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Chantry AA, Merrer J, Blondel B, Le Ray C. Preferences for labor and childbirth, expressed orally or as a written birth plan: Prevalence and determinants from a nationwide population-based study. Birth 2023; 50:847-857. [PMID: 37382211 DOI: 10.1111/birt.12728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/08/2023] [Accepted: 05/06/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Shared decision-making is an important component of a patient-centered healthcare system. We assessed the prevalence of parturients with preferences for their labor and childbirth, expressed verbally in the birthing room or as a written birth plan, and studied maternal, obstetric, and organizational factors associated with their expression. METHODS Data came from the 2016 National Perinatal Survey, a cross-sectional nationwide population-based survey conducted in France. Preferences for labor and childbirth were studied in three categories: expressed verbally, in writing (birth plan), or unexpressed or nonexistent. Analyses used multinomial multilevel logistic regression. RESULTS The analysis included 11,633 parturients: 3.7% had written a birth plan, 17.3% expressed their preferences verbally, and 79.0% either did not have or did not express any preferences. Compared with the latter group, written or verbal preferences were both significantly associated with prenatal care by independent midwives (respectively, adjusted odds ratio (aOR) 2.19; 95% confidence interval (CI), [1.59-3.03], and aOR 1.43; 95% CI [1.19-1.71]) and with attendance at childbirth education classes (respectively, aOR 4.99; 95% CI [3.49-7.15], and aOR 2.27; 95% CI [1.98-2.62]). As years in traditional schooling increased, so did its association with preferences. Conversely, parturients from African countries were significantly less likely than French mothers to express preferences. A written birth plan was also associated with characteristics of maternity unit organization. CONCLUSION Only one in five parturients reported having expressed preferences for labor and childbirth to healthcare professionals in the birthing room. This expression of preferences was associated with maternal characteristics and the organization of care.
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Affiliation(s)
- Anne Alice Chantry
- Université Paris Cité, Center of Research in Epidemiology and Statistics/CRESS/Obstetrical Pediatric and Perinatal Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
- Baudelocque Midwifery School, AP-HP, Université Paris Cité, Paris, France
| | - Jade Merrer
- Université Paris Cité, Center of Research in Epidemiology and Statistics/CRESS/Obstetrical Pediatric and Perinatal Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
| | - Béatrice Blondel
- Université Paris Cité, Center of Research in Epidemiology and Statistics/CRESS/Obstetrical Pediatric and Perinatal Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
| | - Camille Le Ray
- Université Paris Cité, Center of Research in Epidemiology and Statistics/CRESS/Obstetrical Pediatric and Perinatal Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
- Port-Royal Maternity Unit, Department of Obstetrics, Cochin Broca Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), FHU PREMA, Paris, France
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Blondel B, Beuzelin M, Bonnet C, Moreau C. Pregnancy intention and preconception contraceptive behaviors and substandard prenatal care in France. J Gynecol Obstet Hum Reprod 2023; 52:102608. [PMID: 37245644 DOI: 10.1016/j.jogoh.2023.102608] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Evaluate the association between a combined measure of time-based pregnancy intention and preconception contraceptive behavior and suboptimal prenatal care. POPULATION AND METHOD Women delivering a live birth in all maternity units during one week in March 2016 were interviewed in the postpartum ward (N = 13,132). Multinomial logistic regression models were used to assess the association between the indicator of pregnancy intention and substandard prenatal care (late initiation of care and less than the recommended number of prenatal visits (<60% recommended)). RESULTS 83.6% of women had timed pregnancies, 4.7% had mistimed pregnancies but discontinued contraception to conceive, 8.0% had mistimed pregnancies without discontinuing contraception to conceive and 3.7% had unwanted pregnancies. Women with timed pregnancies or mistimed pregnancies despite discontinuing contraception to conceive were more socially advantaged than those who had an unwanted pregnancy or a mistimed pregnancy without discontinuing contraception to conceive. 3.3% of women had a substandard number of prenatal visits and 2.5% had delayed prenatal care initiation. The adjusted odds ratios (aOR) of substandard prenatal visits were high among women with unwanted pregnancies (aOR=2.78; 95% confidence interval [1.91-4.05]) and women with mistimed pregnancies who had not discontinued contraception to conceive (aOR=1.69; [1.21-2.35]) compared to women with timed pregnancies. No difference was observed for women with mistimed pregnancies who discontinued contraception to conceive (aOR=1.22; [0.70-2.12]). CONCLUSION Using routinely collected information on preconception contraception allows a more nuanced assessment of pregnancy intentions that can help caregivers identify women at greater risk of substandard prenatal care.
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Affiliation(s)
- Béatrice Blondel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team (Epopé), Center of Research in Epidemiology and Statistics, Université Paris Cité, INSERM, 75014 Paris, France.
| | - Maxime Beuzelin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team (Epopé), Center of Research in Epidemiology and Statistics, Université Paris Cité, INSERM, 75014 Paris, France
| | - Camille Bonnet
- Obstetrical, Perinatal, and Pediatric Epidemiology Team (Epopé), Center of Research in Epidemiology and Statistics, Université Paris Cité, INSERM, 75014 Paris, France
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Primary Care and Prevention, Centre for Research in Epidemiology and Population Health (CESP), U1018, INSERM, 94805 Villejuif, France
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Cormier J, Merrer J, Blondel B, Le Ray C. Influence of the maternity unit and region of delivery on episiotomy practice in France: a nationwide population-based study. Acta Obstet Gynecol Scand 2023; 102:438-449. [PMID: 36852493 PMCID: PMC10008350 DOI: 10.1111/aogs.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Our objective was to identify factors associated with episiotomy practice in France, in particular, characteristics of the maternity units and regions of delivery. MATERIAL AND METHODS We performed a national cross-sectional population-based study in all French maternity units in 2016 including 9284 women with vaginal delivery. Our outcome was the performance of an episiotomy. After stratification for parity, associations of episiotomy practice with individual and organizational characteristics and the region of delivery were estimated with multilevel logistic regression models. The variability in maternity unit episiotomy rates explained by the characteristics studied was estimated by the proportional change in variance. RESULTS A total of 19.9% of the women had an episiotomy. The principal factors associated with episiotomy practice were maternal and obstetric and delivery in a maternity unit with <2000 annual deliveries. After adjusting for individual, obstetric and organizational characteristics, the practice of episiotomy was strongly associated with women's region of delivery. Additionally, women's individual characteristics did not explain the significant variability in episiotomy rates between maternity units (P < 0.001) but maternity unit characteristics partly did (proportion of variance explained: 7.2% for primiparas and 13.6% for multiparas) and regional differences still more (18% and 30.7%, respectively). CONCLUSIONS Episiotomy practices in France in 2016 varied strongly between maternity units, largely due to regional differences. Targeted actions by the regional perinatal care networks may reduce the national episiotomy rate and standardize practices.
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Affiliation(s)
- Julie Cormier
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
- Port‐Royal Maternity, AP‐HPHôpital Cochin, FHU PREMAParisFrance
| | - Jade Merrer
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
- Clinical Epidemiology Unit, Robert Debré HospitalAssistance Publique‐Hôpitaux de ParisParisFrance
| | - Béatrice Blondel
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
| | - Camille Le Ray
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
- Port‐Royal Maternity, AP‐HPHôpital Cochin, FHU PREMAParisFrance
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Amyx M, Zeitlin J, Blondel B, Le Ray C. Gestational weight gain adequacy and intrapartum oxytocin and cesarean section use: Observational population-based study in France. Acta Obstet Gynecol Scand 2023; 102:301-312. [PMID: 36704845 PMCID: PMC9951319 DOI: 10.1111/aogs.14496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/13/2022] [Accepted: 11/23/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Research on maternal prepregnancy weight suggests adiposity is associated with dysfunctional labor, but knowledge about how gestational weight gain (GWG) affects labor is sparse. Our objective was to evaluate associations between GWG adequacy and intrapartum obstetric interventions (oxytocin administration; cesarean section) necessitated by labor dysfunction. MATERIAL AND METHODS Using national, population-based French National Perinatal Survey 2016 data, we included term cephalic singleton pregnancies involving trial of labor (n = 9724). For the intrapartum oxytocin administration analysis, we included only women with spontaneous labor (n = 7352). GWG was calculated as the difference between end of pregnancy and prepregnancy weight (both self-reported) and categorized as insufficient, adequate (reference group), or excessive by prepregnancy body mass index (BMI; underweight <18.5, normal weight 18.5-24.9, overweight 25-29.9, obese ≥30 kg/m2 ) using the 2009 Institute of Medicine thresholds. Multilevel generalized estimating equation logistic regression models, unadjusted and adjusted for a priori confounders, evaluated intervention-GWG adequacy associations within BMI categories (under/normal weight combined), stratified by parity (primiparas; multiparas). RESULTS GWG adequacy was associated with oxytocin use among under/normal weight women (primiparas: insufficient 57.3%, adequate 60.8%, excessive 65.0%, p = 0.014; multiparas: insufficient 27.2%, adequate 29.1%, excessive 36.2%, p < 0.001) and overweight primiparas (insufficient 56.0%, adequate 58.7%, excessive 72.5%, p = 0.002). In unadjusted and adjusted models, trends of increased odds of oxytocin administration among women with excessive GWG were found regardless of parity and prepregnancy BMI. Similarly, among under/normal weight women, GWG adequacy was associated with intrapartum cesarean section (primiparas: insufficient 10.7%, adequate 12.7%, excessive 15.3%, p = 0.014; multiparas: insufficient 3.1%, adequate 3.5%, excessive 6.3%, p < 0.001) with increased cesarean section among multiparas with excessive GWG persisting in adjusted models (adjusted odds ratio 1.9, 95% confidence interval 1.3-2.7). However, intrapartum cesarean section was reduced among multiparas with overweight and obese prepregnancy BMI and excessive GWG. CONCLUSIONS Excessive GWG was associated with intrapartum oxytocin administration, regardless of parity or prepregnancy BMI, and cesarean section among women with under/normal weight prepregnancy BMI, providing evidence for benefits of healthy GWG for normal labor progression. Additional research is needed to verify our findings and understand differences by BMI.
