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Deruelle P, Anahory T, Ranisavljevic N, Duraes M, Fuchs F. [Are gestational weight gain guidelines for obese women still appropriate?]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:73-75. [PMID: 36302474 DOI: 10.1016/j.gofs.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
Guidelines for adequate gestational weight gain were proposed in 2009 by the Institute of Medicine. In case of a BMI>30kg/m2, the recommended gestational weight gain should be between 5 and 9kg. However, these recommendations do not distinguish between different grades of obesity. Recent data suggest that the IOM recommendations are not restrictive enough for obese pregnant women and should be adapted to the grade of obesity.
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Affiliation(s)
- P Deruelle
- Faculté de médecine, maïeutique et sciences de la santé, Strasbourg, France; Pôle Gynécologie, obstétrique Fertilité, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
| | - T Anahory
- Service de gynécologie obstétrique, CHU de Montpellier, Montpellier, France; Faculté de médecine, Montpellier-Nîmes, France
| | - N Ranisavljevic
- Service de gynécologie obstétrique, CHU de Montpellier, Montpellier, France; Faculté de médecine, Montpellier-Nîmes, France
| | - M Duraes
- Service de gynécologie obstétrique, CHU de Montpellier, Montpellier, France; Faculté de médecine, Montpellier-Nîmes, France
| | - F Fuchs
- Service de gynécologie obstétrique, CHU de Montpellier, Montpellier, France; Faculté de médecine, Montpellier-Nîmes, France
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Angras K, Boyd VE, Gray C, Young AJ, Paglia MJ, Mackeen AD. Retrospective application of algorithms to improve identification of pregnancy outcomes from the electronic health record. J Perinatol 2023; 43:10-14. [PMID: 36050515 DOI: 10.1038/s41372-022-01496-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/07/2022] [Accepted: 08/09/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To improve upon the accuracy of ICD codes for identifying maternal and neonatal outcomes by developing algorithms that incorporate readily available EHR data. STUDY DESIGN Algorithms were developed for gestational hypertension (GHTN), pre-eclampsia (PreE), gestational diabetes mellitus (GDM) and were compared to ICD codes and chart review. Accuracy and sensitivity analyses were calculated with their respective 95% confidence limits for each of the comparisons between algorithms, ICD codes alone, and chart review. RESULTS Sensitivity of GHTN ICD codes was 8.1% vs. 83.8% for the algorithm when compared to chart review. In comparison to chart review, sensitivity of ICD codes for PreE was 7.5% vs. 71.4% for the algorithm. GDM had similar sensitivity rates for both ICD codes and the algorithm. CONCLUSION Application of algorithms, validated by chart review, enhanced capture of several outcomes. Algorithms should be obligatory adjunct tools to the ICD codes for identification of outcomes of interest.
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Affiliation(s)
- Kajal Angras
- Women's Health Service Line, Division of Maternal-Fetal Medicine, Geisinger, 100N. Academy Avenue, Danville, PA, 17822, USA.
| | - Victoria E Boyd
- Women's Health Service Line, Division of Maternal-Fetal Medicine, Geisinger, 100N. Academy Avenue, Danville, PA, 17822, USA
| | - Celia Gray
- Phenomic Analytics and Clinical Data Core, Geisinger, 100N. Academy Avenue, Danville, PA, 17822, USA
| | - Amanda J Young
- Biostatistics Core, Department of Population Health Sciences, Geisinger, 100N. Academy Avenue, Danville, PA, 17822, USA
| | - Michael J Paglia
- Women's Health Service Line, Division of Maternal-Fetal Medicine, Geisinger, 100N. Academy Avenue, Danville, PA, 17822, USA
| | - A Dhanya Mackeen
- Women's Health Service Line, Division of Maternal-Fetal Medicine, Geisinger, 100N. Academy Avenue, Danville, PA, 17822, USA
