较.
- 开发了偏差公式来量化未测量的混.
主要成果:
- 当PTB是唯一的调解者时,孕前显示出保护性直接作用 (RR=0.60),与矛盾的发现一致.
- 这种保护作用甚至在调整中介混因子 (断裂,SGA,chorioamnionitis) 之后仍然存在.
- 灵敏度分析表明,需要一个强大的未测量混因子来解决悖论.
结论:
- 对断裂,SGA和胆膜炎等中间体进行调整不足以消除PTB-周产期死亡率的未测量混.
- 孕前对死亡率的保护性直接影响的悖论仍然没有得到解决.
- 对未测量混的敏感性分析对于加强因果调解结论至关重要.
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