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Affiliation(s)
- Melissa Amyx
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, INRAUniversité de Paris CitéParisFrance
| | - Jennifer Zeitlin
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, INRAUniversité de Paris CitéParisFrance
| | - Béatrice Blondel
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, INRAUniversité de Paris CitéParisFrance
| | - Camille Le Ray
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, INRAUniversité de Paris CitéParisFrance,Maternité Port Royal, Hôpital Cochin Port Royal, Assistance Publique‐Hôpitaux de ParisUniversité de Paris CitéParisFrance
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Ray CL, Lelong N, Cinelli H, Blondel B, Lelong N, Cinelli H, Blondel B, Regnault N, Demiguel V, Lebreton E, Salanave B, Fresson J, Vilain A, Deroyon T, Raynaud P, Rey S, Chemlal K, Rabier-Thoreau N. Results of the 2021 French National Perinatal Survey and trends in perinatal health in metropolitan France since 1995. J Gynecol Obstet Hum Reprod 2022; 51:102509. [PMID: 36410664 DOI: 10.1016/j.jogoh.2022.102509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To report results of the 2021 French National Perinatal Survey (ENP) in metropolitan France and assess trends in the main indicators of perinatal health, medical practices, and risk factors in France since 1995. POPULATION AND METHOD All the samples included all women giving birth at a gestational age of at least 22 weeks of gestation and/or to an infant weighing at least 500 grams in all maternity units in metropolitan France during one week in 1995 (N=13 048), 2003 (N=14 324), 2010 (N=14 546), 2016 (N=12 553), and 2021 (N=12 088). The data came from postpartum interviews of the women at the hospital and their medical records. Comparisons between surveys showed trends over time. RESULTS Between 1995 and 2021, maternal characteristics changed. Maternal age and the frequency of women with obesity rose: in 2021, 24.6% of women were 35 years or older (21.1% in 2016, 19.2% in 2010, 15.9% in 2003 and 12.4% in 1995) and 14.4% were obese (11.8% in 2016, 9.9% in 2010 and 7.4% in 2003). Some antenatal prevention behaviors that improved in 2021 were not smoking during the third trimester, acid folic administration before pregnancy, and vaccination against influenza. The percentage of women with an early prenatal appointment ("4th month appointment"), implemented to facilitate screening of maternal vulnerability during pregnancy, has continued to rise. The percentage of women receiving prenatal care by midwives has risen markedly (39.0% in 2021 versus 11.7% in 2016). Serum screening for Down syndrome continues to increase (91.8% of women in 2021). The rate of induction of labor has risen significantly (20.2% in 1995 and 25.8% in 2021). The mode of delivery has not varied significantly since 2003; in 2021, the cesarean rate was 21.4% and the instrumental vaginal delivery rate 12.4%. Episiotomy was increasingly rare, among both primiparous and multiparous women (16.5% and 2.9% in 2021, respectively). The prevalence of coronavirus (SARS-CoV2) infection during pregnancy was 5.7%. Preterm live births increased regularly, slightly but significantly over the 1995-2016 period and then remained stable between 2016 and 2021 (7.0%). In 2021, 56.3% of women exclusively breastfed during their hospital stay, a modest increase in comparison with 2016 (54.6%). CONCLUSION Routine national perinatal surveys highlight positive trends over time in some preventive practices, decreases in some medical interventions consistent with national guidelines, and the increasing role of midwives in prenatal care. Nonetheless, some indicators remain less than optimal and require more detailed analyses.
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Affiliation(s)
- Camille Le Ray
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), CRESS, INSERM, INRAE, Université Paris Cité, 75014 Paris, France; Maternité Port-Royal, Groupe hospitalier Paris Centre, AP-HP, Université Paris Cité, FHU Prema, 75014 Paris.
| | - Nathalie Lelong
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), CRESS, INSERM, INRAE, Université Paris Cité, 75014 Paris, France
| | - Hélène Cinelli
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), CRESS, INSERM, INRAE, Université Paris Cité, 75014 Paris, France
| | - Béatrice Blondel
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), CRESS, INSERM, INRAE, Université Paris Cité, 75014 Paris, France
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Lainé G, Le Huec JC, Blondel B, Fuentes S, Fiere V, Parent H, Lucas F, Roussouly P, Tassa O, Bravant E, Berthiller J, Barrey CY. Factors influencing complications after 3-columns spinal osteotomies for fixed sagittal imbalance from multiple etiologies: a multicentric cohort study about 286 cases in 273 patients. Eur Spine J 2022; 31:3673-3686. [PMID: 36192454 DOI: 10.1007/s00586-022-07410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/14/2022] [Accepted: 09/26/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Spinal osteotomies performed to treat fixed spinal deformities are technically demanding and associated with a high complications rate. The main purpose of this study was to analyze complications and their risk factors in spinal osteotomies performed for fixed sagittal imbalance from multiple etiologies. METHODS The study consisted of a blinded retrospective analysis of prospectively collected data from a large multicenter cohort of patients who underwent 3-columns (3C) spinal osteotomy, between January 2010 and January 2017. Clinical and radiological data were compared pre- and post-operatively. Complications and their risk factors were analyzed. RESULTS Two hundred eighty-six 3C osteotomies were performed in 273 patients. At 1 year follow-up, both clinical (VAS pain, ODI and SRS-22 scores) and radiological (SVA, SSA, loss of lordosis and pelvic version) parameters were significantly improved (p < 0.001). A total of 164 patients (59.2%) experienced at least 1 complication (277 complications). Complications-free survival rates were only 30% at 5 years. Most of those were mechanical (35.2%), followed by general (17.6%), surgical site infection (17.2%) and neurological (10.9%). Pre-operative neurological status [RR = 2.3 (1.32-4.00)], operative time (+ 19% of risk each additional hour) and combined surgery [RR = 1.76 (1.08-2.04)] were assessed as risk factors for overall complication (p < 0.05). The use of patient-specific rods appeared to be significantly associated with less overall complications [RR = 0.5 (0.29-0.89)] (p = 0.02). CONCLUSION Spinal 3C osteotomies were efficient to improve both clinical and radiological parameters despite high rates of complication. Efforts should be made to reduce operative time which appears to be the strongest predictive risk factor for complication.
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Affiliation(s)
- G Lainé
- Department of Spine and Spinal Cord Surgery, P Wertheimer University Hospital, GHE, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69003, Lyon, France.
| | - J C Le Huec
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux University, Bordeaux, France
| | - B Blondel
- Department of Spine Surgery, CHU Timone, Université Aix-Marseille, 264 rue Saint-Pierre, 13005, Marseille, France
| | - S Fuentes
- Department of Spine Surgery, CHU Timone, Université Aix-Marseille, 264 rue Saint-Pierre, 13005, Marseille, France
| | - V Fiere
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - H Parent
- Clinique Saint Léonard, Trélazé, France
| | - F Lucas
- Hopital Privé Saint Martin, Ramsay Générale de Santé, Caen, France
| | - P Roussouly
- Centre Médico-Chirurgical Des Massues, Croix Rouge, Lyon, France
| | - O Tassa
- Department of Biostatistics and Epidemiology, Pôle IMER, Hospices Civils de Lyon, 162 avenue Lacassagne, 69424, Lyon, France
| | - E Bravant
- Department of Biostatistics and Epidemiology, Pôle IMER, Hospices Civils de Lyon, 162 avenue Lacassagne, 69424, Lyon, France
| | - J Berthiller
- Department of Biostatistics and Epidemiology, Pôle IMER, Hospices Civils de Lyon, 162 avenue Lacassagne, 69424, Lyon, France
| | - C Y Barrey
- Department of Spine and Spinal Cord Surgery, P Wertheimer University Hospital, GHE, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69003, Lyon, France
- Laboratory of Biomechanics, ENSAM, Arts et Metiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France
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Saurel-Cubizolles MJ, Azria E, Blondel B, Regnault N, Deneux-Tharaux C. Exploring the socioeconomic disparities of maternal body mass index: a national study in France. Eur J Public Health 2022; 32:528-534. [PMID: 35700453 PMCID: PMC9341669 DOI: 10.1093/eurpub/ckac064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of overweight and obesity has increased in various countries. Normal weight before pregnancy is important to protect maternal and newborn health. This study aimed to describe the evolution of body mass index (BMI) before pregnancy in France and explore its association with two measures of socioeconomic status (SES), education and household income. METHODS Data were from four national perinatal surveys in France in 1998, 2003, 2010 and 2016 to describe the time evolution of maternal BMI. We explored the links between BMI and women's characteristics in the most recent period (2010-2016 surveys) since income information was not available before. Risk ratios (RRs) of underweight, overweight and obesity for each measure of SES were computed by using multivariable Poisson regression models. RESULTS Overweight and obesity prevalence increased between 1998 and 2016, from 6% to 12% for obesity. Both were inversely associated with SES (higher prevalence among least educated and poorest women), with strong variations for each social indicator, even in multivariable analyses including both. Combining education and income revealed a wide gradient; RR for obesity was 6.01 (95% confidence interval 4.89-7.38) with low education and income <2000 euros/month vs. high education and income ≥4000 euros/month. CONCLUSIONS Public policies must implement programs to limit the increase in overweight and its unequal distribution in the population, alongside other policies to address the societal determinants of the obesogenic environment. Health professionals need to advise women to improve their eating and physical activity to limit weight gain from childhood to early adulthood.
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Affiliation(s)
- Marie-Josèphe Saurel-Cubizolles
- Université de Paris Cité, Obstetrical Perinatal and Paediatric Epidemiology Research team (EPOPé), CRESS, INSERM, INRA, Paris, France
| | - Elie Azria
- Université de Paris Cité, Obstetrical Perinatal and Paediatric Epidemiology Research team (EPOPé), CRESS, INSERM, INRA, Paris, France.,Notre Dame de Bon Secours Maternity Unit, Paris Saint Joseph Hospital, Paris, France
| | - Béatrice Blondel
- Université de Paris Cité, Obstetrical Perinatal and Paediatric Epidemiology Research team (EPOPé), CRESS, INSERM, INRA, Paris, France
| | - Nolwenn Regnault
- Departement des maladies non transmissibles, Santé Publique France, Saint-Maurice, France
| | - Catherine Deneux-Tharaux
- Université de Paris Cité, Obstetrical Perinatal and Paediatric Epidemiology Research team (EPOPé), CRESS, INSERM, INRA, Paris, France
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Merrer J, Chantry AA, Blondel B, Le Ray C, Bonnet MP. No pain management for labour: individual and organisational determinants: A secondary analysis of the 2016 French National Perinatal Survey. Eur J Anaesthesiol 2022; 39:489-497. [PMID: 35608876 DOI: 10.1097/eja.0000000000001682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Disparities in access to pain management have been identified in several care settings, such as emergency departments and intensive care units, but with regard to labour analgesia, it remains poorly explored. OBJECTIVES To determine the proportion of women without pain management during labour and its individual and organisational determinants. DESIGN Secondary analysis of a nationwide cross-sectional population-based study, the 2016 French National Perinatal Survey. SETTINGS All maternity units in France. PARTICIPANTS Ten thousand and eleven women who attempted vaginal delivery with a labour duration at least 15 min. MAIN OUTCOME MEASURE Absence of pain management, defined as absence of any pharmacological or nonpharmacological analgesic method during labour. RESULTS Among the 10 011 women included, 542 (5.4%) had no labour pain management: 318 (3.7%) of the 8526 women who initially preferred to use neuraxial analgesia and 222 (15.8%) of the 1402 who did not. Using generalised estimating equations stratified according to the maternal antenatal preference for neuraxial analgesia, the common determinants of no labour pain management in both groups were no attendance at childbirth education classes and admission to a delivery unit during the night. Among women who initially preferred to use neuraxial analgesia, those who delivered in units with <1500 annual deliveries compared with units with 2000 to 3499 annual deliveries, were more likely to do without pain management [adjusted odds ratio (OR) = 1.96; 95% confidence interval (CI), 1.39 to 2.78]; among those who did not prefer to use it, women born abroad were more likely to do without labour pain management (adjusted OR = 1.64; 95% CI, 1.12 to 2.40). CONCLUSION In France, 1 : 20 women had no labour pain management, and this proportion was three times higher among women who preferred not to use neuraxial analgesia. Enhancing maternal information on labour pain and its management, especially nonpharmacological methods, and rethinking care organisation, could improve access to analgesia of any kind.