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Barasinski C, Debost‐Legrand A, Savary D, Bouchet P, Curinier S, Vendittelli F. Does the type of pushing at delivery influence pelvic floor function at 2 months postpartum? A pragmatic randomized trial-The EOLE study. Acta Obstet Gynecol Scand 2022; 102:67-75. [PMID: 36352788 PMCID: PMC9780713 DOI: 10.1111/aogs.14461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Maternal pushing techniques during the second stage of labor may affect women's pelvic floor function. Our main objective was to assess the impact of the type of pushing used at delivery on the mother's medium-term pelvic floor function. MATERIAL AND METHODS This is a secondary analysis of a randomized clinical trial (clinicaltrials.gov: NCT02474745) that took place in four French hospitals from 2015 through 2017 (n = 250). Women in labor with a singleton fetus in cephalic presentation at term who had undergone standardized training in both of these types of pushing were randomized after cervical dilation ≥7 cm. The exclusion criteria were a previous cesarean, a cesarean delivery in this pregnancy or a fetal heart rate anomaly. In the intervention group, open-glottis (OG) pushing was defined as a prolonged exhalation contracting the abdominal muscles to help move the fetus down the birth canal. Closed-glottis (CG) pushing was defined as Valsalva pushing. The principal outcome was the stage of pelvic organ prolapse (POP) assessed by the Pelvic Organ Prolapse-Quantification 2 months after delivery. A secondary outcome was incidence of urinary incontinence (UI). The results of our multivariable, modified intention-to-treat analysis are reported as crude relative risks (RRs) with their 95% confidence intervals. RESULTS Our analysis included 207 women. Mode of birth was similar in both groups. The two groups did not differ for stage II POP: 10 of 104 (9.4%) in the OG group compared with 7 of 98 (7.1%) in the CG group, for a RR 1.32, 95% confidence interval [CI] 0.52-3.33, and an adjusted RR of 1.22, 95% CI 0.42-3.6. Similarly, the incidence of UI did not differ: 26.7% in the OG group and 28.6% in the CG group (aRR 0.81, 95% CI 0.42-1.53). Subgroup analysis suggests that for secundiparous and multiparous women, OG pushing could have a protective effect on the occurrence of UI (RR 0.33, 95% CI 0.13-0.80). CONCLUSIONS The type of directed pushing used at delivery did not impact the occurrence of pelvic organ prolapse 2 months after delivery. OG pushing may have a protective effect against UI among secundiparous and multiparous women.
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Affiliation(s)
- Chloé Barasinski
- Centre National de la Recherche Scientifique, Institut PascalUniversité Clermont Auvergne, University Hospital Center Clermont‐FerrandClermont‐FerrandFrance
| | - Anne Debost‐Legrand
- Centre National de la Recherche Scientifique, Institut PascalUniversité Clermont Auvergne, University Hospital Center Clermont‐FerrandClermont‐FerrandFrance,Auvergne Perinatal Health NetworkClermont‐FerrandFrance
| | | | - Pamela Bouchet
- University Hospital Center Clermont‐FerrandClermont‐FerrandFrance
| | - Sandra Curinier
- University Hospital Center Clermont‐FerrandClermont‐FerrandFrance
| | - Françoise Vendittelli
- Centre National de la Recherche Scientifique, Institut PascalUniversité Clermont Auvergne, University Hospital Center Clermont‐FerrandClermont‐FerrandFrance,Auvergne Perinatal Health NetworkClermont‐FerrandFrance,AUDIPOG (Association of Users of Computerized Records in Pediatrics, Obstetrics and Gynecology)RTH Laennec Medical UniversityLyonFrance
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Gachon B, Fritel X, Rivière O, Pereira B, Vendittelli F. French guidelines for restrictive episiotomy during instrumental delivery were not followed by an increase in obstetric anal sphincter injury. Sci Rep 2022; 12:6330. [PMID: 35428837 PMCID: PMC9012794 DOI: 10.1038/s41598-022-10379-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
The objective was to assess the influence of the French guidelines in favor of a restrictive use of episiotomy on both episiotomy and obstetric anal sphincter injury (OASI) rates during instrumental delivery. It was aulticenter study involving 193 maternities between 2000 and 2016. We included women with a singleton pregnancy, with cephalic presentation at 34 weeks of gestation or more who underwent an instrumental delivery. The study period was divided into three phases: 2000-2005 (reference) 2006-2011, and 2012-2016. We calculated the adjusted relative risk (aRR) of episiotomy and OASI and investigated for changes in episiotomy and OASI rates over time by using Prais-Winsten regression. We considered 96,035 deliveries. The episiotomy's risk was lower in 2006-2011 (69.4%) and 2012-2016 (59.1%) compared to 2000-2005 (81.2%), respectively: aRR 0.93 [0.92-0.95] and 0.89 [0.87-0.90]. The OASI's risk was higher in 2006-2011 (2.5%) and 2012-2016 (3.1%) compared to 2000-2005, respectively: aRR 1.30 [1.10-1.53]) and 1.57 [1.33-1.85]. However, Prais-Winsten regression showed no difference in the OASI rate during the study period. We observed a massive decrease in episiotomy use and a moderate increase in crude OASI's rate but multivariate analysis failed to report an association between these outcomes.
