학술논문

Different effects for different questions: An illustration using short cervix and the risk of preterm birth.
Document Type
Article
Source
International Journal of Gynecology & Obstetrics. Mar2023, Vol. 160 Issue 3, p842-849. 8p.
Subject
*PREMATURE labor
*PREGNANT women
*STILLBIRTH
*CONFIDENCE intervals
Language
ISSN
0020-7292
Abstract
Objective: To illustrate the difference between exposure effects and population attributable effects. Methods: We examined the effect of mid‐pregnancy short cervical length (<25 mm) on preterm birth using data from a prospective cohort of pregnant women in Lusaka, Zambia. Preterm birth was live birth or stillbirth before 37 weeks of pregnancy. For estimation, we used multivariable regression and parametric g‐computation. Results: Among 1409 women included in the analysis, short cervix was rare (2.4%); 13.6% of births were preterm. Exposure effect estimates were large (marginal risk ratio 2.86, 95% confidence interval [CI] 1.80–4.54), indicating that the preterm birth risk was substantially higher among women with a short cervix compared with women without a short cervix. However, the population attributable effect estimates were close to the null (risk ratio 1.06, 95% CI 1.02–1.10), indicating that an intervention to counteract the impact of short cervix on preterm birth would have minimal effect on the population risk of preterm birth. Conclusion: Although authors often refer to "the" effect, there are actually different types of effects, as we have illustrated here. In planning research, it is important to consider which effect to estimate to ensure that the estimate aligns with the research objective. Synopsis: Multiple types of effects can be estimated from observational data, and researchers should estimate the type of effect that aligns with the stated research objective. [ABSTRACT FROM AUTHOR]