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Affiliation(s)
- Jade Merrer
- From the Université de Paris, Centre of Research in Epidemiology and StatisticS/CRESS/Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA (JM, AAC, BB, ClR, M-PB), Midwifery school of Baudelocque, AP-HP, Université de Paris (AAC), Port-Royal Maternity Unit, Department of Obstetrics, Cochin Broca Hôtel-Dieu hospital, Assistance Publique-Hôpitaux de Paris (ClR) and Sorbonne University, GRC 29, DMU DREAM, Department of Anaesthesiology and Critical Care, Armand Trousseau Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France (M-PB)
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9
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Trinh NT, de Visme S, Cohen JF, Bruckner T, Lelong N, Adnot P, Rozé JC, Blondel B, Goffinet F, Rey G, Ancel PY, Zeitlin J, Chalumeau M. Recent historic increase of infant mortality in France: A time-series analysis, 2001 to 2019. Lancet Reg Health Eur 2022; 16:100339. [PMID: 35252944 PMCID: PMC8891691 DOI: 10.1016/j.lanepe.2022.100339] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The infant mortality rate (IMR) serves as a key indicator of population health. Methods We used data from the French National Institute of Statistics and Economic Studies on births and deaths during the first year of life from 2001 to 2019 to calculate IMR aggregated by month. We ran joinpoint regressions to identify inflection points and assess the linear trend of each segment. Exploratory analyses were performed for overall IMR, as well as by age at death subgroups (early neonatal [D0-D6], late neonatal [D7-27], and post-neonatal [D28-364]), and by sex. We performed sensitivity analyses by excluding deaths at D0 and using other time-series modeling strategies. Results Over the 19-year study period, 53,077 infant deaths occurred, for an average IMR of 3·63/1000 (4·00 in male, 3·25 in female); 24·4% of these deaths occurred during the first day of life and 47·8% during the early neonatal period. Joinpoint analysis identified two inflection points in 2005 and 2012. The IMR decreased sharply from 2001 to 2005 (slope: -0·0167 deaths/1000 live births/month; 95%CI: -0·0219 to -0·0116) and then decreased slowly between 2005 and 2012 (slope: -0·0041; 95%CI: -0·0065 to -0·0016). From 2012 onwards, a significant increase in IMR was observed (slope: 0·0033; 95%CI: 0·0011 to 0·0056). Subgroup analyses indicated that these trends were driven notably by an increase in the early neonatal period. Sensitivity analyses provided consistent results. Interpretation The recent historic increase in IMR since 2012 in France should prompt urgent in-depth investigation to understand the causes and prepare corrective actions. Funding No financial relationships with any organizations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.
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10
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Fresson J, Bruckner TA, Ray CL, Goffinet F, Rey S, Blondel B, Deneux-Tharaux C, Ancel PY, Zeitlin J. Decreases in preterm birth during the first COVID-19 lockdown in France by gestational age sub-groups and regional COVID-19 incidence. Ann Epidemiol 2022; 72:74-81. [DOI: 10.1016/j.annepidem.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 05/08/2022] [Accepted: 05/17/2022] [Indexed: 11/01/2022]
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11
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Hocquette A, Monier I, Blondel B, Dufourg MN, Heude B, Zeitlin J. Testing the assumptions of customized intrauterine growth charts using national birth studies. Acta Obstet Gynecol Scand 2022; 101:405-416. [PMID: 35224718 DOI: 10.1111/aogs.14335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/06/2021] [Accepted: 01/22/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Customized intrauterine growth charts are widely used for growth monitoring and research. They are based on three assumptions: (1) estimated fetal weight (EFW) has a normal distribution with a constant coefficient of variation at all gestational ages; (2) Hadlock's growth curve accurately describes the relation between EFW and gestational ages; (3) associations between EFW and the fetal and maternal characteristics included in the customization model (fetal sex, pre-pregnancy weight, height, parity) are proportional throughout pregnancy. The aim of this study was to test whether these underlying assumptions are verified. MATERIAL AND METHODS Data came from (1) the French Longitudinal Study of Children (ELFE) cohort, which recruited births after 32 weeks' gestation in 349 maternity hospitals in France in 2011, and (2) the National Perinatal Survey, which included births from all French maternity hospitals in 2016. The study population included, respectively, 6 920 and 8 969 singleton non-malformed term live births with data on customization characteristics and EFW. We computed the coefficient of variation by gestational age and then modeled the association of gestational age, maternal and fetal characteristics with EFW at the second and third trimester ultrasound and with birthweight using linear regression. To assess the proportionality of the impact of maternal and fetal characteristics, we computed the percent change in weight associated with these characteristics at these three time points. RESULTS The coefficient of variation was close to 12% at each gestational age, but EFW was not normally distributed, leading to small but systematic underestimation of fetuses under the 10th percentile. Weights representing the 50th and 10th percentiles based on Hadlock's growth trajectory were lower than observed or predicted weights. Most characteristics more strongly impacted weight at birth than during pregnancy. In the French Longitudinal study of Children (ELFE) cohort, boys were 1.8% (95% confidence interval [CI] 1.3-2.4) heavier than girls in the third trimester, whereas this percentage was 4.6% (95% CI 4.0-5.2) at birth. In the National Perinatal Survey, these percentages were 2.3% (95% CI 1.8-2.8) and 4.3% (95% CI 3.8-4.8). CONCLUSIONS These results from two independent sources revealed discrepancies between routine clinical EFW data used for growth monitoring and the customized growth model's assumptions.
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Affiliation(s)
- Alice Hocquette
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université de Paris, Paris, France
| | - Isabelle Monier
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université de Paris, Paris, France.,Department of Obstetrics and Gynecology, Antoine Béclère Hospital, AP-HP, University Paris Saclay, Clamart, France
| | - Béatrice Blondel
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université de Paris, Paris, France
| | | | - Barbara Heude
- Research Team on the Early Life Origins of Health (EAROH), Center for Research in Epidemiology and Statistics (CRESS), INSERM, Université de Paris, Villejuif, France
| | - Jennifer Zeitlin
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université de Paris, Paris, France
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12
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Moreau C, Bonnet C, Beuzelin M, Blondel B. Pregnancy planning and acceptance and maternal psychological distress during pregnancy: results from the National Perinatal Survey, France, 2016. BMC Pregnancy Childbirth 2022; 22:162. [PMID: 35227224 PMCID: PMC8883609 DOI: 10.1186/s12884-022-04496-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Studies report heightened risks of mental health problems among women who experience an unintended pregnancy, but few consider the complexity of pregnancy intentions. In this study, we evaluate how different dimensions of pregnancy intentions (pregnancy planning and pregnancy acceptance) relate to two maternal depressive symptoms and perceived psychological distress. Methods This study draws from a cross-sectional national survey conducted in all maternities in France over a one-week period in 2016. All mothers 18 years and older who had a live birth during the study period were invited to participate. After excluding women who underwent infertility treatment, our analytical sample included 10,339 women. We first described levels and correlates of pregnancy planning and acceptance, defined in four categories; planned/welcomed, unplanned/welcomed, planned/unwelcomed, unplanned/unwelcomed. We then assessed the bivariate and multivariate associations between pregnancy planning and acceptance and two outcomes: women’s self-perceived psychological health and the presence of two depressive symptoms during pregnancy. We used multivariate logistic regressions to evaluate these associations, after adjusting for socio-demographic and medical factors. Results Altogether 7.5 to 24.1% of mothers perceived their psychological health during pregnancy was poor, according to pregnancy planning and acceptance categories and 10.3 to 22.4% indicated feelings of sadness and loss of interest during pregnancy, according to pregnancy planning and acceptance categories. As compared to women with planned/welcomed pregnancies, the odds of perceived poor psychological health and depressive symptoms were 2.55 times (CI 2.20–2.95) and 1.75 times higher (CI 1.51–2.02), respectively, among unplanned/unwelcomed pregnancies and 2.02 (CI 1.61–2.53) and 2.07 (CI 1.7–2.5) higher, among planned/unwelcomed pregnancies. Among women with unplanned pregnancies, we also found higher odds of perceived poor psychological health among women whose pregnancy was unwelcomed while the odds of depressive symptoms were not different by pregnancy planning status among women with unwelcomed pregnancies. Conclusions These findings consolidate previous reports of the association between pregnancy intentions and maternal psychological distress, while further specifying the relationship, which mostly depends on the acceptance of pregnancy timing rather than on pregnancy planning. Identifying women with low pregnancy acceptance can potentially enhance current medical practice by improving early detection of maternal depression.
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Affiliation(s)
- Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21203, USA. .,Soins et Santé Primaire, CESP Centre for Research in Epidemiology and Population Health, U1018, INSERM, F-94805, Villejuif, France.
| | - Camille Bonnet
- Obstetrical, Perinatal and Pediatric Research Team, INSERM, Université de Paris, F-75014, Paris, France
| | - Maxime Beuzelin
- Obstetrical, Perinatal and Pediatric Research Team, INSERM, Université de Paris, F-75014, Paris, France
| | - Béatrice Blondel
- Obstetrical, Perinatal and Pediatric Research Team, INSERM, Université de Paris, F-75014, Paris, France
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13
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Gissler M, Durox M, Smith L, Blondel B, Broeders L, Hindori-Mohangoo A, Kearns K, Kolarova R, Loghi M, Rodin U, Szamotulska K, Velebil P, Weber G, Zurriaga O, Zeitlin J. Clarity and consistency in stillbirth reporting in Europe: why is it so hard to get this right? Eur J Public Health 2022; 32:200-206. [PMID: 35157046 PMCID: PMC8975542 DOI: 10.1093/eurpub/ckac001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Stillbirth is a major public health problem, but measurement remains a challenge even in high-income countries. We compared routine stillbirth statistics in Europe reported by Eurostat with data from the Euro-Peristat research network. Methods We used data on stillbirths in 2015 from both sources for 31 European countries. Stillbirth rates per 1000 total births were analyzed by gestational age (GA) and birthweight groups. Information on termination of pregnancy at ≥22 weeks’ GA was analyzed separately. Results Routinely collected stillbirth rates were higher than those reported by the research network. For stillbirths with a birthweight ≥500 g, the difference between the mean rates of the countries for Eurostat and Euro-Peristat data was 22% [4.4/1000, versus 3.5/1000, mean difference 0.9 with 95% confidence interval (CI) 0.8–1.0]. When using a birthweight threshold of 1000 g, this difference was smaller, 12% (2.9/1000, versus 2.5/1000, mean difference 0.4 with 95% CI 0.3–0.5), but substantial differences remained for individual countries. In Euro-Peristat, missing data on birthweight ranged from 0% to 29% (average 5.0%) and were higher than missing data for GA (0–23%, average 1.8%). Conclusions Routine stillbirth data for European countries in international databases are not comparable and should not be used for benchmarking or surveillance without careful verification with other sources. Recommendations for improvement include using a cut-off based on GA, excluding late terminations of pregnancy and linking multiple sources to improve the quality of national databases.
