Pregnancy-related factors are important for short- and long-term health in mothers and offspring. The nationwide population-based Swedish Medical Birth Register (MBR) was established in 1973. The present study describes the content and quality of the MBR, using original MBR data, Swedish-language and international publications based on the MBR.The MBR includes around 98% of all births in Sweden. From 1982 onwards, the MBR is based on prospectively recorded information in standardized antenatal, obstetric, and neonatal records. When the mother and infant are discharged from hospital, this information is forwarded to the MBR, which is updated annually. Maternal data include information from first antenatal visit on self-reported obstetric history, infertility, diseases, medication use, cohabitation status, smoking and snuff use, self-reported height and measured weight, allowing calculation of body mass index. Birth and neonatal data include date and time of birth, mode of delivery, singleton or multiple birth, gestational age, stillbirth, birth weight, birth length, head circumference, infant sex, Apgar scores, and maternal and infant diagnoses/procedures, including neonatal care. The overall quality of the MBR is very high, owing to the semi-automated data extraction from the standardized regional electronic health records, Sweden’s universal access to antenatal care, and the possibility to compare mothers and offspring to the Total Population Register in order to identify missing records. Through the unique personal identity numbers of mothers and live-born offspring, the MBR can be linked to other health registers. The Swedish MBR contains high-quality pregnancy-related information on more than 5 million births during five decades.

Unmeasured confounding is one of the main sources of bias in observational studies. A popular way to reduce confounding bias is to use sibling comparisons, which implicitly adjust for several factors in the early environment or upbringing without requiring them to be measured or known. In this article we provide a broad exposition of the statistical analysis methods for sibling comparison studies. We further discuss a number of methodological challenges that arise in sibling comparison studies. Expected final online publication date for the Annual Review of Statistics and Its Application, Volume 9 is March 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

ImportanceRituximab is a third-line option for refractory generalized myasthenia gravis (MG) based on empirical evidence, but its effect in new-onset disease is unknown.ObjectiveTo investigate the efficacy and safety of rituximab compared with placebo as an add-on to standard of care for MG.Design, Setting, and ParticipantsThis randomized, double-blind, placebo-controlled study took place throughout 48 weeks at 7 regional clinics in Sweden. Key inclusion criteria were age older than 18 years, onset of generalized symptoms within 12 months or less, and a Quantitative Myasthenia Gravis (QMG) score of 6 or more. Patients were screened from October 20, 2016, to March 2, 2020. Key exclusion criteria included pure ocular MG, suspected thymoma, previous thymectomy, and prior noncorticosteroid immunosuppressants or high doses of corticosteroids.InterventionsParticipants were randomized 1:1 without stratification to a single intravenous infusion of 500 mg of rituximab or matching placebo.Main Outcomes and MeasuresMinimal disease manifestations at 16 weeks defined as a QMG score of 4 or less with prednisolone, 10 mg or less daily, and no rescue treatment.ResultsOf 87 potentially eligible patients, 25 were randomized to rituximab (mean [SD] age, 67.4 [13.4] years; 7 [28%] female) and 22 to placebo (mean [SD] age, 58 [18.6] years; 7 [32%] female). Compared with placebo, a greater proportion with rituximab met the primary end point; 71% (17 of 24) in the rituximab group vs 29% (6 of 21) in the placebo group (Fisher exact test P = .007; probability ratio, 2.48 [95% CI, 1.20-5.11]). Secondary end points, comparing changes in Myasthenia Gravis Activities of Daily Living and Myasthenia Gravis Quality of Life at 16 weeks with QMG at 24 weeks did not differ between groups with censoring for rescue treatment (per-protocol analysis) but were in favor of active treatment when rescue treatment was taken into account by worst rank imputation (post hoc analysis). Rescue treatments were also more frequent in the placebo arm (rituximab: 1 [4%]; placebo, 8 [36%]). One patient in the placebo arm had a myocardial infarction with cardiac arrest and 1 patient in the active arm experienced a fatal cardiac event.Conclusions and RelevanceA single dose of 500 mg of rituximab was associated with greater probability of minimal MG manifestations and reduced need of rescue medications compared with placebo. Further studies are needed to address long-term benefit-risk balance with this treatment.Trial RegistrationClinicalTrials.gov Identifier: NCT02950155

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Objectives To describe the use of baricitinib and tofacitinib by Swedish rheumatoid arthritis (RA) patients and to compare their effectiveness with that of biological disease-modifying anti-rheumatic drugs (bDMARDs). Methods RA patients who initiated baricitinib [N = 1420], tofacitinib [N = 316], abatacept [N = 1050], interleukin-6 inhibitors (IL6i) [N = 849], rituximab [N = 1101] or tumour necrosis factor inhibitors (TNFi) [N = 6036] between January 2017 and November 2019 were followed for minimum one year, using data from several linked Swedish national registers. Proportions reaching good-EULAR-DAS28 response, HAQ-DI improvement above 0.2 units and CDAI remission were compared at one year, imputing discontinued treatments as “non-response”. Additionally, we compared drug retention and changes in DAS28, HAQ-DI and CDAI from baseline to three months after treatment initiation. Results On average, baricitinib and particularly tofacitinib were initiated as later lines of therapy and more frequently as monotherapy compared with rituximab and TNFi. Adjusted one-year response proportions were consistently lower on TNFi compared with baricitinib, with differences of -4.3 percentage points (95% CI: -8.7–0.1) for good-EULAR response, -9.9 (-14.4 to -5.4) for HAQ-DI improvement, and -6.0 (-9.8 to -2.2) for CDAI remission. Comparisons with non-TNFi bDMARDs also favoured baricitinib, but not consistently. Treatment responses for tofacitinib were only marginally lower than those for baricitinib and generally similar to those of bDMARDs, with precision limited by low power. Comparisons of drug retention and changes in disease activity from baseline to three months supported the one-year findings. Conclusions Baricitinib and tofacitinib showed at least equivalent effectiveness compared with bDMARDs after exploring several different effectiveness measures.