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American Journal of Epidemiology Vol. 132, No. 6: 1021-1038
Copyright © 1990 by The Johns Hopkins University School of Hygiene and Public Health

review-article

MEASUREMENT OF TOTAL RISK OF SPONTANEOUS ABORTION: THE VIRTUE OF CONDITIONAL RISK ESTIMATION

JENS MODVIG, LONE SCHMIDT and MOGENS T. DAMSGAARD

From the Institute of Social Medicine, University of Copenhagen, Panum Institute, DK-2200 Copenhagen N Denmark

Reprint requests to Dr. Jens Modvig, Institute of Social Medicine, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark

The concepts, methods, and problems of measuring spontaneous abortion risk are reviewed. The problems touched on include the process of pregnancy verification, the changes in risk by gestational age and maternal age, and the presence of induced abortions. Methods used in studies of spontaneous abortion risk include biochemical assays as well as life table technique, although the latter appears in two different forms. The consequences of using either of these are discussed. It is concluded that no study design so far is appropriate for measuring the total risk of spontaneous abortion from early conception to the end of the 27th week. It is proposed that pregnancy may be considered to consist of two or three specific periods and that different study designs should concentrate on measuring the conditional risk within each period. A careful estimate using this principle leads to an estimate of total risk of spontaneous abortion of 0.33.

epidemiologic methods; fetal death; gestatlonal age; research design


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