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Affiliation(s)
- Mika Gissler
- THL Finnish Institute for Health and Welfare, Helsinki, Finland and Karolinska Institute, Stockholm, Sweden
| | - Mélanie Durox
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, F-75004, France
| | - Lucy Smith
- Department of Health Sciences, College of Life Sciences, University of Leicester, LE1 7RH, UK
| | - Béatrice Blondel
- THL Finnish Institute for Health and Welfare, Helsinki, Finland and Karolinska Institute, Stockholm, Sweden
| | - Lisa Broeders
- The Netherlands Perinatal Registry (Perined), Utrecht, The Netherlands
| | - Ashna Hindori-Mohangoo
- Foundation for Perinatal Interventions and Research in Suriname (PeriSur), Paramaribo, Suriname.,Tulane University, School of Public Health and Tropical Medicine, New Orleans, USA
| | - Karen Kearns
- National Finance Division, Healthcare Pricing Office, HSE, Dublin
| | | | - Marzia Loghi
- Directorate for Social Statistics and Welfare, Italian Statistical Institute (ISTAT), Rome, Italy
| | - Urelija Rodin
- Croatian Institute of Public Health, School of Public Health 'Andrija Štampar', School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Katarzyna Szamotulska
- Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland
| | - Petr Velebil
- Institute for the Care of Mother and Child, Prague, Czech Republic
| | - Guy Weber
- Department of Epidemiology and Statistics, Directorate of Health, Luxembourg
| | - Oscar Zurriaga
- Public Health General Directorate, Valencia Regional Public Health Authority, Spain.,Public Health and Preventive Medicine Department, University of Valencia, Spain.,Centre for Network Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, F-75004, France
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14
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Monier I, Ego A, Benachi A, Hocquette A, Blondel B, Goffinet F, Zeitlin J. Comparison of the performance of estimated fetal weight charts for the detection of small- and large-for-gestational age newborns with adverse outcomes: a French population-based study. BJOG 2021; 129:938-948. [PMID: 34797926 DOI: 10.1111/1471-0528.17021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 10/19/2021] [Accepted: 11/16/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To compare the performance of estimated fetal weight (EFW) charts at the third trimester ultrasound for detecting small- and large-for-gestational age (SGA/LGA) newborns with adverse outcomes. DESIGN Nationally representative observational study. SETTING French maternity units in 2016. POPULATION 9940 singleton live births with an ultrasound between 30 and 35 weeks of gestation. METHODS We compared three prescriptive charts (INTERGROWTH-21st, World Health Organization (WHO), Eunice Kennedy Shriver National Institute of Child Health and Human Development [NICHD]), four descriptive charts (Hadlock, Fetal Medicine Foundation, two French charts) and a French customised growth model (Epopé). MAIN OUTCOME MEASURES SGA and LGA (birthweights <10th and >90th percentiles) associated with adverse outcomes (low Apgar score, delivery-room resuscitation, neonatal unit admission). RESULTS 2.1% and 1.1% of infants had SGA and LGA and adverse outcomes, respectively. The sensitivity and specificity for detecting these infants with an EFW <10th and >90th percentile varied from 29-65% and 84-96% for descriptive charts versus 27-60% and 83-96% for prescriptive charts. WHO and French charts were closest to the EFW distribution, yielding a balance between sensitivity and specificity for SGA and LGA births. INTERGROWTH-21st and Epopé had low sensitivity for SGA with high sensitivity for LGA. Areas under the receiving operator characteristics curve ranged from 0.62 to 0.74, showing low to moderate predictive ability, and diagnostic odds ratios varied from 7 to 16. CONCLUSION Marked differences in the performance of descriptive as well as prescriptive EFW charts highlight the importance of evaluating them for their ability to detect high-risk fetuses. TWEETABLE ABSTRACT Choice of growth chart strongly affected identification of high-risk fetuses at the third trimester ultrasound.
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Affiliation(s)
- I Monier
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Epidemiology and Statistics Research Centre (CRESS), Institut national de la santé et de la recherche médicale (INSERM), Institut national de la recherche agronomique (INRA), Université de Paris, Paris, France.,Department of Obstetrics and Gynaecology, Antoine Béclère Hospital, AP-HP, Paris Saclay University, Clamart, France
| | - A Ego
- Public Health Department, CHU Grenoble Alpes, Université de Grenoble Alpes, CNRS, Grenoble INP (Institute of Engineering Univ. Grenoble Alpes), TIMC-IMAG, Grenoble, France.,INSERM CIC U1406, Grenoble, France
| | - A Benachi
- Department of Obstetrics and Gynaecology, Antoine Béclère Hospital, AP-HP, Paris Saclay University, Clamart, France
| | - A Hocquette
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Epidemiology and Statistics Research Centre (CRESS), Institut national de la santé et de la recherche médicale (INSERM), Institut national de la recherche agronomique (INRA), Université de Paris, Paris, France
| | - B Blondel
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Epidemiology and Statistics Research Centre (CRESS), Institut national de la santé et de la recherche médicale (INSERM), Institut national de la recherche agronomique (INRA), Université de Paris, Paris, France
| | - F Goffinet
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Epidemiology and Statistics Research Centre (CRESS), Institut national de la santé et de la recherche médicale (INSERM), Institut national de la recherche agronomique (INRA), Université de Paris, Paris, France.,Maternité Port-Royal, AP-HP, APHP. Centre-Université de Paris, FHU PREMA, Paris, France
| | - J Zeitlin
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Epidemiology and Statistics Research Centre (CRESS), Institut national de la santé et de la recherche médicale (INSERM), Institut national de la recherche agronomique (INRA), Université de Paris, Paris, France
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15
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Desplanches T, Morgan AS, Jones P, Diguisto C, Zeitlin J, Martin-Marchand L, Benhammou V, Lecomte B, Rozé JC, Truffert P, Ancel PY, Sagot P, Roussot A, Fresson J, Blondel B. Risk factors for very preterm delivery out of a level III maternity unit: The EPIPAGE-2 cohort study. Paediatr Perinat Epidemiol 2021; 35:694-705. [PMID: 33956996 DOI: 10.1111/ppe.12770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Regionalisation programmes aim to ensure that very preterm infants are born in level III units (inborn) through antenatal referral or transfer. Despite widespread knowledge about better survival without disability for inborn babies, 10%-30% of women deliver outside these units (outborn). OBJECTIVE To investigate risk factors associated with outborn deliveries and to estimate the proportion that were probably or possibly avoidable. METHODS We used a national French population-based cohort including 2205 women who delivered between 24 and 30+6 weeks in 2011. We examined risk factors for outborn delivery related to medical complications, antenatal care, sociodemographic characteristics and living far from a level III unit using multivariable binomial regression. Avoidable outborn deliveries were defined by pregnancy risk (obstetric history, antenatal hospitalisation) and time available for transfer. RESULTS 25.0% of women were initially booked in level III, 9.1% were referred, 49.8% were transferred, and 16.1% had outborn delivery. Risk factors for outborn delivery were gestational age <26 weeks (adjusted relative risk (aRR) 1.37, 95% confidence interval (CI) 1.13, 1.66), inadequate antenatal care (aRR 1.39, 95% CI 1.10, 1.81), placental abruption (aRR 1.66, 95% CI 1.27, 2.17), and increased distance to the closest level III unit ((aRR 2.79, 95% CI 2.00, 3.92) in the 4th versus 1st distance quartile). Among outborn deliveries, 16.7% were probably avoidable, and 25.6% possibly avoidable, which could increase the proportion of inborn deliveries between 85.9% and 92.9%. Avoidable outborn deliveries were mainly associated with gestational age, intrauterine growth restriction, preterm premature rupture of membranes, and haemorrhage, but not distance. CONCLUSIONS Our study identified some modifiable risk factors for outborn delivery; however, when regionalised care relies heavily on antenatal transfer, as it does in France, only some outborn deliveries may be prevented. Earlier referral of high-risk women will be needed to achieve full access to tertiary care.
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Affiliation(s)
- Thomas Desplanches
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,CHRU Dijon, Department of Gynaecology, Obstetrics, Foetal Medicine and Infertility, Dijon, France
| | - Andrei S Morgan
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,Department of Neonatology, Elizabeth Garrett Anderson Institute for Women's Health, UCL, London, UK.,Embrace Yorkshire and Humber Infant and Paediatric Transport Service, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Peter Jones
- SAMU de Paris, AP-HP, Hôpital Necker Enfants Malades, Paris, France.,Réanimation Pédiatrique AP-HP, Hôpital Robert Debré, Paris, France
| | - Caroline Diguisto
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,Department of Obstetrics and Gynecology, University Hospital of Tours, Tours University, Tours, France
| | - Jennifer Zeitlin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France
| | - Laetitia Martin-Marchand
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France
| | - Valérie Benhammou
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France
| | | | - Jean-Christophe Rozé
- Pediatric Intensive Care Unit, Mothers' and Children's Hospital, Nantes Teaching Hospital, Nantes, France
| | - Patrick Truffert
- Neonatal Intensive Care Unit, Jeanne de Flandre Hospital, CHRU Lille, Lille, France
| | - Pierre-Yves Ancel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,Clinical Research Unit, Center for Clinical Investigation P1419, CHU Cochin Broca Hôtel-Dieu, Paris, France
| | - Paul Sagot
- CHRU Dijon, Department of Gynaecology, Obstetrics, Foetal Medicine and Infertility, Dijon, France
| | - Adrien Roussot
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.,Bourgogne Franche-Comté University, Dijon, France
| | - Jeanne Fresson
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,Department of Medical Information, University Hospital (CHRU) Nancy, Nancy, France
| | - Béatrice Blondel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France
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16
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Merrer J, Le Ray C, Bonnet C, Coulm B, Blondel B. Overuse of antenatal visits and ultrasounds in low-risk women: A national population-based study. Paediatr Perinat Epidemiol 2021; 35:674-685. [PMID: 34160099 DOI: 10.1111/ppe.12782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/28/2021] [Accepted: 05/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND A better understanding of the overuse of antenatal care is needed to improve its organisation to deal with limited medical resources and doctor shortages. OBJECTIVES To assess the proportion of women who overuse antenatal care and the associations of overuse with maternal characteristics and the qualifications of healthcare providers. METHODS We used the 2016 National Perinatal Survey, a cross-sectional population-based survey, performed in all maternity units in France, including 13,132 women. Based on the French national guidelines, 6-8 antenatal visits were defined as adequate, 9-11 as high use, and ≥12 as overuse, while 3 ultrasounds were considered adequate, 4-5 as high use, and ≥6 as overuse. We performed binary modified Poisson regressions-with adequate care as the reference-including maternal social and medical characteristics and the healthcare professionals' qualifications. RESULTS After women with inadequate care were excluded, 19.2% of low-risk women had at least 12 visits and 30.5% at least 6 ultrasounds. Overuse of visits was associated with primiparity, average to high income, less than good psychological well-being, and care by an obstetrician. The risks of overuse of ultrasounds were higher among primiparous, women with average to high income and those receiving care from a public-sector obstetrician (adjusted relative risk 1.17, 95% CI, 1.13, 1.21) or private obstetrician (adjusted relative risk 1.12, 95% CI, 1.07, 1.16), compared with a public-sector midwife. CONCLUSIONS Antenatal care overuse is very common in France and associated with some maternal characteristics and also the qualification of care provider. Antenatal care should be customised according to women's needs, in particular for primiparae and those with poor well-being, and available medical resources.
