Seminar Series: KS Joseph MD, PhD

Epidemiologic first principles in perinatology: Survival analysis from the fetal perspective

KS Joseph MD, PhD

Department of Obstetrics & Gynaecology
School of Population and Public Health
University of British Columbia

Children's and Women's Hospital of British Columbia

Short Biography:
Dr. K.S. Joseph is a Professor in the Departments of Obstetrics and Gynaecology and the School of Population and Public Health, University of British Columbia and the Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, Canada. His work is supported by the BC Children’s Hospital Research Institute. Dr. Joseph received his MBBS and MD (Community Medicine) degrees from Christian Medical College, Vellore, India, and a PhD in Epidemiology and Biostatistics from McGill University, Montreal, Canada.
Dr. Joseph’s research focuses on epidemiologic issues related to maternal, fetal and infant morbidity and mortality. He has received awards for teaching and research from local, national and international organizations.

Perinatology is remarkable for its use of two distinct and overlapping time scales for measuring the duration of life, namely, gestational age for life in utero and chronologic age for life after birth. This and related phenomena have resulted in several long-standing perinatal conundrums that have defied resolution. Chief among these is the paradox of intersecting perinatal mortality curves. For example, neonatal mortality rates among low birth weight infants of women who smoke in pregnancy are substantially lower than neonatal mortality rates among low birth weight infants of non-smoking women, whereas the opposite pattern is seen among normal birth weight infants. In fact, this mortality crossover is a general phenomenon observed across several contrasts (e.g., women with hypertensive disorders of pregnancy vs. normotensive women, older vs. younger women, twins vs. singletons) and outcomes (stillbirth, neonatal death, sudden infant death syndrome and cerebral palsy), and irrespective of how advancing “maturity” is defined (i.e., using birth weight or gestational age). One approach proposed to address and explain these unexpected phenomena is the fetuses-at-risk model. This formulation involves a re-conceptualization of the denominator for perinatal outcome rates from births to surviving fetuses.

This presentation provides an overview of the fetuses-at-risk model, and discusses the central tenets of the births-based and the fetuses-based formulations. Also described is an extension of the fetuses-at-risk approach to outcomes beyond the neonatal period and a multivariable adaptation. The presentation concludes with a brief discussion of the biological mechanisms that could underlie perinatal phenomena.

Perinatal; preterm birth; growth restriction; perinatal mortality; severe neonatal morbidity; severe maternal morbidity and maternal mortality

Date: Friday, February 17th
Time: 1:30 pm - 2:30 pm
Location: PHFM 3015 (Western Centre for Public Health and Family Medicine)