Perinatal epidemiology: Issues, challenges, and potential solutions

Abstract

Perinatal epidemiology research is concerned with identifying the effects of events during pregnancy on pregnancy outcomes that include maternal, fetal, and neonatal health outcomes. Randomized trials in perinatal research face many challenges, including randomization difficulties, ethical considerations, and inadequate statistical power due to the small number of subjects eligible for participation. For these reasons, most epidemiological studies conducted in this research field are observational and include different types of bias. This review describes the key methodological difficulties in the design and analysis of randomized and observational studies in perinatal epidemiology, and provides potential corrective approaches.

Pre‐eclampsia and long‐term health outcomes for mother and infant: an umbrella review

“…Changes in the cognitive ability of the offspring, 20 as well as psychiatric disorders, mood and anxiety disorders, 21 were also reported. However, most of this research has been observational in design, often summarised by outcome through systematic review and meta‐analysis, therefore susceptible to bias, resulting in false positives or inflated estimates of the associations 22–24 …”

“…However, most of this research has been observational in design, often summarised by outcome through systematic review and meta-analysis, therefore susceptible to bias, resulting in false positives or inflated estimates of the associations. [22][23][24] To our knowledge, there has been no systematic effort to summarise the current evidence from existing meta-analyses on long-term health outcomes in women and/or their offspring after pre-eclampsia and to examine their potential limitations. This umbrella review of meta-analyses of observational studies aims to contextualise the quality and strength of the evidence across all long-term health outcomes in women and/or their offspring, and to identify those associations with the strongest epidemiological evidence.…”

Dual Trigger with Gonadotropin Releasing Hormone Agonist and Human Chorionic Gonadotropin of Fresh Autologous Cycles in High Responders: A Systematic Review

“…Sufficient enrollment for well powered randomized clinical trials in a reasonable amount of time can also be challenging, primarily due to women’s concerns about the risks associated with a trial, while many factors that affected the outcome of pregnancy cannot be controlled. Consequently, many of the trials conducted in this field are underpowered to detect significant differences in clinical outcomes ( 64 ). The luteal phase in IVF protocols is still not fully understood, leading to suboptimal luteal phase support which can negatively affect the outcomes of these studies.…”

Prediction of pre-eclampsia

“…Thus, standardization of definitions, methods, and statistical analyses will be useful for multi-national comparison and meta-analysis of results as well as development and evaluation of prediction models, which ultimately promote clinical health practice. 58 Furthermore, well-designed large prospective studies are needed to assess the accuracy of risk prediction models according to disease onset and population risk in comparison to the current single risk factor screening. Further research is necessary to determine whether predictive models can be further improved with the addition of novel biomarkers implicated in the pathophysiology of PE as well as identify additional combinations of markers that may predict the occurrence of PE.…”