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Affiliation(s)
- Bertrand Gachon
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Department of Obstetrics & Gynecology, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Miletrie, 86000, Poitiers, France.
- INSERM CIC61402, Université de Poitiers, CHU de Poitiers, Poitiers, France.
| | - Xavier Fritel
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Department of Obstetrics & Gynecology, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Miletrie, 86000, Poitiers, France
- INSERM CIC61402, Université de Poitiers, CHU de Poitiers, Poitiers, France
| | - Olivier Rivière
- Audipog, Université Claude Bernard Lyon 1-Laennec, Lyon, France
| | - Bruno Pereira
- Centre Hospitalier Universitaire de Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Françoise Vendittelli
- Audipog, Université Claude Bernard Lyon 1-Laennec, Lyon, France
- Institut Pascal, CHU, CNRS, Clermont Auvergne INP, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
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Impact of maternal pre-pregnancy body mass index on maternal, fetal and neonatal adverse outcomes in the worldwide populations: A systematic review and meta-analysis. Obes Res Clin Pract 2021; 15:536-545. [PMID: 34782256 DOI: 10.1016/j.orcp.2021.10.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Systematic review and meta-analysis conducted to investigate the effect of stratified pre-pregnancy maternal body mass index on twenty maternal and fetal/neonatal adverse outcomes. METHODS PubMed, Google Scholar, Medline, Embase, Web of Science databases were searched from inception till July 11, 2020. Cohort studies were included. The pooled odds ratio with 95% confidence interval was reported considering the random effect and the quality effect model. The sub-group analysis and meta-regression were conducted for BMI cut-offs, geographical region, source of BMI, and sample size. RESULTS Overall, 86 studies representing 20,328,777 pregnant women were included in this meta-analysis. Our study reveals that overweight and obese mothers are at increased odds of cesarean delivery, elective cesarean delivery, emergency cesarean delivery, gestational diabetes, gestational hypertension, induction of labor, postpartum hemorrhage, pre-eclampsia, pre-term premature rupture of membrane, and the fetuses/neonates of overweight and obese mothers are at increased risk of admission in the newborn intensive care unit, APGAR scores less than 7 at 5 min, large for gestational age, macrosomia, extreme pre-term birth in pregnant mothers compared with standard BMI mothers. However, the underweight mothers showed increased odds for small for gestational age infant and pre-term birth, whereas obese mothers were at higher risk for post-term birth and stillbirths. The subgroup and meta-regression analyses have shown the impact of BMI cut-offs, geographical region, source of BMI, and sample size on several maternal, fetal/neonatal adverse outcomes. CONCLUSION The meta-analysis confirmed the association of elevated pre-pregnancy maternal BMI with higher odds of adverse maternal and fetal/neonatal outcomes.
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Trombe KSD, Rodrigues LS, Nascente LMP, Simões VMF, Batista RFL, Cavalli RC, Grandi C, Cardoso VC. Is birth weight associated with pregestational maternal BMI? BRISA Cohort, Ribeirão Preto, Brazil. ACTA ACUST UNITED AC 2020; 54:e10037. [PMID: 33295534 PMCID: PMC7727099 DOI: 10.1590/1414-431x202010037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 10/09/2020] [Indexed: 01/01/2023]
Abstract
Given the increase of women with excess weight or obesity and its possible effects on birth weight, the present study aimed to investigate the association between pregestational maternal body mass index (BMI) and birth weight in a birth cohort from Ribeirão Preto, SP, Brazil. This was a prospective study conducted on 1362 mother-child pairs involving singleton births. The women were evaluated using standardized questionnaires during the second trimester of pregnancy and at the time of childbirth. Information about the newborns was obtained from their medical records. The dependent variable was birth weight, categorized as low, adequate, or high. The independent variable was pregestational maternal BMI, categorized as malnutrition, adequate weight, overweight, and obesity. A multinomial regression model was used to estimate the crude and adjusted relative risk (RR) of low and high birth weight. A high frequency of pregestational excess weight (39.6%) was detected and found to be independently associated with high birth weight (RR=2.13, 95%CI: 1.19-3.80 for overweight and RR=3.34, 95%CI: 1.80-6.19 for obese pregnant women). There was no association between pregestational malnutrition and low birth weight (RR=1.70; 95%CI: 0.81-3.55). The present data showed a high rate of women with excess pregestational weight, supporting the hypothesis that pregestational BMI may contribute to high birth weight babies and indicating the need for actions aiming to prevent excessive weight in women at reproductive age.
