Target trial emulation for chronic medication effects in early pregnancy
Exploring causal inference challenges with an applied example from research in ACE inhibitors.
In observational studies for investigating the safety in early pregnancy of chronic medications that are initiated preconception, such as antidepressants, the causal estimand and corresponding target trial is often unclear. One approach, which lends itself to a well-defined causal question and to target trial emulation, is to estimate the effect of continuation vs. non-continuation of dispensing in early pregnancy among prevalent users of the medication.
Studying continuation vs. non-continuation in early pregnancy comes with its own considerations. This includes the potential for confounding by recent treatment history, possible selection bias due to non-capture of early losses, and exposure misclassification if gestational age is inaccurate.
In this seminar, Jeremy will discuss these considerations and illustrate the approach through an applied example in which we estimate using cloning, censoring, and weighting the risk of non-live birth and major congenital malformations with ACE inhibitor continuation in US claims data.
Speaker
- Jeremy Brown, lecturer in Epidemiology, King’s College London
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