Infections and Reproduction (with Allen J. Wilcox and Pierre M. Buekens

Abstract Infectious disease is the foundation of epidemiology. Even so, the epidemiologic study of infectious diseases has had a rocky history. Early epidemiologic studies identified unsanitary conditions as a cause of disease, and interventions improved population health—despite being based on mistaken notions of “bad air” as the cause of infections. Later, epidemiologists abandoned the study of infectious diseases under the mistaken belief that infections were a vanishing threat. Today, emerging and reemerging infectious diseases present new challenges to epidemiology in general and to the study of fertility and pregnancy in particular. Many stages of reproduction involve the close physical contact that allows transmission of infection. Infections in turn are able to damage reproduction through diverse mechanisms including acute and chronic infection, immune reaction, and disruption of fetal development. Problems of confounding, selection bias, and time-varying exposures that are an inherent part of infectious disease studies can be especially challenging for reproductive epidemiology.