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Affiliation(s)
- Jade Merrer
- Université de Paris/ Center of Research in Epidemiology and StatisticS(CRESS)/ Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé)/ INSERM/ INRA, Paris, France
| | - Camille Le Ray
- Université de Paris/ Center of Research in Epidemiology and StatisticS(CRESS)/ Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé)/ INSERM/ INRA, Paris, France.,Port-Royal Maternity Unit, Assistance Publique-Hôpitaux de Paris - Centre, Université de Paris, Paris, France
| | - Camille Bonnet
- Université de Paris/ Center of Research in Epidemiology and StatisticS(CRESS)/ Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé)/ INSERM/ INRA, Paris, France
| | - Bénédicte Coulm
- Université de Paris/ Center of Research in Epidemiology and StatisticS(CRESS)/ Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé)/ INSERM/ INRA, Paris, France
| | - Béatrice Blondel
- Université de Paris/ Center of Research in Epidemiology and StatisticS(CRESS)/ Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé)/ INSERM/ INRA, Paris, France
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17
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Brebion M, Bonnet MP, Sauvegrain P, Saurel-Cubizolles MJ, Blondel B, Deneux-Tharaux C, Azria E. Use of labour neuraxial analgesia according to maternal immigration status: a national cross-sectional retrospective population-based study in France. Br J Anaesth 2021; 127:942-952. [PMID: 34511258 DOI: 10.1016/j.bja.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Disparities in neuraxial analgesia use for childbirth by maternal origin have been reported in high-resource countries. We explored the association between maternal immigrant status (characterised separately by geographic continental origin and Human Development Index [HDI] of maternal country of birth) and neuraxial analgesia use. We hypothesised that immigrant women from low-resource countries may have more limited access to neuraxial analgesia than native French women. METHODS The study population, extracted from the 2016 National Perinatal Survey, a cross-sectional study of a representative sample of births in France, included only women who initially wished to deliver with neuraxial analgesia. We used multivariable multilevel logistic regression to explore the association between immigrant status and both use of neuraxial analgesia and its timely administration. RESULTS Among the 6070 women included, 88.1% gave birth with neuraxial analgesia and 15.8% were immigrants. There was no difference in neuraxial analgesia use between native French women and either immigrant women by geographic continental region of origin, or immigrants from countries with low HDI. However, immigrants from countries with very high HDI were more likely to give birth with neuraxial analgesia (adjusted odds ratio [aOR]=2.6; 95% confidence interval (CI), 1.2-5.8; P=0.018) and its timeliness <60 min after admission (aOR=1.8; 95% CI, 1.2-2.7; P=0.005) compared with native French women. CONCLUSIONS In France, immigrant women from low-resource countries have similar access to labour neuraxial analgesia to native French women. Our results suggest differential neuraxial analgesia use in favour of immigrant women from very high HDI countries compared with native women.
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Affiliation(s)
- Myriam Brebion
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.
| | - Marie-Pierre Bonnet
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France; Sorbonne University, GRC 29, DMU DREAM, Department of Anaesthesia and Intensive Care, Armand Trousseau Hospital, AP-HP, Paris, France
| | - Priscille Sauvegrain
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Marie-Josèphe Saurel-Cubizolles
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Béatrice Blondel
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Catherine Deneux-Tharaux
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Elie Azria
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France; Maternity Unit, Notre Dame de Bon Secours - Groupe Hospitalier Paris-Saint-Joseph Hospital, Paris University, Paris, France
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18
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Farah K, Prost S, Meyer M, Albader F, Mansouri N, Blondel B, Fuentes S. Surgery for spinal deformity in Parkinson's disease patients: What are we missing? Neurochirurgie 2021; 68:183-187. [PMID: 34481864 DOI: 10.1016/j.neuchi.2021.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Deformity associating coronal and sagittal malalignment can severely impair quality of life in Parkinson's disease (PD). Realignment using patient-specific rods (PSRs) is useful for achieving alignment goals. METHODS This was a retrospective single-center analysis of a prospectively maintained database of all PD patients who underwent surgery between January 2013 and January 2017. Clinical evaluation, preoperatively and at 1 year's follow-up, used the Oswestry Disability Index (ODI). Radiological evaluation used systematic preoperative and 1-year postoperative full-spine radiographs. RESULTS Twelve patients were included: 6 female, 6 male; mean age, 68.4 years. Mean follow-up was 40.8 months [range 12-70]. On average, 14 levels were fused [range 10-18]. Unplanned revision surgery was necessary for 8 patients at a mean 15.625 months after index surgery. Mean preoperative ODI score was 64% preoperatively [range 56-70] versus 52% [range 28-64] at 1 year's follow-up (P=0.004). Lumbar lordosis improved significantly, from -16.7° preoperatively to -41.4° at 1 year (P=0.006). Pelvic tilt was the least effectively corrected parameter, with a mean preoperative value of 31.6° vs. 27.8° at 1 year (P=0.19). Mean preoperative sagittal vertical axis was 149.7mm versus 73.6mm at 1 year (P=0.013). Mean preoperative coronal tilt was 68.2mm versus 22.9mm at 1 year (P=0.007). CONCLUSION Parkinson's disease is a degenerative disease frequently associated with major spine malalignment. The severity of the postural disorders in these patients needs special precautions to avoid complications.
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Affiliation(s)
- K Farah
- Department of neurosurgery, Aix-Marseille university, CHU Timone, AP-HM, Marseille, France; Spine unit, Aix-Marseille university, CHU Timone, AP-HM, Marseille, France.
| | - S Prost
- Spine unit, Aix-Marseille university, CHU Timone, AP-HM, Marseille, France; Department of orthopedic surgery, Aix-Marseille university, CHU Timone, AP-HM, Marseille, France
| | - M Meyer
- Department of neurosurgery, Aix-Marseille university, CHU Timone, AP-HM, Marseille, France; Spine unit, Aix-Marseille university, CHU Timone, AP-HM, Marseille, France
| | - F Albader
- Department of neurosurgery, Aix-Marseille university, CHU Timone, AP-HM, Marseille, France; Spine unit, Aix-Marseille university, CHU Timone, AP-HM, Marseille, France
| | - N Mansouri
- Department of neurosurgery, university hospital of Nancy, 54035 Nancy, France
| | - B Blondel
- Spine unit, Aix-Marseille university, CHU Timone, AP-HM, Marseille, France; Department of orthopedic surgery, Aix-Marseille university, CHU Timone, AP-HM, Marseille, France
| | - S Fuentes
- Department of neurosurgery, Aix-Marseille university, CHU Timone, AP-HM, Marseille, France; Spine unit, Aix-Marseille university, CHU Timone, AP-HM, Marseille, France
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19
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Hocquette A, Durox M, Wood R, Klungsøyr K, Szamotulska K, Berrut S, Rihs T, Kyprianou T, Sakkeus L, Lecomte A, Zile I, Alexander S, Klimont J, Barros H, Gatt M, Isakova J, Blondel B, Gissler M, Zeitlin J. International versus national growth charts for identifying small and large-for-gestational age newborns: A population-based study in 15 European countries. Lancet Reg Health Eur 2021; 8:100167. [PMID: 34557855 PMCID: PMC8454535 DOI: 10.1016/j.lanepe.2021.100167] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND To inform the on-going debate about the use of universal prescriptive versus national intrauterine growth charts, we compared perinatal mortality for small and large-for-gestational-age (SGA/LGA) infants according to international and national charts in Europe. METHODS We classified singleton births from 33 to 42 weeks of gestation in 2010 and 2014 from 15 countries (N = 1,475,457) as SGA (birthweight <10th percentile) and LGA (>90th percentile) using the international Intergrowth-21st newborn standards and national charts based on the customised charts methodology. We computed sex-adjusted odds ratios (aOR) for stillbirth, neonatal and extended perinatal mortality by this classification using multilevel models. FINDINGS SGA and LGA prevalence using national charts were near 10% in all countries, but varied according to international charts with a north to south gradient (3.0% to 10.1% and 24.9% to 8.0%, respectively). Compared with appropriate for gestational age (AGA) infants by both charts, risk of perinatal mortality was increased for SGA by both charts (aOR[95% confidence interval (CI)]=6.1 [5.6-6.7]) and infants reclassified by international charts from SGA to AGA (2.7 [2.3-3.1]), but decreased for those reclassified from AGA to LGA (0.6 [0.4-0.7]). Results were similar for stillbirth and neonatal death. INTERPRETATION Using international instead of national charts in Europe could lead to growth restricted infants being reclassified as having normal growth, while infants with low risks of mortality could be reclassified as having excessive growth. FUNDING InfAct Joint Action, CHAFEA Grant n°801,553 and EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking ConcePTION grant n°821,520. AH received a PhD grant from EHESP.
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Affiliation(s)
- Alice Hocquette
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
| | - Mélanie Durox
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
| | - Rachael Wood
- Public Health Scotland, Edinburgh and University of Edinburgh, Edinburgh, Scotland
| | - Kari Klungsøyr
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway and Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Katarzyna Szamotulska
- Institute of Mother and Child, Department of Epidemiology and Biostatistics, Warsaw, Poland
| | - Sylvan Berrut
- Federal Statistical Office FSO, Neuchâtel, Switzerland
| | - Tonia Rihs
- Federal Statistical Office FSO, Neuchâtel, Switzerland
| | | | - Luule Sakkeus
- Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
| | - Aline Lecomte
- Department of Population Health, Luxembourg Institute of Health, Luxembourg
| | - Irisa Zile
- The Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Sophie Alexander
- Université Libre de Bruxelles, School of Public Health, Perinatal Epidemiology and Reproductive health Unit, Brussels, Belgium
| | | | - Henrique Barros
- University of Porto Medical School, Department of Public Health, Forensic Sciences and Medical Education, Porto, Portugal
| | - Miriam Gatt
- Directorate for Health Information and Research, National Obstetric Information Systems (NOIS) Register, Tal-Pietà, Malta
| | - Jelena Isakova
- Institute of Hygiene, Health Information Centre, Health Statistics Department, Vilnius, Lithuania
| | - Béatrice Blondel
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki and Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
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20
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Anselem O, Saurel-Cubizolles MJ, Khoshnood B, Blondel B, Sauvegrain P, Bertille N, Azria E. Does women's place of birth affect their opportunity for an informed choice about Down syndrome screening? A population-based study in France. BMC Pregnancy Childbirth 2021; 21:590. [PMID: 34461849 PMCID: PMC8406966 DOI: 10.1186/s12884-021-04041-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background To examine disparities by maternal place of birth in the opportunity to make an informed choice about Down syndrome screening, in France, where the national guidelines recommend that physicians offer it to all pregnant women. Methods We used population-based data from the nationally representative French Perinatal Surveys in 2010 and 2016 (N=24,644 women) to analyze the opportunity for an informed choice for prenatal screening, measured by a composite indicator. Results Among the 24 644 women in the study, 20 612 (83.6%) were born in France, 861 (3.5%) elsewhere in Europe, 1550 (6.3%) in North Africa, and 960 (3.9%) in sub-Saharan Africa. The probability of screening was lower for women born outside France. After adjustment for survey year, maternal age, parity, education level, and the maternity unit’s level of perinatal care, women born outside France had the opportunity to make an informed choice less often than women born in France. This association remained essentially the same even after excluding women without adequate prenatal care. Conclusions Women born outside France, including those with adequate prenatal care, had less opportunity than women born in France to make an informed choice about prenatal screening for Down syndrome.