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Affiliation(s)
- K S D Trombe
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L S Rodrigues
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L M P Nascente
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - V M F Simões
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - R F L Batista
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - R C Cavalli
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - C Grandi
- Research Committee, Argentine Society of Pediatrics, Buenos Aires, Argentina
| | - V C Cardoso
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Is directed open-glottis pushing more effective than directed closed-glottis pushing during the second stage of labor? A pragmatic randomized trial - the EOLE study. Midwifery 2020; 91:102843. [PMID: 32992159 DOI: 10.1016/j.midw.2020.102843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/01/2020] [Accepted: 09/20/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the effectiveness of directed open-glottis and directed closed-glottis pushing. DESIGN Pragmatic, randomised, controlled, non-blinded superiority study. SETTINGS Four French hospitals between July 2015 and June 2017 (2 academic hospitals and 2 general hospitals). PARTICIPANTS 250 women in labour who had undergone standardised training in the two types of pushing with a singleton fetus in cephalic presentation at term (≥37 weeks) were included by midwives and randomised; 125 were allocated to each group. The exclusion criteria were previous caesarean birth or fetal heart rate anomaly. Participants were randomised during labour, after a cervical dilation ≥ 7 cm. INTERVENTIONS In the intervention group, open-glottis pushing was defined as a prolonged exhalation contracting the abdominal muscles (pulling the stomach in) to help move the fetus down the birth canal. Closed-glottis pushing was defined as Valsalva pushing. MEASUREMENTS The principal outcome was "effectiveness of pushing" defined as a spontaneous birth without any episiotomy, second-, third-, or fourth-degree perineal lesion. The results in our intention-to-treat analysis are reported as crude relative risks (RR) with their 95% confidence intervals. A multivariable analysis was used to take the relevant prognostic and confounding factors into account and obtain an adjusted relative risk (aRR). FINDINGS In our intention-to-treat analysis, most characteristics were similar across groups including epidural analgesia (>95% in each group). The mean duration of the expulsion phase was longer among the open-glottis group (24.4 min ± 17.4 vs. 18.0 min ± 15.0, p=0.002). The two groups did not appear to differ in the effectiveness of their pushing (48.0% in the open-glottis group versus 55.2% in the closed-glottis group, for an adjusted relative risk (aRR) of 0.92, 95% confidence interval (CI) 0.74-1.14) or in their risk of instrumental birth (aRR 0.97, 95%CI 0.85-1.10). KEY CONCLUSIONS In maternity units with a high rate of epidural analgesia, the effectiveness of the type of directed pushing does not appear to differ between the open- and closed-glottis groups. IMPLICATIONS FOR PRACTICE If directed pushing is necessary, women should be able to choose the type of directed pushing they prefer to use during birth. Professionals must therefore be trained in both types so that they can adequately support women as they give birth.
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Hendriks M, Bartolo S, Constans B, Gonzalez M, Tavernier B, Garabedian C, Subtil D. [Factors related to severe neonatal acidosis in planned cesarean section. A case-control study]. ACTA ACUST UNITED AC 2020; 48:784-789. [PMID: 32417399 DOI: 10.1016/j.gofs.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify factors related to the occurrence of severe neonatal acidosis in case of planned caesarean section. METHODS Case-control study conducted between 1997 and 2016 among women with planned caesarean delivery at term. Cases were women whose neonates had neonatal arterial pH<7,0. For each case, two planned caesarean sections with neonatal pH≥7,0 were selected as controls. Women whose fetus had a congenital malformation and those whose anesthesia was not spinal anesthesia were excluded. RESULTS Among the 5014 planned cesarean sections of the study period, 38 severe neonatal acidosis were observed (incidence of 0,76% CI95 [0,54-1,04]). Compared to 72 controls, the 36 caesareans with severe neonatal acidosis were associated with more frequent maternal obesity (BMI≥30kg/m2), higher ephedrine doses, longer time from skin incision to infant delivery, and more extraction difficulties. After logistic regression, only maternal obesity remained associated with a significant increase in the risk of severe neonatal acidosis, ORa=3,73, 95%CI (1,11-12,56). CONCLUSIONS In case of planned cesarean section, the main risk factor for severe neonatal acidosis is the existence of maternal obesity.
