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Read the attached paper from the British Medical Journal titled “Maternal Overweight and Obesity in Early Pregnancy and Risk of Infant Mortality: A Population Based Cohort Study in Sweden”.

10 Questions, answer to each question is not more than 100-150 words.

Paper is available in this link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4028185/

1. The study aimed to investigate the associations between maternal overweight and obesity and infant mortality outcomes. Study researchers adjusted odds ratios for seven confounders. Briefly explain and discuss the justification for controlling each confounder in the analysis
Note: You may need to search on PubMed to find the associations between these variables.

2. Although the researchers adjusted the odds ratios for parity, birth spacing was not included in the adjusted model. Briefly discuss whether you think the researchers should have adjusted the odds ratios for inter-pregnancy interval(s).
Note: You may need to search on PubMed to find the associations between birth spacing and both the exposure variable and the outcome variable.

3. In many European countries, mothers continue to smoke during pregnancy. Briefly discuss how smoking habits were measured in this study and the validity of these estimates.

4. Discuss whether you think the strength of the association between maternal overweight/obesity and infant mortality may have been affected by information bias related to the exposure variable

5. Review Table 1 and briefly discuss why you think the rates of infant, neonatal and postneonatal mortality declined from 1992-1996, 1997-2000, 2001-2005, 2006-2010

6. Study authors report that the population attributable fraction (PAF) related to maternal overweight/obesity was 11% and 7% for smoking. Interpret and discuss the public health significance of the reported PAF

7. The authors report that the study findings may have been influenced by residual confounding. Define the term residual confounding and discuss the potential role of residual confounding in the context of this study

8. One method to minimize potential residual confounding is to use a within-siblings study (or sibship) design or sibling control analysis. Briefly discuss how sibling control analysis can be used to decrease potential residual confounding in observational epidemiological studies.
Note: your answer does not need to be related to the context of this study; rather, observational epidemiological studies in general.

9. Briefly discuss the public health implications of the study findings for female UAE Nationals (or other female GCC nationals). Consider the public health interventions during preconception planning and the periconception period, the first antenatal appointment, and throughout pregnancy.

10. Briefly discuss the challenges and opportunities for conducting this study in the UAE (or another GCC country of your choice;). Consider the sources of data and linkage between registries/databases required for the exposure variable, outcome variable, and confounding variables.

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