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UBC Theses and Dissertations

Estimating the preventable portion of lifestyle-related reproductive casualties Ross, Susan E.


The purpose of this study was to review the evidence linking maternal and paternal lifestyle habits in the preconception and prenatal period to adverse reproductive outcomes; to determine either the proportion of reproductive casualties which could be attributed to lifestyle risk, thus be amenable to prevention, or the information required to estimate the preventable portion of lifestyle-related reproductive casualties; and to examine a method for surveillance of reproductive health in the community which would provide the basis for a comprehensive information system suited to the needs of the research, planning, preventive medicine and health promotion communities. As a means of managing the size of the study report, only a representative set of lifestyles (smoking, alcohol consumption and nutrition) and research literature (major cohort and case-control studies in human populations) was reported in detail. A method was developed to review and describe the degree to which the evidence meets established criteria for causal association. The most recently available prevalence data for determining smoking, alcohol and nutritional risk, and incidence data for seven reproductive outcomes (infertility, spontaneous abortion, stillbirth, infant mortality, congenital anomalies, fetal growth and morbidity) in the British Columbia population were used to calculate the preventable portion of reproductive casualties in this community. A review of the variables required, compared with the data available, provided the basis for recommendations regarding a reproductive health information system to support community surveillance, evaluation and research. The study supports the conclusion that there is evidence of a causal link between exposure to lifestyle risks and the majority of adverse reproductive outcomes selected as indicators of reproductive health. The calculation of the preventable portion (etiologic fraction) of lifestyle-related reproductive casualties in British Columbia suggests the preventable portion associated with single lifestyle risk variables may be in the range of 10-50 percent. A more extensive and up-to-date set of population data for British Columbia is required to determine an accurate estimate. The benefits to be derived from an improved information system were detailed in the study. Reproductive health data collected for British Columbia is primarily outcome oriented with very little input data on which to base rational planning decisions for the improvement of reproductive health outcomes. The study recommends that a more comprehensive reproductive health information system, with an integrated, linked data base, be considered a high priority by government and all institutions, agencies and individuals working to improve reproductive health outcomes in British Columbia. The potential to improve reproductive health is significant enough to warrant action at the clinical and community level, but additional data are required to plan cost-effective intervention strategies, to monitor improvements in reproductive health, and to support applied research initiatives.

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