From panel A of the Figure in the paper by Vilamer et al. Association between ma

Question

From panel A of the Figure in the paper by Vilamer et al. Association between maternal body mass index in early pregnancy and incidence of cerebral palsy (JAMA 2017:317:925-36), list all the paths from child's sex (represented as C2) to cerebral palsy. Treat C1 as if it represented only one variable. For each path state whether 1. lt is closed or open (if closed explain why), 2. It is directed or undirected, 3. Whether the path implies the presence of a statistical association, 4. Whether the path implies a causal effect and if so, what Maternal BMI in Early Pregnancy and Offspring Cerebral Palsy Original Investigation Research Figure. Causal Diagrams Representing Potential Mediation of Maternal Obesity Consequences on the Association Between Early Pregnancy BMI and Incidence of Cerebral Palsy A Potential mediation of preterm delivery on the association between early pregnancy BMI and cerebral palsy C2 Potential causes set 2 (C) Smoking during pregnancy Child's sex Potential causes set 1 (C,) Maternal age Country of origin Education level Cohabitation with a partner Parity Maternal height Year of delivery Preterm delivery Early Cerebral palsy C,-. pregnancy BMI B Potential mediation of consequences of maternal obesity on the association between early pregnancy BMI and cerebral palsy in children born at full term 3Potential causes set 3 (C,) Intrauterine growth Preterm delivery Instrumental delivery Traumatic delivery Macrosomia Neonatal infections Asphyxia-related neonatal complications Apgar

Explanation / Answer

Answer:

Figure A is an open path i.e early pregnancy BMI is leading to more case of cerebral palsy and the factors such as smoking, maternal age during pregnancy period is the root cause for such cases.

Figure B is an closed path where due to BMI measured value lots of factors are getting affected such as traumatic delivery, macrosomia, neonatal infection, nervous system malformations, as well as intrauterine growth as a result the combine effect of all such error in the pathway and as it is interlinked between each other the second pathway is a closed interlinked pathway, where parameters are connected in a consequence manner.

2) Both figure is a direct pathway, as behavioural factor such as smoking during pregnancy is the root cause of initiation of these pathway.

3) yes pathway implies statistical association where BMI index is the controlling parameter and age at which the women is conceiving also playing significant role

4) yes the pathway implies a causal effect and obesity, age, smoking are the root cause of such cases.

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