Article Text
Abstract
Perinatal morbidity scores are tools that score or weight different adverse events according to their relative severity. Perinatal morbidity scores are appealing for maternal–infant health researchers because they provide a way to capture a broad range of adverse events to mother and newborn while recognising that some events are considered more serious than others. However, they have proved difficult to implement as a primary outcome in applied research studies because of challenges in testing if the scores are significantly different between two or more study groups. We outline these challenges and describe a solution, based on Poisson regression, that allows differences in perinatal morbidity scores to be formally evaluated. The approach is illustrated using an existing maternal-neonatal scoring tool, the Adverse Outcome Index, to evaluate the safety of labour and delivery before and after the closure of obstetrical services in small rural communities. Applying the proposed Poisson regression to the case study showed a protective risk ratio for adverse outcome following closures as compared with the original analysis, where no difference was found. This approach opens the door for considerably broader use of perinatal morbidity scoring tools as a primary outcome in applied population and clinical maternal-infant health research studies.
- pregnancy
- perinatal epidemiology
- morbidity measure
- epidemiological methods
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Footnotes
Contributors JAH and RWP conceived the study concept, LBM advised on the application of the approach to observational data. JAH conducted analyses and wrote the first manuscript draft. All authors revised the manuscript critically for important intellectual content and have approved the final version.
Funding JAH is the recipient of New Investigator Awards from the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research. RWP holds a Chercheur-National award from the Fonds de la Recherche du Québec-Santé.
Competing interests None declared.
Ethics approval University of British Columbia/BC Children’s and Women’s Research Ethics Board.
Provenance and peer review Not commissioned; externally peer reviewed.