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Affiliation(s)
- M Hendriks
- Hôpital Jeanne-de-Flandre, pôle Femme-Mère-Nouveau-né, université de Lille, CHU de Lille, 1, rue Eugène-Avinée, 59000 Lille, France.
| | - S Bartolo
- Hôpital Jeanne-de-Flandre, pôle Femme-Mère-Nouveau-né, université de Lille, CHU de Lille, 1, rue Eugène-Avinée, 59000 Lille, France
| | - B Constans
- Département d'anesthésie réanimation, université de Lille, CHU de Lille, 59000 Lille, France
| | - M Gonzalez
- Département d'anesthésie réanimation, université de Lille, CHU de Lille, 59000 Lille, France
| | - B Tavernier
- Département d'anesthésie réanimation, université de Lille, CHU de Lille, 59000 Lille, France
| | - C Garabedian
- Hôpital Jeanne-de-Flandre, pôle Femme-Mère-Nouveau-né, université de Lille, CHU de Lille, 1, rue Eugène-Avinée, 59000 Lille, France; EA 2694 santé publique, épidémiologie et qualité des soins, université de Lille, 59000 Lille, France; Obstetric Department, Catholic Hospitals, Lille Catholic University, 59000 Lille, France
| | - D Subtil
- Hôpital Jeanne-de-Flandre, pôle Femme-Mère-Nouveau-né, université de Lille, CHU de Lille, 1, rue Eugène-Avinée, 59000 Lille, France; EA 2694 santé publique, épidémiologie et qualité des soins, université de Lille, 59000 Lille, France; Obstetric Department, Catholic Hospitals, Lille Catholic University, 59000 Lille, France
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Nohuz E, Rivière O, Coste K, Vendittelli F. Prenatal identification of small-for-gestational age and risk of neonatal morbidity and stillbirth. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:621-628. [PMID: 30950117 DOI: 10.1002/uog.20282] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/17/2019] [Accepted: 03/20/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess whether prenatal identification of small-for-gestational age (SGA) was associated with lower rates of the primary composite outcome of stillbirth, death in the delivery room or neonatal complications, and secondary outcomes of the composite outcome according to gestational age at delivery, stillbirth and low 5-min Apgar score. METHODS This historical cohort study included women who had a singleton delivery (≥ 32 weeks) between 1994 and 2011 at one of 247 French maternity units. We excluded pregnancies terminated medically, infants with malformations or with missing data on estimated fetal weight or birth weight, and women with missing delivery data. Among the 24 946 infants born SGA (< 5th percentile), we compared those who had been identified as such prenatally (n = 5093; 20%), with those who had not (n = 19 853; 80%). The main outcome was a composite variable defined as stillbirth or death in the delivery room, or transfer to a neonatal department either immediately or during the neonatal stay in the obstetrics ward. Secondary outcomes were the composite outcome according to gestational age at delivery (32 to < 35 weeks; 35 to < 37 weeks, 37 to < 40 weeks, or ≥ 40 weeks), stillbirth and low 5-min Apgar score (≤ 4 and < 7). RESULTS The mean ± SD birth weight was 2449.1 ± 368.3 g. The rate of the main composite outcome was higher in the group identified prenatally as SGA compared with non-identified SGA fetuses (39.5% vs 13.5%; adjusted relative risk (aRR), 1.29; 95% CI, 1.21-1.38). This association was not observed in the subgroups delivered before 37 weeks. The stillbirth rate was lower in fetuses with prenatal suspicion of SGA (aRR, 0.47; 95% CI, 0.27-0.79), while the 5-min Apgar score did not differ between the two groups. The a-posteriori study power with α = 0.05 was 99%. CONCLUSION Prenatal identification of SGA was not associated with lower fetal or neonatal morbidity overall, although it was associated with a lower rate of stillbirth. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E Nohuz
