A markov regression model for the analysis of the postpartum lactational amenorrhea

Failure time data represent a particular case of binary longitudinal data. The corresponding analysis of the effect of explanatory covariates repeatedly collected over time on the failure rate has been largely facilitated by the Cox semi-parametric regression model. However, neither the interpretation of the estimated parameters associated with time-dependent covariates is straight-forward, nor does this model fully account for the dynamics of the effect of a covariate over time. Markovian regression models appear as complementary tools to address these specific issues from the predictive point of view. We illustrate these aspects using data from the WHO multicenter study, which was designed to analyze the relation between the duration of postpartum lactational amenorrhea and the breastfeeding pattern. One of the main advantage of this approach applied to the field of reproductive epidemiology was to provide a flexible tool, easily and directly understood by clinicians and fieldworkers, for simulating situations, which were still unobserved, and to predict their effects on the duration of amenorrhea.