Reevaluating the protective effect of smoking on preeclampsia risk through the lens of bias
(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)
- author
- Rodriguez-Lopez, Merida LU ; Escobar, Maria Fernanda ; Merlo, Juan LU and Kaufman, Jay S
- organization
- publishing date
- 2023-05
- 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}}, }