CHEST Guidelines-Enhancing-the-Understanding-of-Pregnancy-Outcomes-

Enhancing-the-Understanding-of-Pregnancy-Outcomes-

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The document contains two primary responses to comments received on published studies about air pollution and respiratory diseases, and pregnancy outcomes in critically ill women. <br /><br />In the first response, researchers Zhuo, Tian, and Lin address comments regarding their study about air pollution and chronic respiratory disease (CRD) risk, initially conducted using nonfasting plasma samples from the UK Biobank, which could introduce dietary confounding bias. A healthy diet score was adjusted in the analysis, and further adjustments were made for traffic noise exposure, with results remaining consistent. They acknowledged that personal exposure monitors could improve study precision, although such data was unavailable in their survey.<br /><br />The second response is from He, Wang, and Yi, addressing Kohn et al’s study on pregnancy outcomes among critically ill women. This study was appreciated, but concerns were raised about differences in clinical interventions between pregnant and non-pregnant patients and inadequate consideration of socioeconomic factors and healthcare access. The long timespan of the study (2008-2021) could introduce bias due to evolving medical practices. Future studies were encouraged to address these factors for more accurate outcomes.<br /><br />Kohn et al responded by acknowledging the critique related to the prolonged study period and indicating they performed post hoc sensitivity analyses to explore temporal trends in their data. These analyses confirmed their original findings, demonstrating no significant interactions between pregnancy status and discharge year, supporting the robustness of their conclusions.<br /><br />Overall, both responses highlight the challenges of accounting for confounding factors in epidemiological studies and suggest potential improvements for future research, such as refined exposure assessments and control for healthcare access and socioeconomic status.

Keywords

air pollution

respiratory diseases

pregnancy outcomes

critically ill women

dietary confounding

traffic noise exposure

socioeconomic factors

healthcare access

epidemiological studies

UK Biobank