- AUDIPOG (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique et Gynécologie), Faculty of Medicine RTH Laennec, Lyon, France
- Department of Obstetrics and Gynecology, General Hospital of Thiers, Thiers, France
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - O Rivière
- AUDIPOG (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique et Gynécologie), Faculty of Medicine RTH Laennec, Lyon, France
| | - K Coste
- AUDIPOG (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique et Gynécologie), Faculty of Medicine RTH Laennec, Lyon, France
- Université Clermont Auvergne, CHU de Clermont-Ferrand, GRED, CNRS 6293, Inserm U1103, Institut Pascal, Clermont-Ferrand, France
| | - F Vendittelli
- AUDIPOG (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique et Gynécologie), Faculty of Medicine RTH Laennec, Lyon, France
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
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[Early prevention and nutritional education]. SOINS; LA REVUE DE RÉFÉRENCE INFIRMIÈRE 2019; 64:25-28. [PMID: 30771844 DOI: 10.1016/j.soin.2018.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
To be effective, prevention must not remain a theoretical concept and its implementation must not be perceived negatively. Ignorance and prejudices need to be overcome. From conception to adolescence, simple and easy-to-follow nutritional education measures, as well as practical and concrete advice, can be easily applied. Caregivers have an important role to play in communicating these guidelines.
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Siddiqui A, Azria E, Howell EA, Deneux-Tharaux C, Dupont C, Rudigoz R, Vendittelli F, Beucher G, Rozenberg P, Carbillon L, Baunot N, Crenn‐Hebert C, Kayem G, Fresson J, Mignon A, Touzet S, Bonnet M, Bouvier‐Colle M, Chantry AA, Chiesa‐Dubruille C, Seco A. Associations between maternal obesity and severe maternal morbidity: Findings from the French EPIMOMS population-based study. Paediatr Perinat Epidemiol 2019; 33:7-16. [PMID: 30328636 DOI: 10.1111/ppe.12522] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 09/02/2018] [Accepted: 09/13/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Maternal obesity is increasing. There is growing evidence of its effect on severe maternal morbidity. We assessed prepregnancy obesity as an independent risk factor for severe maternal morbidity by timing and cause. METHODS We designed a case-control analysis within the EPIMOMS prospective population-based study conducted in six French regions in 2012-2013 (182 309 women who delivered at ≥22 weeks). Cases were all women who experienced severe maternal morbidity during pregnancy to 42 days postpartum as per a multicriteria definition derived by national expert consensus (n = 2540, severe maternal morbidity prevalence 1.4%). Controls were randomly selected from the same health centres (n = 3651). The association between obesity and severe maternal morbidity was assessed from fitting multivariable logistic regression models: overall, by timing (antepartum and intrapartum/ postpartum), and by cause. RESULTS Prepregnancy obesity was associated with overall severe maternal morbidity (adjusted odds ratio [OR] 1.34, 95% confidence interval [CI] 1.14, 1.59) and antepartum severe maternal morbidity (OR 2.07, 95% CI 1.61, 2.65), but not with intra/postpartum severe maternal morbidity (OR 1.15, 95% CI 0.96, 1.38). Among antepartum severe maternal morbidity, severe hypertensive disorders were most strongly associated with obesity (OR 2.50, 95% CI 1.85, 3.40) but the risk of antepartum severe maternal morbidity due to other causes was also increased among obese women (OR 1.64, 95% CI 1.13, 2.37). Obesity was not associated with severe postpartum haemorrhage (OR 1.12, 95% CI 0.92, 1.37). CONCLUSION Obesity is associated with an increased risk of antepartum, but not intra/ postpartum, severe maternal morbidity.