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Affiliation(s)
- Olivia Anselem
- Maternité Port-Royal, APHP.Centre-Université de Paris, FHU PREMA, 123 boulevard de Port-Royal, 75014, Paris, France.
| | - Marie-Josèphe Saurel-Cubizolles
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Babak Khoshnood
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Béatrice Blondel
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Priscille Sauvegrain
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Maternité du Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Université Paris, Paris, France
| | - Nathalie Bertille
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Elie Azria
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Maternité du Groupe Hospitalier Paris Saint Joseph, FHU Prema, Paris, France
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21
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Amyx M, Zeitlin J, Hermann M, Castetbon K, Blondel B, Le Ray C. Maternal characteristics associated with gestational weight gain in France: a population-based, nationally representative study. BMJ Open 2021; 11:e049497. [PMID: 34215613 PMCID: PMC8256790 DOI: 10.1136/bmjopen-2021-049497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To provide nationally representative estimates of gestational weight gain (GWG) and identify maternal characteristics associated with inadequate GWG in France. DESIGN A population-based study using data from the French National Perinatal Survey: 2010 and 2016. SETTING All maternity units in metropolitan, mainland France (n=535 in 2010; n=493 in 2016). PARTICIPANTS Singleton live births with GWG data (N=24 850). PRIMARY OUTCOME MEASURES GWG was calculated as end of pregnancy minus pre-pregnancy weight (kg) and categorised as 'insufficient', 'adequate', or 'excessive' using 2009 Institute of Medicine thresholds. Classification accounted for pre-pregnancy body mass index (BMI) (kg/m2; underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), obese (≥30)) and gestational age at birth. We estimated average GWG and the percentage of women in each GWG category. Polytomous logistic regression identified characteristics associated with GWG adequacy. RESULTS Average GWG was 13.0 kg (SD 5.6), with 26.8% of women gaining insufficiently, 37.0% adequately and 36.1% excessively. Among other factors, insufficient GWG was associated with underweight (vs normal weight; adjusted OR (aOR) 1.4, 95% CI 1.2 to 1.5) and obese (aOR 1.5, 95% CI 1.4 to 1.7) BMI. Excessive GWG was associated with overweight (aOR 2.8, 95% CI 2.6 to 3.1) and obese BMI (aOR 3.3, 95% CI 2.9 to 3.6). Examining obesity classes separately, odds of insufficient GWG increased from obesity class I to III, while odds of excessive GWG decreased from obesity class I to III. Primiparity (insufficient: aOR 0.9, 95% CI 0.9 to 1.0; excessive: aOR 1.2, 95% CI 1.2 to 1.3), maternal characteristics indicative of lower socioeconomic status, and continuing or quitting smoking during pregnancy were also associated with inadequate GWG. CONCLUSIONS In France, insufficient and excessive GWG are common. For optimal outcomes, clinician education, with special attention to the needs of higher risk/vulnerable groups, is needed to ensure all women receive appropriate advice for recommended GWG.
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Affiliation(s)
- Melissa Amyx
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), University of Paris, INSERM UMR 1153, Paris, France
| | - Jennifer Zeitlin
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), University of Paris, INSERM UMR 1153, Paris, France
| | - Monika Hermann
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), University of Paris, INSERM UMR 1153, Paris, France
| | - Katia Castetbon
- Epidemiology, Biostatistics and Clinical Research Research Center, ULB School of Public Health, Brussels, Belgium
| | - Béatrice Blondel
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), University of Paris, INSERM UMR 1153, Paris, France
| | - Camille Le Ray
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), University of Paris, INSERM UMR 1153, Paris, France
- Cochin Hospital Port Royal, Port Royal Maternity, Department of Obstetrics, University of Paris, APHP, Paris, France
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22
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Zeitlin J, Durox M, Macfarlane A, Alexander S, Heller G, Loghi M, Nijhuis J, Sól Ólafsdóttir H, Mierzejewska E, Gissler M, Blondel B. International comparisons and holistic patient care. BJOG 2021; 128:1557-1558. [PMID: 34089213 DOI: 10.1111/1471-0528.16747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Affiliation(s)
- J Zeitlin
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université de Paris, CRESS, Paris, F-75004, France
| | - M Durox
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université de Paris, CRESS, Paris, F-75004, France
| | - A Macfarlane
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - S Alexander
- Perinatal Epidemiology and Reproductive Health Unit, CR2, School of Public Health, ULB, Brussels, Belgium
| | - G Heller
- Institute for Quality Assurance and Transparency in Health Care, Katharina-Heinroth-Ufer 1, Berlin, 10707, Germany
| | - M Loghi
- Directorate for Social Statistics and Welfare, Italian Statistical Institute (ISTAT), Rome, Italy
| | - J Nijhuis
- Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, MUMC+, Maastricht, The Netherlands
| | - H Sól Ólafsdóttir
- Department of Obstetrics and Gynaecology, Landspitali University Hospital, Reykjavik, Iceland
| | - E Mierzejewska
- Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland
| | - M Gissler
- THL Finnish Institute for Health and Welfare, Helsinki, Finland.,Karolinska Institute, Stockholm, Sweden
| | - B Blondel
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université de Paris, CRESS, Paris, F-75004, France
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23
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Demiguel V, Blondel B, Bonnet C, Nguyen-Thanh V, Saurel-Cubizolles MJ, Regnault N. Trends in Tobacco Smoking in Pregnant Women: Data From French National Perinatal Surveys. Int J Public Health 2021; 66:602873. [PMID: 34744568 PMCID: PMC8565271 DOI: 10.3389/ijph.2021.602873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/11/2021] [Indexed: 01/04/2023] Open
Abstract
Objectives: To describe maternal smoking trends in France between 1972 and 2016, and identify whether maternal characteristics associated with smoking in the 3rd trimester of pregnancy evolved between 2010 and 2016. Methods: Using French National Perinatal Surveys, we estimated proportions of smokers and the number of cigarettes smoked both just before pregnancy and during the 3rd trimester from 1972 to 2016. We used a Poisson model with robust variance to estimate prevalence ratios for smoking during pregnancy. Results: Proportions of mothers quitting smoking were relatively stable (46.0% in 1972 and 45.8% in 2016). The number of cigarettes smoked just before pregnancy and in the 3rd trimester decreased from 1995 onward. However, proportions of smokers remained high before (30.1%) and during the 3rd trimester in 2016 (16.2%). Smoking in the 3rd trimester was associated with a lower education level and lower income in both 2010 and 2016, whereas the association with age, country of birth and parity varied according to the survey year. Conclusion: Early targeted interventions are needed for smokers who plan to have a child and must take smokers' characteristics during pregnancy into account.
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Affiliation(s)
- Virginie Demiguel
- Santé Publique France, French National Public Health Agency, Saint-Maurice, France
| | - Béatrice Blondel
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- INSERM U1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Paris, France
| | - Camille Bonnet
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- INSERM U1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Paris, France
| | - Viêt Nguyen-Thanh
- Santé Publique France, French National Public Health Agency, Saint-Maurice, France
| | - Marie-Josèphe Saurel-Cubizolles
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- INSERM U1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Paris, France
| | - Nolwenn Regnault
- Santé Publique France, French National Public Health Agency, Saint-Maurice, France
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24
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Bonnet C, Blondel B, Moreau C. A rise in births following contraceptive failure in France between 2010 and 2016: results from the French national perinatal surveys. BMC Womens Health 2021; 21:115. [PMID: 33743652 PMCID: PMC7981992 DOI: 10.1186/s12905-021-01255-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/08/2021] [Indexed: 11/17/2022]
Abstract
Background In France, while the prevalence of contraception is high, a significant proportion of pregnancies are unintended. Following the 2012 pill scare, the contraceptive method mix, which was mostly comprised of pills and intrauterine devices (IUD), has become more diversified. In this changing landscape, our objective was to describe trends in live births resulting from contraceptive failure and evaluate how patterns of contraceptive use have contributed to observed changes between 2010 and 2016. Methods We used data from the 2010 and the 2016 French National Perinatal surveys which included all births from all maternity units in France over a one-week period. Interviews collecting information about pre-conception contraceptive practices were conducted in the maternity ward post-delivery. Women were classified as having a contraceptive failure if they discontinued contraception because they were pregnant. Our study sample included adult women who had a live birth, had ever used contraception and did not undergo infertility treatment (n = 11,590 in 2010 and n = 9703 in 2016). We evaluated changes in contraceptive failure over time using multivariate Poisson regressions to adjust for sociodemographic characteristics and pre-pregnancy contraceptive methods. Results Pre-pregnancy contraception evolved between 2010 and 2016 with a 12.3% point-drop in pill use, and conversely, 4.6%- and 3.2%-point increases in IUD and condom use, respectively. Use of other barrier or natural methods doubled between 2010 and 2016 but remained marginal (1.4% in 2010 vs 3.6% in 2016). Between 2010 and 2016, the proportion of live births resulting from contraceptive failure rose from 7.8 to 10.0%, with higher risks among younger, parous and socially disadvantaged mothers. The risk ratio of contraceptive failure in 2016 compared to 2010 remained higher after sociodemographic adjustments (aRR = 1.34; 95% CI; 1.23–1.47) and after adjusting for pre-pregnancy contraceptive method mix (aRR = 1.35; 95% CI; 1.25–1.49). Increases in contraceptive failures were concentrated among pill and condom users. Conclusions Recent shifts in contraceptive behaviors in France following the 2012 pill scare may be associated with a subsequent increase in births resulting from short acting contraceptives failures. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01255-y.
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Affiliation(s)
- Camille Bonnet
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, INSERM, Université de Paris, Maternité Port Royal, 123, Boulevard Port Royal, 75014, Paris, France
| | - Béatrice Blondel
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, INSERM, Université de Paris, Maternité Port Royal, 123, Boulevard Port Royal, 75014, Paris, France.
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Primary Care and Prevention, Centre for Research in Epidemiology and Population Health (CESP), U1018, INSERM, Villejuif, France
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25
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Girault A, Blondel B, Goffinet F, Le Ray C. Contemporary duration of spontaneous labor and association with maternal characteristics: A French national population-based study. Birth 2021; 48:86-95. [PMID: 33274503 DOI: 10.1111/birt.12518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The objective of this study was to describe labor duration of women managed with current obstetric practices in a French national population-based cohort and to assess the association of age and BMI on this duration. METHODS All women in the French perinatal survey of 2016 with a singleton cephalic fetus, delivering at term after a spontaneous labor were included. Duration of labor was defined as time between admission to the labor ward and birth. Duration of total labor and first and second stage of labor were described. Then, duration of labor was estimated according to maternal age and BMI, using Kaplan-Meier's method and compared with the log-rank test after stratification on parity. Intrapartum cesarean birth was considered as a censoring event. Multivariable modeling was performed using Cox's proportional hazard's method. RESULTS Data of 3120 nulliparous and 4385 multiparous women were analyzed. Median labor duration was 6.1 hours ([5th; 95th percentile]) [1.4; 12.6] and 3.1 hours [0.3; 8.5] in nulliparous and multiparous women. Multivariable Cox analysis showed no independent association of maternal age and duration of labor. Nulliparous obese women had significantly lower odds of having a shorter labor than women with a BMI < 25 kg/m2 , HR: 0.75; 95% CI [0.64-0.88], but BMI was not associated with labor duration in multiparous women. CONCLUSIONS Our study provides important information for both women and care practitioners on what to expect when entering the labor ward. There appears to be little association between maternal characteristics and labor duration, with the exception of BMI in nulliparous women.
