Comment on: The association between pre‐eclampsia and neonatal complications in relation to gestational age
Notice bibliographique
Résumé
We read Ulfsdottir et al.'s1 article on pre-eclampsia and risk of adverse neonatal outcomes at different gestational ages with great interest. The authors analysed a cohort of 805 591 singletons, including 34 145 (4.2%) newborns exposed to pre-eclampsia and 46 586 (5.8%) that were born pre-term. The authors stratified their population to examine pre-term newborns separately from term newborns. While they found that pre-eclampsia was strongly associated with neonatal morbidity at term, pre-eclampsia was not as great a risk factor for morbidity pre-term. The findings suggest that pre-eclampsia is less worrisome when neonates are delivered before term. Among births at 22–31 weeks, pre-eclampsia was associated with only a 23% greater risk of resuscitation compared with no pre-eclampsia, while at term, the risk of resuscitation was 94% greater. Other results suggest that birth before term could even be protective. Among births at 22–31 weeks, pre-eclampsia was associated with a 53% lower risk of having an Apgar score below 7 compared with no pre-eclampsia, whereas among term births, pre-eclampsia was associated with a 66% greater risk of this outcome. Based on these findings, it may be tempting to recommend delivering infants early when pre-eclampsia presents before 37 weeks. However, there is a possibility of bias as the data were stratified by gestational age. Neonates exposed to pre-eclampsia who were born at 22–31 weeks were compared with unexposed neonates who were also born extremely premature. The comparison group is not representative of normal foetuses because other severe complications requiring delivery were likely present. These complications could potentially be more dangerous to the foetus than pre-eclampsia. As a result, pre-eclampsia may appear less harmful or even paradoxically protective against neonatal morbidity in pre-term newborns. Paradoxical findings before term may be a sign of collider stratification bias, a widely recognised problem in perinatal epidemiology.2 When gestational age is an intermediate variable, restricting the study population to pre-term births can distort the association between prenatal exposures and neonatal outcomes.2 The protective effect of pre-eclampsia on cerebral palsy among pre-term children is a well-established example of collider bias.2 The birthweight paradox is another example, where maternal smoking is seemingly protective against mortality among low birthweight infants.2 Methods are available to prevent collider bias, including avoiding stratification and adjustment or using a foetuses-at-risk approach.3 The foetuses-at-risk approach relies on using ongoing pregnancies in the analysis, rather than only pregnancies that are delivered early.3 Ulfsdottir et al.'s1 study is important and reinforces the harmful impact of pre-eclampsia on neonatal morbidity at term. However, the results for pre-term newborns should be interpreted with caution as stratification can inadvertently attenuate or lead to protective associations between pre-eclampsia and morbidity. Future studies of prenatal exposures should be mindful of collider bias when gestational age is an intermediate and data are stratified by pre-term birth. Nathalie Auger: Conceptualization; writing – review and editing. Méloë Maigné: Conceptualization; writing – original draft. Émilie Brousseau: Conceptualization; writing – original draft. The authors declare no conflicts of interest.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».