ArticlePaediatric and perinatal epidemiology2016
Implications of Using a Fetuses-at-Risk Approach When Fetuses Are Not at Risk.
Article in Paediatric and perinatal epidemiology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
24 citing papers in PubMed, 44 citations in OpenAlex.
- The Effect of Prenatal Treatments on Offspring Events in the Presence of Competing Events: An Application to a Randomized Trial of Fertility Therapies.Epidemiology (Cambridge, Mass.) · 2020Trial
- Maternal Obesity and Neonatal Death in Preterm US Pacific Islander Neonates Using 2 Analytic Approaches.JAMA network open · 2025Article
- Methodologic considerations in estimating racial disparity of mortality among very preterm infants.Pediatric research · 2025Review
- Who Is at Risk for Stillbirth? The Discussion Continues.Paediatric and perinatal epidemiology · 2025Article
- The not-so-simple question of when or if to induce a term pregnancy.Paediatric and perinatal epidemiology · 2024Article
- Epidemiology of elective induction of labour: a timeless exposure.International journal of epidemiology · 2024Article
- Cohort selection and the estimation of racial disparity in mortality of extremely preterm neonates.Pediatric research · 2024Observational
- Racial disparities in the development of comorbid conditions after preterm birth: A narrative review.Seminars in perinatology · 2022Review
- Maternal characteristics as indications for routine induction of labor: A nationwide retrospective cohort study.Birth (Berkeley, Calif.) · 2022Article
- The Global Pregnancy Collaboration (CoLab) symposium on short- and long-term outcomes in offspring whose mothers had preeclampsia: A scoping review of clinical evidence.Frontiers in medicine · 2022Article
- Stillbirth as left truncation for early neonatal death in California, 1989-2015: a time-series study.BMC pregnancy and childbirth · 2021Article
- Environmental hazards, social inequality, and fetal loss: Implications of live-birth bias for estimation of disparities in birth outcomes.Environmental epidemiology (Philadelphia, Pa.) · 2021Article
- Article
- Epidemiological Studies on Fetal Loss - Better Data and Research Methods are Needed.Clinical epidemiology · 2020Article
- Towards a unified perinatal theory: Reconciling the births-based and fetus-at-risk models of perinatal mortality.Paediatric and perinatal epidemiology · 2019Article
- The curse of the perinatal epidemiologist: inferring causation amidst selection.Current epidemiology reports · 2018Article
- Shifting Patterns in Cesarean Delivery Scheduling and Timing in Oregon before and after a Statewide Hard Stop Policy.Health services research · 2018Article
- Two denominators for one numerator: the example of neonatal mortality.European journal of epidemiology · 2018Article
- The fetuses-at-risk approach: survival analysis from a fetal perspective.Acta obstetricia et gynecologica Scandinavica · 2018Review
- Paternal and maternal urinary phthalate metabolite concentrations and birth weight of singletons conceived by subfertile couples.Environment international · 2017Article
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Authors and funding
1 author at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGestational-age-specific rates of postnatal endpoints are sometimes estimated with denominators based on fetuses-at-risk (FAR), rather than live births. However, as infants can only be included in the numerator after they are born alive, interpretation of such rates is problematic.
methodsUsing simple algebra it can be shown that, at each gestational week, FAR rates of postnatal endpoints are the product of the conventional risk of outcome among live births and the probability of live birth, which increases from near zero early in gestation to close to one in the final weeks. The consequences of such a pattern of live birth on FAR rates are further illustrated in hypothetical scenarios with known conditions.
resultsFAR rates of postnatal endpoints will generally increase towards the end of pregnancy due to the rising probability of live birth, regardless of the 'true' effect of immaturity on risk. In the presence of an exposure that increases the probability of early birth, the same mechanism will cause FAR rates to be higher in the exposed group, even if the exposure has no effect.
conclusionsGestational-age-specific FAR rates of postnatal outcomes strongly depend on the probability of live birth. Thus, they reflect neither the causal effect of gestational length, nor that of a given exposure. Indeed, if an exposure shortens gestation, FAR rates will be higher in exposed infants even when the exposure has no impact on the outcome under study. These intrinsic limitations should be taken into account when applying FAR analyses to postnatal endpoints.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.