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These include recent increases in iatrogenic delivery at late preterm and early term gestation, which are incongruent with the belief that stillbirth and neonatal death risks decrease exponentially with advancing gestational age. Perinatal epidemiologists have also puzzled over the paradox of intersecting birthweight\u2010specific and gestational age\u2010specific perinatal mortality curves for decades. For example, neonatal mortality rates among preterm infants of women who smoke are substantially lower than neonatal mortality rates among preterm infants of non\u2010smoking women, whereas the reverse pattern occurs at term gestation. This mortality crossover is observed across several contrasts (for example, 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 \u201cmaturity\u201d is defined (birthweight or gestational age). One approach proposed to address and explain these unexpected phenomena is the fetuses\u2010at\u2010risk model. This formulation involves a reconceptualization of the denominator for perinatal outcome rates from births to surviving fetuses. In this overview of the fetuses\u2010at\u2010risk model, we discuss the central tenets of the births\u2010based and the fetuses\u2010based formulations. We also describe the extension of the fetuses\u2010at\u2010risk approach to outcomes into and beyond the neonatal period and to a multivariable adaptation. Finally, we provide a substantive context by discussing biological mechanisms underlying the fetuses\u2010at\u2010risk model and contemporary obstetric phenomena that are better understood from that model than from one based on births.<\/jats:p>","DOI":"10.1111\/aogs.13194","type":"journal-article","created":{"date-parts":[[2017,7,25]],"date-time":"2017-07-25T12:44:45Z","timestamp":1500986685000},"page":"454-465","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":72,"title":["The fetuses\u2010at\u2010risk approach: survival analysis from a fetal perspective"],"prefix":"10.1111","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2317-5607","authenticated-orcid":false,"given":"K.S.","family":"Joseph","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology and the School of Population and Public Health University of British Columbia and the Children's and Women's Hospital and Health Center of British Columbia Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Kramer","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and of Epidemiology Biostatistics and Occupational Health McGill University Faculty of Medicine Montreal QC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,8,29]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-7-4"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/152.12.1117"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a121278"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a121427"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(12)90849-2"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3016.2009.01051.x"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-3-3"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31822add60"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-13-87"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/15.2.188"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-3797(18)30683-4"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-4-7"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2011.01.006"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1375\/twin.10.4.644"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-12-59"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/fn.75.3.F174"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(87)92154-4"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwf077"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2003.11.018"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/acprof:oso\/9780195387902.003.0065"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/acprof:oso\/9780195387902.003.0073"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0105155"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2014.09.017"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742-4755-12-S2-S7"},{"key":"e_1_2_13_26_1","first-page":"3388","article-title":"A community based case control study on determinants of perinatal mortality in a tribal population of southern India","volume":"15","author":"Viswanath K","year":"2015","journal-title":"Rural Remote Health"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1998.tb10047.x"},{"key":"e_1_2_13_28_1","first-page":"547","article-title":"Prospective risk of stillbirth","volume":"79","author":"Feldman GB","year":"1992","journal-title":"Obstet Gynecol"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.319.7205.287"},{"key":"e_1_2_13_30_1","first-page":"444","article-title":"Prospective risk of stillbirth: study results are flawed by reliance on cumulative prospective risk","volume":"320","author":"Hilder L","year":"2000","journal-title":"Br Med J"},{"key":"e_1_2_13_31_1","first-page":"445","article-title":"Prospective risk of stillbirth: randomized trials of early induction of labor are needed","volume":"320","author":"Boulvain M","year":"2000","journal-title":"Br Med J"},{"key":"e_1_2_13_32_1","first-page":"445","article-title":"Prospective risk of stillbirth. 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