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Affiliation(s)
- Ayesha Siddiqui
- National Institute for Health and Medical Research (INSERM) Unit 1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elie Azria
- National Institute for Health and Medical Research (INSERM) Unit 1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Maternity Unit, Notre Dame de Bon Secours -Paris Saint Joseph Hospital/University Hospital Department (DHU) Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Elizabeth A Howell
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Catherine Deneux-Tharaux
- National Institute for Health and Medical Research (INSERM) Unit 1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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Cho NA, Klancic T, Nettleton JE, Paul HA, Reimer RA. Impact of Food Ingredients (Aspartame, Stevia, Prebiotic Oligofructose) on Fertility and Reproductive Outcomes in Obese Rats. Obesity (Silver Spring) 2018; 26:1692-1695. [PMID: 30358146 DOI: 10.1002/oby.22325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/21/2018] [Accepted: 09/05/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study aimed to investigate the interaction between obesity, low-calorie sweeteners, and prebiotic oligofructose on reproductive parameters in rats. METHODS Data were derived from two separate studies of female Sprague-Dawley rats with (1) Lean (n = 24), (2) Obese (n = 27), (3) Obese+Aspartame (n = 14), (4) Obese+Stevia (n = 15), and (5) Obese+Prebiotic (n = 15) groups. Obesity was induced with a high-fat/high-sucrose diet prior to pregnancy. In one study, human-approved doses of aspartame (5-7 mg/kg/d) and stevia (2-3 mg/kg/d) in drinking water were examined, and in the second, 10% prebiotics (oligofructose) in the diet was examined. Reproductive parameters, including fertility, pregnancy, and delivery indexes, were analyzed. RESULTS Obesity significantly reduced pregnancy index in Obese dams (60.7% successful pregnancies) compared with lean (100%). Obesity also reduced the number of pups born alive and pup survival percentage compared with those of Lean dams (P < 0.001). Only 53.3% of rats were able to conceive in the Obese+Stevia group, but if rats did become pregnant, they had 100% pregnancy and delivery index. While prebiotic administration rescued the pregnancy index, it could not remediate pup survival percentage (P = 0.025) in Obese dams. CONCLUSIONS Both obesity status and dietary ingredients affect the ability to conceive. Future rigorously controlled studies designed to examine reproductive outcomes in depth are needed to confirm these findings.
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Affiliation(s)
- Nicole A Cho
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Teja Klancic
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jodi E Nettleton
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Heather A Paul
- Department of Biochemistry & Molecular Biology, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Raylene A Reimer
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Biochemistry & Molecular Biology, Cumming School of Medicine, Calgary, Alberta, Canada
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Song G, Wei YM, Zhu WW, Yang HX. Cesarean Section Rate in Singleton Primiparae and Related Factors in Beijing, China. Chin Med J (Engl) 2018; 130:2395-2401. [PMID: 29052558 PMCID: PMC5684626 DOI: 10.4103/0366-6999.216415] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The cesarean section rate (CSR) has been a main concern worldwide. The present study aimed to investigate the CSR in Beijing, China, and to analyze the related factors of CS delivery. METHODS An observational study was conducted in 15 medical centers in Beijing using a systemic cluster sampling method. In total, 15,194 pregnancies were enrolled in the study between June 20, 2013 and November 30, 2013. Independent t-tests and Pearson's Chi-square test were used to examine differences between two groups, and related factors of the CSR were examined by multivariable logistic regression. RESULTS The CSR was 41.9% (4471/10,671) in singleton primiparae. Women who were more than 35 years old had a 7.4-fold increased risk of CS delivery compared with women <25 years old (odd ratio [OR] = 7.388, 95% confidence interval [CI] = 5.561-9.816, P < 0.001). Prepregnancy obese women had a 2-fold increased risk of CS delivery compared with prepregnancy normal weight women (OR = 2.058, 95% CI = 1.640-2.584, P < 0.001). The excessive weight gain group had a 1.4-fold increased risk of CS delivery compared with the adequate weight gain group (OR = 1.422, 95% CI = 1.289-1.568, P < 0.001). Gestational diabetes mellitus (GDM) women and DM women had an increased risk of CS delivery (1.2- and 1.7-fold, respectively) compared with normal blood glucose women. Women who were born in rural areas had a lower risk of CS delivery than did those who were born in urban areas (OR = 0.696, 95% CI = 0.625-0.775, P < 0.001). The risk of CS delivery gradually increased with a decreasing education level. Neonates weighing 3000-3499 g had the lowest CSR (36.2%). Neonates weighing <2500 g had a 2-fold increased risk of CS delivery compared with neonates weighing 3000-3499 g (OR = 2.020, 95% CI = 1.537-2.656, P < 0.001). Neonates weighing ≥4500 g had an 8.3-fold increased risk of CS delivery compared with neonates weighing 3000-3499 g (OR = 8.313, 95% CI = 4.436-15.579, P < 0.001). CONCLUSIONS Maternal age, prepregnancy body mass index, gestational weight gain, blood glucose levels, residence, education level, and singleton fetal birth weight are all factors that might significantly affect the CSR.
