A novel indicator of selection in utero

Ralph Catalano; Tim A Bruckner; Alison Gemmill; Joan A Casey; Claire Margerison; Terry Hartig

doi:10.1093/emph/eoad018

A novel indicator of selection in utero

Evol Med Public Health. 2023 Jul 19;11(1):244-250. doi: 10.1093/emph/eoad018. eCollection 2023.

Authors

Ralph Catalano¹, Tim A Bruckner², Alison Gemmill³, Joan A Casey⁴, Claire Margerison⁵, Terry Hartig⁶

Affiliations

¹ School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
² Program in Public Health and Center for Population, Inequality and Policy, University of California, Irvine, Irvine, CA, USA.
³ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁴ Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
⁵ Epidemiology & Biostatistics, Michigan State University, East Lansing, MI, USA.
⁶ Institute for Housing and Urban Research, Uppsala University, Uppsala, Sweden.

Abstract

Background and objectives: Selection in utero predicts that population stressors raise the standard for how quickly fetuses must grow to avoid spontaneous abortion. Tests of this prediction must use indirect indicators of fetal loss in birth cohorts because vital statistics systems typically register fetal deaths at the 20th week of gestation or later, well after most have occurred. We argue that tests of selection in utero would make greater progress if researchers adopted an indicator of selection against slow-growing fetuses that followed from theory, allowed sex-specific tests and used readily available data. We propose such an indicator and assess its validity as a dependent variable by comparing its values among monthly birth cohorts before, and during, the first 10 months of the COVID-19 pandemic in Sweden.

Methodology: We apply Box-Jenkins methods to 50 pre-pandemic birth cohorts (i.e., December 2016 through January 2020) and use the resulting transfer functions to predict counterfactual values in our suggested indicator for selection for ten subsequent birth cohorts beginning in February 2020. We then plot all 60 residual values as well as their 95% detection interval. If birth cohorts in gestation at the onset of the pandemic lost more slow-growing fetuses than expected from history, more than one of the last 10 (i.e. pandemic-exposed) residuals would fall below the detection interval.

Results: Four of the last 10 residuals of our indicator for males and for females fell below the 95% detection interval.

Conclusions and implications: Consistent with selection in utero, Swedish birth cohorts in gestation at the outset of the COVID-19 pandemic included fewer than expected infants who grew slowly in utero.

Keywords: COVID-19; selection in utero; spontaneous abortion.