Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Reevaluating the protective effect of smoking on preeclampsia risk through the lens of bias

Rodriguez-Lopez, Merida LU ; Escobar, Maria Fernanda ; Merlo, Juan LU orcid and Kaufman, Jay S (2023) In Journal of Human Hypertension 37. p.338-344
Abstract

Preeclampsia is a hypertensive disorder that is usually diagnosed after 20 weeks' gestation. Despite the deleterious effect of smoking on cardiovascular disease, it has been frequently reported that smoking has a protective effect on preeclampsia risk and biological explanations have been proposed. However, in this manuscript, we present multiple sources of bias that could explain this association. First, key concepts in epidemiology are reviewed: confounder, collider, and mediator. Then, we describe how eligibility criteria, losses of women potentially at risk, misclassification, or performing incorrect adjustments can create bias. We provide examples to show that strategies to control for confounders may fail when they are applied to... (More)

Preeclampsia is a hypertensive disorder that is usually diagnosed after 20 weeks' gestation. Despite the deleterious effect of smoking on cardiovascular disease, it has been frequently reported that smoking has a protective effect on preeclampsia risk and biological explanations have been proposed. However, in this manuscript, we present multiple sources of bias that could explain this association. First, key concepts in epidemiology are reviewed: confounder, collider, and mediator. Then, we describe how eligibility criteria, losses of women potentially at risk, misclassification, or performing incorrect adjustments can create bias. We provide examples to show that strategies to control for confounders may fail when they are applied to variables that are not confounders. Finally, we outline potential approaches to manage this controversial effect. We conclude that there is probably no single epidemiological explanation for this counterintuitive association.

(Less)
Please use this url to cite or link to this publication:
author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Pregnancy, Female, Humans, Pre-Eclampsia/diagnosis, Smoking/adverse effects, Bias, Hypertension/epidemiology, Cardiovascular Diseases
in
Journal of Human Hypertension
volume
37
pages
338 - 344
publisher
Nature Publishing Group
external identifiers
  • scopus:85152387672
  • pmid:37041252
ISSN
1476-5527
DOI
10.1038/s41371-023-00827-9
language
English
LU publication?
yes
additional info
© 2023. The Author(s).
id
c31262d2-7eba-43eb-857e-fd3d7abe3563
date added to LUP
2023-05-20 13:36:01
date last changed
2024-04-19 21:53:10
@article{c31262d2-7eba-43eb-857e-fd3d7abe3563,
  abstract     = {{<p>Preeclampsia is a hypertensive disorder that is usually diagnosed after 20 weeks' gestation. Despite the deleterious effect of smoking on cardiovascular disease, it has been frequently reported that smoking has a protective effect on preeclampsia risk and biological explanations have been proposed. However, in this manuscript, we present multiple sources of bias that could explain this association. First, key concepts in epidemiology are reviewed: confounder, collider, and mediator. Then, we describe how eligibility criteria, losses of women potentially at risk, misclassification, or performing incorrect adjustments can create bias. We provide examples to show that strategies to control for confounders may fail when they are applied to variables that are not confounders. Finally, we outline potential approaches to manage this controversial effect. We conclude that there is probably no single epidemiological explanation for this counterintuitive association.</p>}},
  author       = {{Rodriguez-Lopez, Merida and Escobar, Maria Fernanda and Merlo, Juan and Kaufman, Jay S}},
  issn         = {{1476-5527}},
  keywords     = {{Pregnancy; Female; Humans; Pre-Eclampsia/diagnosis; Smoking/adverse effects; Bias; Hypertension/epidemiology; Cardiovascular Diseases}},
  language     = {{eng}},
  pages        = {{338--344}},
  publisher    = {{Nature Publishing Group}},
  series       = {{Journal of Human Hypertension}},
  title        = {{Reevaluating the protective effect of smoking on preeclampsia risk through the lens of bias}},
  url          = {{http://dx.doi.org/10.1038/s41371-023-00827-9}},
  doi          = {{10.1038/s41371-023-00827-9}},
  volume       = {{37}},
  year         = {{2023}},
}