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Affiliation(s)
- Geng Song
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 10034, China
| | - Yu-Mei Wei
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 10034, China
| | - Wei-Wei Zhu
- Exchange and Cooperation Division, National Institute of Hospital Administration, Beijing 100191, China
| | - Hui-Xia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 10034, China
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Marie C, Léger S, Guttmann A, Rivière O, Marchiset N, Lémery D, Vendittelli F, Sauvant-Rochat MP. Exposure to arsenic in tap water and gestational diabetes: A French semi-ecological study. ENVIRONMENTAL RESEARCH 2018; 161:248-255. [PMID: 29169099 DOI: 10.1016/j.envres.2017.11.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/09/2017] [Accepted: 11/10/2017] [Indexed: 05/22/2023]
Abstract
INTRODUCTION The increase in the prevalence of gestational diabetes mellitus (GDM) and its consequences for mother and children prompts research on their risk factors including environmental factors. Studies on exposure to arsenic (As) in tap water and the risk of GDM have not provided conclusive evidence, particularly when levels of exposure were low (from 10 to 50µg As/L). The main objective of this study was to assess the association between exposure to As in tap water and the risk of GDM. METHODS A semi-ecological study was conducted from births recorded at the University Hospital of Clermont-Ferrand, France, in 2003, 2006 and 2010. Individual medical/obstetric data were available. As exposure was estimated from the concentrations of As measured during sanitary control of tap water supplied in the mothers' commune of residence (aggregate data). French guidelines for As in tap water were used to identify groups potentially exposed, designated "As +" (≥ 10µg As/L) and "As -" (< 10µg As/L). Multivariate logistic regression analysis was performed. RESULTS 5053 women (5.7% with a GDM) were included. Overall, women in the As + group had a higher risk of GDM than those in the As - group (adjusted OR = 1.62; 95%CI: 1.01-2.53). Stratified analysis of pre-pregnancy body mass index (BMI) showed a positive association only for obese or overweight women (adjusted OR = 2.30; 95%CI: 1.13-4.50). CONCLUSION This French semi-ecological study provides additional arguments for an association between As exposure and the risk of GDM in particular in a context of low exposure. Further studies are needed to assess a potential interaction between As exposure and body mass index.
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Affiliation(s)
- Cécile Marie
- Université Clermont Auvergne, CNRS, Sigma Clermont, Institut Pascal, CHU de Clermont-Ferrand, Service de biostatistique, Clermont-Ferrand, France.
| | - Stéphanie Léger
- Université Clermont Auvergne, CNRS, Laboratoire de mathématiques Blaise Pascal, Aubière, France
| | - Aline Guttmann
- Université Clermont Auvergne, CNRS, Sigma Clermont, Institut Pascal, CHU de Clermont-Ferrand, Service de biostatistique, Clermont-Ferrand, France
| | | | | | - Didier Lémery
- AUDIPOG, Faculté de Médecine RTH Laennec, Lyon, France; Université Clermont Auvergne, CNRS, Sigma Clermont, Institut Pascal, CHU de Clermont-Ferrand, Service de Gynécologie-obstétrique, Réseau de Santé en Périnatalité d'Auvergne, Clermont-Ferrand, France
| | - Françoise Vendittelli
- AUDIPOG, Faculté de Médecine RTH Laennec, Lyon, France; Université Clermont Auvergne, CNRS, Sigma Clermont, Institut Pascal, CHU de Clermont-Ferrand, Service de Gynécologie-obstétrique, Réseau de Santé en Périnatalité d'Auvergne, Clermont-Ferrand, France
| | - Marie-Pierre Sauvant-Rochat
- Université Clermont Auvergne, CNRS, Institut Pascal, UFR Pharmacie, Département Santé Publique et Environnement, Clermont-Ferrand, France
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Trends in perinatal health in metropolitan France from 1995 to 2016: Results from the French National Perinatal Surveys. J Gynecol Obstet Hum Reprod 2017; 46:701-713. [DOI: 10.1016/j.jogoh.2017.09.002] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/12/2017] [Accepted: 09/19/2017] [Indexed: 11/20/2022]
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