Modelling stillbirths with natural cubic splines

[摘要] Fetal deaths such as spontaneous abortion and stillbirth are the most common adverse events during the process of pregnancy. According to the Center for Disease Control and Prevention, in 2016, about 1 in 10 babies failed to reach full term birth in the U.S. Spontaneous abortion occurs when the fetus dies in the uterus prior to 20 weeks of gestational age and life birth is not viable then. After 21 weeks, stillbirth may occur when the baby dies during delivery and the risk of stillbirth changes dramatically over the late course of pregnancy. Current studies focus on assessing the overall risk of stillbirth and discovery of preconception markers for the overall risk. In this thesis, we propose a flexible logistic regression model with time-varying, modelled by natural cubic splines, to study the temporal pattern in the risk of stillbirth over time and characterize the temporal association between preconception markers and the risk of stillbirth accordingly. The proposed method was illustrated via analysis of pregnancy outcome data from the Longitudinal Indian Family HEalth (LIFE) study and simulation studies. Public health importance: Application of the proposed method provides accurate assessment of the risk of stillbirth over the course of pregnancy and identify potential preconception makers which leads to the development of novel intervention strategies and treatments and improvement in the well-being of both mothers and babies.

[发布机构] the University of Pittsburgh