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Affiliation(s)
- Aude Girault
- INSERM, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, FHU PREMA, Université de Paris, Paris, France.,Department of Obstetrics, Cochin Port Royal Hospital, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin Port Royal, Port Royal Maternity, Université de Paris, Paris, France
| | - Béatrice Blondel
- INSERM, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, FHU PREMA, Université de Paris, Paris, France
| | - François Goffinet
- INSERM, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, FHU PREMA, Université de Paris, Paris, France.,Department of Obstetrics, Cochin Port Royal Hospital, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin Port Royal, Port Royal Maternity, Université de Paris, Paris, France
| | - Camille Le Ray
- INSERM, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, FHU PREMA, Université de Paris, Paris, France.,Department of Obstetrics, Cochin Port Royal Hospital, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin Port Royal, Port Royal Maternity, Université de Paris, Paris, France
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Barrey CY, di Bartolomeo A, Barresi L, Bronsard N, Allia J, Blondel B, Fuentes S, Nicot B, Challier V, Godard J, Marinho P, Kouyoumdjian P, Lleu M, Lonjon N, Freitas E, Berthiller J, Charles YP. C1-C2 Injury: Factors influencing mortality, outcome, and fracture healing. Eur Spine J 2021; 30:1574-1584. [PMID: 33635376 DOI: 10.1007/s00586-021-06763-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND C1-C2 injury represents 25-40% of cervical injuries and predominantly occurs in the geriatric population. METHODS A prospective multicentre study was conducted under the aegis of the french spine surgery society (SFCR) investigating the impact of age, comorbidities, lesion type, and treatment option on mortality, complications, and fusion rates. RESULTS A total of 417 patients were recruited from 11 participating centres. The mean ± SD age was 66.6 ± 22 years, and there were 228 men (55%); 5.4% presented a neurological deficit at initial presentation. The most frequent traumatic lesion was C2 fracture (n = 308). Overall mortality was 8.4%; it was 2.3% among those aged ≤ 60 years, 5.0% 61-80 years, and 16.0% > 80 years (p < 0.001). Regarding complications, 17.8% of patients ≤ 70 years of age presented with ≥ 1 complication versus 32.3% > 70 years (p = 0.0009). The type of fracture did not condition the onset of complications and/or mortality (p > 0.05). The presence of a comorbidity was associated with a risk factor for both death (p = 0.0001) and general complication (p = 0.008). Age and comorbidities were found to be independently associated with death (p < 0.005). The frequency of pseudoarthrosis ranged from 0 to 12.5% up to 70 years of age and then constantly and progressively increased to reach 58.6% after 90 years of age. CONCLUSIONS C1-C2 injury represents a serious concern, possibly life-threatening, especially in the elderly. We found a major impact of age and comorbidities on mortality, complications, and pseudarthrosis; injury pattern or treatment option seem to have a minimal effect.
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Affiliation(s)
- C Y Barrey
- Department of Spine and Spinal Cord Surgery, P Wertheimer University Hospital, GHE, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69003, Lyon, France.
- Laboratory of Biomechanics, ENSAM, Arts et Metiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France.
| | - A di Bartolomeo
- Division of Neurosurgery, Department of Neurology and Psychiatry, Sapienza University, Roma, Italy
| | - L Barresi
- Department of Spine Surgery, Institut Universitaire de L'appareil Locomoteur Et du Sport, CHU de Nice, Hopital Pasteur 2, 30 voie Romaine, 06001, Nice, France
| | - N Bronsard
- Department of Spine Surgery, Institut Universitaire de L'appareil Locomoteur Et du Sport, CHU de Nice, Hopital Pasteur 2, 30 voie Romaine, 06001, Nice, France
| | - J Allia
- Department of Spine Surgery, Institut Universitaire de L'appareil Locomoteur Et du Sport, CHU de Nice, Hopital Pasteur 2, 30 voie Romaine, 06001, Nice, France
| | - B Blondel
- Department of Spine Surgery, CHU Timone, AP-HM, Université Aix-Marseille, 264 rue Saint-Pierre, 13005, Marseille, France
| | - S Fuentes
- Department of Spine Surgery, CHU Timone, AP-HM, Université Aix-Marseille, 264 rue Saint-Pierre, 13005, Marseille, France
| | - B Nicot
- Department of Neurosurgery, CHU de Grenoble, Avenue Maquis-du-Grésivaudan, 38700, Grenoble-La Tronche, France
| | - V Challier
- Department of Orthopaedic Surgery, Hôpital Tripode, CHU de Bordeaux, Place Amélie-Raba-Léon, 33076, Bordeaux cedex, France
| | - J Godard
- Department of Spine Surgery, Hôpital Jean-Minjoz, 3 boulevard A Fleming, 25030, Besançon, France
| | - P Marinho
- Department of Neurosurgery, Hôpital Roger-Salengro, CHRU de Lille, Rue Emile-Laine, 59037, Lille, France
| | - P Kouyoumdjian
- Department of Orthopaedic Surgery, CHU de Nîmes, Avenue du Pr Debré, 30000, Nîmes, France
| | - M Lleu
- Department of Neurosurgery, CHU de Dijon, 14 rue Paul Gaffarel, 21000, Dijon, France
| | - N Lonjon
- Department of Neurosurgery, Hôpital Gui de Chauliac, 80 Avenue Augustin Fliche, 34090, Montpellier, France
| | - E Freitas
- Department of Spine and Spinal Cord Surgery, P Wertheimer University Hospital, GHE, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69003, Lyon, France
| | - J Berthiller
- Department of Biostatistics and Epidemiology, Pôle IMER, Hospices Civils de Lyon, 162 Avenue Lacassagne, 69424, Lyon, France
| | - Y P Charles
- Department of Spine Surgery, Hopitaux Universitaires de Strasbourg, 1 place de l'Hopital, BP 426, 67091, Strasbourg, France
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Girault A, Blondel B, Goffinet F, Le Ray C. Frequency and determinants of misuse of augmentation of labor in France: A population-based study. PLoS One 2021; 16:e0246729. [PMID: 33561131 PMCID: PMC7872232 DOI: 10.1371/journal.pone.0246729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/25/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction While use of augmentation of labor (AL) is appropriate for labor dystocia, it is frequently used inadequately and unnecessarily. The objective was to assess at a national level, the frequency and determinants of misuse of augmentation of labor (AL). Material and methods Women of the French perinatal survey of 2016 with a singleton cephalic fetus, delivering at term after a spontaneous labor were included. “Misuse of AL” was defined by artificial rupture of the membranes (ROM) and/or oxytocin within one hour of admission and/or duration between ROM and oxytocin of less than one hour. Women, labor and maternity unit’s characteristics were compared between the “misuse of AL” and “no misuse of AL” groups by bivariate analysis. To identify the determinants of misuse of AL, a multivariable multilevel logistic regression was performed taking into account the data’s hierarchical structure (first level: women, second level: maternity units). Results Among the 7196 women included, 1524 (21.2%) had a misuse of AL. The determinants of misuse of AL were middle school educational level (reference high school), aOR = 1.21; 95%CI[1.01–1.45], gestational age at delivery ≥41weeks (reference 39–40 weeks), aOR = 1.19; 95%CI[1.00–1.42], cervical dilation ≥6cm at admission (reference <3cm), aOR = 1.39; 95%CI[1.10–1.76], epidural analgesia aOR = 1.63; 95%CI[1.35–1.96], delivery in a private hospital (reference public teaching hospital), aOR = 2.25; 95%CI[1.57–3.23]; and maternity units with <1000 deliveries/year and 1000–1999 deliveries/year (reference ≥3000 deliveries/year), respectively aOR = 1.52; 95%CI[1.11–2.08] and aOR = 1.42; 95%CI[1.05–1.92]. Less than 3% of the variance was explained by women characteristics, and 24.17% by the maternity units’ characteristics. Conclusions In France, one spontaneous laboring woman among five is subject to misuse of AL. The misuse is mostly explained by maternity unit’s characteristics. The determinants identified in this study can be used to implement targeted actions in small and private maternity units.
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Affiliation(s)
- Aude Girault
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
- * E-mail:
| | - Béatrice Blondel
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
| | - François Goffinet
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
| | - Camille Le Ray
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
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Zeitlin J, Durox M, Macfarlane A, Alexander S, Heller G, Loghi M, Nijhuis J, Sól Ólafsdóttir H, Mierzejewska E, Gissler M, Blondel B. Using Robson's Ten-Group Classification System for comparing caesarean section rates in Europe: an analysis of routine data from the Euro-Peristat study. BJOG 2021; 128:1444-1453. [PMID: 33338307 PMCID: PMC8359161 DOI: 10.1111/1471-0528.16634] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 12/04/2022]
Abstract
Objective Robson's Ten Group Classification System (TGCS) creates clinically relevant sub‐groups for monitoring caesarean birth rates. This study assesses whether this classification can be derived from routine data in Europe and uses it to analyse national caesarean rates. Design Observational study using routine data. Setting Twenty‐seven EU member states plus Iceland, Norway, Switzerland and the UK. Population All births at ≥22 weeks of gestational age in 2015. Methods National statistical offices and medical birth registers derived numbers of caesarean births in TGCS groups. Main outcome measures Overall caesarean rate, prevalence and caesarean rates in each of the TGCS groups. Results Of 31 countries, 18 were able to provide data on the TGCS groups, with UK data available only from Northern Ireland. Caesarean birth rates ranged from 16.1 to 56.9%. Countries providing TGCS data had lower caesarean rates than countries without data (25.8% versus 32.9%, P = 0.04). Countries with higher caesarean rates tended to have higher rates in all TGCS groups. Substantial heterogeneity was observed, however, especially for groups 5 (previous caesarean section), 6, 7 (nulliparous/multiparous breech) and 10 (singleton cephalic preterm). The differences in percentages of abnormal lies, group 9, illustrate potential misclassification arising from unstandardised definitions. Conclusions Although further validation of data quality is needed, using TGCS in Europe provides valuable comparator and baseline data for benchmarking and surveillance. Higher caesarean rates in countries unable to construct the TGCS suggest that effective routine information systems may be an indicator of a country's investment in implementing evidence‐based caesarean policies. Tweetable abstract Many European countries can provide Robson's Ten‐Group Classification to improve caesarean rate comparisons. Many European countries can provide Robson's Ten‐Group Classification to improve caesarean rate comparisons.
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Affiliation(s)
- J Zeitlin
- CRESS, Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPe, INSERM, INRA, Universite de Paris, Paris, France
| | - M Durox
- CRESS, Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPe, INSERM, INRA, Universite de Paris, Paris, France
| | - A Macfarlane
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - S Alexander
- Perinatal Epidemiology and Reproductive Health Unit, CR2, School of Public Health, ULB, Brussels, Belgium
| | - G Heller
- Institute for Quality Assurance and Transparency in Health Care, Berlin, Germany
| | - M Loghi
- Directorate for Social Statistics and Welfare, Italian Statistical Institute (ISTAT), Rome, Italy
| | - J Nijhuis
- Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, MUMC+, Maastricht, The Netherlands
| | - H Sól Ólafsdóttir
- Department of Obstetrics and Gynaecology, Landspitali University Hospital, Reykjavik, Iceland
| | - E Mierzejewska
- Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland
| | - M Gissler
- Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland
| | - B Blondel
- THL Finnish Institute for Health and Welfare, Helsinki, Finland.,Karolinska Institute, Stockholm, Sweden
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Farah K, Lubiato A, Meyer M, Prost S, Ognard J, Blondel B, Fuentes S. Surgical site infection following surgery for spinal deformity: About 102 patients. Neurochirurgie 2020; 67:152-156. [PMID: 33157123 DOI: 10.1016/j.neuchi.2020.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/07/2020] [Accepted: 10/23/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Complex spinal surgery is known to be at risk of complications. Surgical site infection is a serious complication in spine surgery and its frequency is significantly increased in adult spinal deformity correction. The aim of this study is to identify patients' characteristics and risk factors of surgical site infection (SSI) following an osteotomy. METHODS This is a single-center retrospective study of patients who underwent an osteotomy between January 2015 and December 2017. Surgical site infection diagnosis was based upon patient's clinical evidence of infection, biologic parameters, microbiological criteria and/or image findings. RESULTS In total, 102 patients were eligible and 70 were women (68.6%). Mean age was 65 years old (27-83 years) and mean body mass index (BMI) was 26.14kg.m-2 (18.4-44.1). Eleven patients were in the SSI group and 91 in the No-SSI group. The mean Schwab grade was 1.5 (1-4) in the SSI group vs. 1.4 (1-5) in the No-SSI group (P=0.435). The mean operative time was on 201.9 minutes (67-377). Mean length of stay was 20.6 days (10-73) in the SSI group vs. 15 days (5-44) in the No-SSI group (P=0.041). Favorable outcome was found in 10 patients (90.9%) in the SSI group. CONCLUSION Correction surgery for adult spinal deformity with osteotomies carries a high risk of complications specially SSI. Identification of risk factors, prevention and medical management of SSI should be well assessed.
