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Pregnancy complications following fertility treatment-disentangling the role of multiple gestation.

https://arctichealth.org/en/permalink/ahliterature299898
Source
Int J Epidemiol. 2018 08 01; 47(4):1333-1342
Publication Type
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Date
08-01-2018
Author
Anna Sara Oberg
Tyler J VanderWeele
Catarina Almqvist
Sonia Hernandez-Diaz
Author Affiliation
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
Source
Int J Epidemiol. 2018 08 01; 47(4):1333-1342
Date
08-01-2018
Language
English
Publication Type
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Keywords
Adult
Cesarean Section - statistics & numerical data
Female
Humans
Infant, Newborn
Infertility - therapy
Logistic Models
Male
Pre-Eclampsia - epidemiology
Pregnancy
Pregnancy Complications - epidemiology
Pregnancy outcome
Pregnancy, Multiple
Premature Birth - epidemiology
Reproductive Techniques, Assisted - adverse effects - statistics & numerical data
Sweden - epidemiology
Abstract
To assess the extent to which multiple gestations mediate risk of pregnancy complications from fertility treatment and to address possible confounding by the underlying infertility.
From the nearly 1.8 million pregnancies recorded in the Swedish Medical Birth Register between 1996 and 2013, we selected the 9.9% (N?=?174 067) that occurred to couples with known trouble conceiving (clinical infertility). Fertility treatment was identified from self-reports, medical records and procedural information from fertility clinics. We used logistic regression to estimate odds ratios (ORs) and their 95% confidence intervals (CIs), and decomposed the total effect into direct and mediated effects to estimate the proportion mediated by multiple gestations.
Compared with pregnancies achieved without any assistance, those having received some treatment had higher odds of all studied complications except gestational diabetes. Associations with placenta previa (OR 2.17, 95% CI 1.95-2.40) and placental abruption (OR 1.77, 95% CI 1.54-2.03) were almost entirely independent of multiple gestations. In contrast, the majority of the associations with preterm birth (OR 1.69, 95% CI 1.62-1.77), caesarean delivery (RR 1.15, 95% CI 1.13-1.17) and pre-eclampsia (OR 1.17, 95% CI 1.11-1.22) were mediated by multiple gestations (87%, 62% and 91% of the effect mediated, respectively). Both direct and mediated pathways contributed to the remaining positive associations with chorioamnionitis, labour induction and postpartum haemorrhage. Results were similar when considering primi- and multi-parous women separately, and after restriction to assisted reproductive technologies only.
Multiple gestations are responsible for a large proportion of pregnancy complications associated with fertility treatment, suggesting that interventions to restrict the occurrence of multiples could reduce excess risk of pre-eclampsia, preterm birth and caesarean delivery after fertility treatment. However, the elevated risk of serious placental complications after fertility treatment appears to be largely independent of multiple gestations.
PubMed ID
29939263 View in PubMed
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War-Related Traumas and Mental Health Across Generations.

https://arctichealth.org/en/permalink/ahliterature303054
Source
JAMA Psychiatry. 2018 01 01; 75(1):5-6
Publication Type
Editorial
Comment
Date
01-01-2018
Author
Theresa S Betancourt
Dana Thomson
Tyler J VanderWeele
Author Affiliation
Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, Massachusetts.
Source
JAMA Psychiatry. 2018 01 01; 75(1):5-6
Date
01-01-2018
Language
English
Publication Type
Editorial
Comment
Keywords
Child
Finland
Hospitalization
Humans
Mental health
Stress Disorders, Post-Traumatic
War-Related Injuries
World War II
Notes
CommentOn: JAMA Psychiatry. 2018 Jan 1;75(1):21-27 PMID 29188292
PubMed ID
29188290 View in PubMed
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