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Affiliation(s)
- K Farah
- Department of neurosurgery, assistance publique des hôpitaux de Marseille, La Timone university hospital, Marseille, France; Spine Unit, assistance publique des hôpitaux de Marseille, La Timone university hospital, Marseille, France.
| | - A Lubiato
- Department of neurosurgery, CHRU de Brest, Brest, France
| | - M Meyer
- Department of neurosurgery, assistance publique des hôpitaux de Marseille, La Timone university hospital, Marseille, France; Spine Unit, assistance publique des hôpitaux de Marseille, La Timone university hospital, Marseille, France
| | - S Prost
- Department of neurosurgery, assistance publique des hôpitaux de Marseille, La Timone university hospital, Marseille, France; Department of orthopedic surgery, assistance publique des hôpitaux de Marseille, La Timone university hospital, Marseille, France
| | - J Ognard
- Department of neurosurgery, CHRU de Brest, Brest, France
| | - B Blondel
- Department of neurosurgery, assistance publique des hôpitaux de Marseille, La Timone university hospital, Marseille, France; Department of orthopedic surgery, assistance publique des hôpitaux de Marseille, La Timone university hospital, Marseille, France
| | - S Fuentes
- Department of neurosurgery, assistance publique des hôpitaux de Marseille, La Timone university hospital, Marseille, France; Spine Unit, assistance publique des hôpitaux de Marseille, La Timone university hospital, Marseille, France
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Abstract
Background Universal antenatal HIV screening programmes are an effective method of preventing mother-to-child transmission. Aims To assess the coverage and yield of the French programme on a nationally representative sample of pregnant women, and predictive factors for being unscreened or missing information on the performance/ result of a HIV test. Methods Data came from the medical records of women included in the cross-sectional 2016 French National Perinatal Survey. We calculated odds ratios (OR) to identify factors for being unscreened for HIV and for missing information by multivariable analyses. Results Of 13,210 women, 12,782 (96.8%) were screened for HIV and 134 (1.0%) were not; information was missing for 294 (2.2%). HIV infection was newly diagnosed in 19/12,769 (0.15%) women screened. The OR for being unscreened was significantly higher in women in legally registered partnerships (OR: 1.3; 95% CI: 1.1–1.6), with 1–2 years of post-secondary schooling (OR: 1.6; 95% CI: 1.2–2.1), part-time employment (OR: 1.4; 95% CI: 1.1–1.8), inadequate antenatal care (OR: 1.9; 95% CI: 1.5–2.4) and receiving care from > 1 provider (OR: 1.8; 95% CI: 1.1–2.8). The OR of missing information was higher in multiparous women (OR: 1.4; 95% CI: 1.2–1.5) and women cared for by general practitioners (OR: 1.4; 95% CI: 1.1–1.9). Conclusions The French antenatal HIV screening programme is effective in detecting HIV among pregnant women. However, a few women are still not screened and awareness of the factors that predict this could contribute to improved screening levels.
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Affiliation(s)
- Thi-Chiên Tran
- Santé publique France, French national public health agency, Saint-Maurice, France
| | - Josiane Pillonel
- Santé publique France, French national public health agency, Saint-Maurice, France
| | - Françoise Cazein
- Santé publique France, French national public health agency, Saint-Maurice, France
| | - Cécile Sommen
- Santé publique France, French national public health agency, Saint-Maurice, France
| | | | | | - Florence Lot
- Santé publique France, French national public health agency, Saint-Maurice, France
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Saucedo M, Bouvier-Colle MH, Blondel B, Bonnet MP, Deneux-Tharaux C. Delivery Hospital Characteristics and Postpartum Maternal Mortality: A National Case-Control Study in France. Anesth Analg 2020; 130:52-62. [PMID: 31283618 DOI: 10.1213/ane.0000000000004290] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The variability in resources for managing critical events among maternity hospitals may impact maternal safety. Our main objective was to assess the risk of postpartum maternal death according to hospitals' organizational characteristics. A secondary objective aimed to assess the specific risk of death due to postpartum hemorrhage (PPH). METHODS This national population-based case-control study included all 2007-2009 postpartum maternal deaths from the national confidential enquiry (n = 147 cases) and a 2010 national representative sample of parturients (n = 14,639 controls). To adjust for referral bias, cases were classified by time when the condition/complication responsible for the death occurred: postpartum maternal deaths due to conditions present before delivery (n = 66) or during or after delivery (n = 81). Characteristics of delivery hospitals included 24/7 on-site availability of an anesthesiologist and an obstetrician, level of perinatal care, number of deliveries annually, and their teaching and profit status. In teaching and other nonprofit hospitals in France, obstetric care is organized on the principle of collective team-based management, while in for-profit hospitals, this organization is based mostly on that of "one woman-one doctor." Logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for postpartum maternal death. RESULTS The risk of maternal death from prepartum conditions was lower for women who gave birth in for-profit compared with teaching hospitals (aOR, 0.3; 95% CI, 0.1-0.8; P = .02) and in hospitals with <1500 vs ≥1500 annual deliveries (aOR, 0.4; 95% CI, 0.1-0.9; P = .02). Conversely, the risk of postpartum maternal death from complications occurring during or after delivery was higher for women who delivered in for-profit compared with teaching hospitals (aOR, 2.8; 95% CI, 1.3-6.0; P = .009), as was the risk of death from PPH in for-profit versus nonprofit hospitals (aOR, 2.8; 95% CI, 1.2-6.5; P = .019). CONCLUSIONS After adjustment for the referral bias related to prepartum morbidity, the risk of postpartum maternal mortality in France differs according to the hospital's organizational characteristics.
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Affiliation(s)
- Monica Saucedo
- From the Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Marie-Hélène Bouvier-Colle
- From the Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Béatrice Blondel
- From the Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Marie-Pierre Bonnet
- From the Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Department of Anesthesiology and Critical Care, Hôpital Armand Trousseau, Hôpitaux Universitaires Est Parisien, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Catherine Deneux-Tharaux
- From the Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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Affiliation(s)
- S Alexander
- Perinatal Epidemiology and Reproductive Health Unit, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - B Blondel
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, National Institute of Health and Medical Research (INSERM), Université de Paris, Paris, France
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Farah K, Peyriere H, Graillon T, Prost S, Dufour H, Blondel B, Fuentes S. Minimally invasive posterior fixation and anterior debridement-fusion for thoracolumbar spondylodiscitis: A 40-case series and review of the literature. Neurochirurgie 2019; 66:24-28. [PMID: 31836488 DOI: 10.1016/j.neuchi.2019.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/20/2019] [Accepted: 10/26/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Pyogenic spondylodiscitis is a rare disease, but incidence is increasing. Reported failure rates following conservative management range from 12% to 18%. The purpose of this study was to determine the safety and efficacy of posterior percutaneous pedicle screw fixation combined with anterior debridement and fusion (ADF) for infective spondylodiscitis in the thoracic and/or lumbar spine. METHODS The retrospective study cohort comprised all patients without neurological deficit who underwent minimally invasive posterior and anterior surgery between April 2008 and April 2016 for thoracic and/or lumbar spondylodiscitis. RESULTS Forty patients were eligible (16 female: 40%). The lumbar region was affected in 31 cases (77.5%). Source of infection was identified in only 22 cases (55%) and bacteriological identification was obtained in 32 cases (80%). Mean hospital stay was 14.8 days (range, 6-39 days). Complete recovery was achieved in 39 patients (97.5%) at 3 months' follow-up. Mean preoperative local kyphosis angle was 16.1o, versus 14o at 1-year (P>0.05). 36 patients (90%) had at least 1 year's follow-up, and fusion was obtained for all these cases. CONCLUSION Two-stage minimally invasive surgery is effective and safe for the treatment of single or two-level thoracolumbar spondylodiscitis. It could be an alternative to conventional open surgery or conservative treatment.
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Affiliation(s)
- K Farah
- Department of neurosurgery, La Timone university hospital, AP-HM, 13005 Marseille, France; Spine Unit, La Timone university hospital, AP-HM, Marseille, France.
| | - H Peyriere
- Department of neurosurgery, La Timone university hospital, AP-HM, 13005 Marseille, France; Spine Unit, La Timone university hospital, AP-HM, Marseille, France
| | - T Graillon
- Department of neurosurgery, La Timone university hospital, AP-HM, 13005 Marseille, France; Spine Unit, La Timone university hospital, AP-HM, Marseille, France
| | - S Prost
- Department of orthopedic surgery, La Timone university hospital, AP-HM, Marseille, France; Spine Unit, La Timone university hospital, AP-HM, Marseille, France
| | - H Dufour
- Department of neurosurgery, La Timone university hospital, AP-HM, 13005 Marseille, France; Spine Unit, La Timone university hospital, AP-HM, Marseille, France
| | - B Blondel
- Department of orthopedic surgery, La Timone university hospital, AP-HM, Marseille, France; Spine Unit, La Timone university hospital, AP-HM, Marseille, France
| | - S Fuentes
- Department of neurosurgery, La Timone university hospital, AP-HM, 13005 Marseille, France; Spine Unit, La Timone university hospital, AP-HM, Marseille, France
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Bouthors C, Prost S, Court C, Blondel B, Charles YP, Fuentes S, Mousselard HP, Mazel C, Flouzat-Lachaniette CH, Bonnevialle P, Sailhan F. Correction to: Outcomes of surgical treatments of spinal metastases: a prospective study. Support Care Cancer 2019; 28:2137. [PMID: 31811488 DOI: 10.1007/s00520-019-05213-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The correct name of F. Saihlan should be F. Sailhan.
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Affiliation(s)
- C Bouthors
- Orthopedic and Traumatology Surgery Department, Bicetre University Hospital, AP-HP, Paris XI University, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France.
| | - S Prost
- Orthopedic and Traumatology Surgery Department, La Timone Hospital, AP-HM, Aix Marseille University, CNRS ISM, 264 rue Saint Pierre, 13005, Marseille, France
| | - C Court
- Orthopedic and Traumatology Surgery Department, Bicetre University Hospital, AP-HP, Paris XI University, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France
| | - B Blondel
- Orthopedic and Traumatology Surgery Department, La Timone Hospital, AP-HM, Aix Marseille University, CNRS ISM, 264 rue Saint Pierre, 13005, Marseille, France
| | - Y P Charles
- Orthopedic and Traumatology Surgery Department, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
| | - S Fuentes
- Neurosurgery Department, La Timone Hospital, AP-HM, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
| | - H P Mousselard
- Orthopedic and traumatology surgery department, La Pitié-Salpétrière Hospital, AP-HP, Parix VI University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - C Mazel
- Orthopedic and traumatology surgery department, Institut Mutualiste Montsouris, Paris V University, 42 Boulevard Jourdan, 75014, Paris, France
| | - C H Flouzat-Lachaniette
- Orthopedic and traumatology surgery department, Mondor Hospital, APHP, Paris XII University, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - P Bonnevialle
- Orthopedic and traumatology surgery department, Riquet Pierre-Paul Hospital, Place du Docteur Baylac,, TSA 40031-31059, Toulouse cedex 9, France
| | - F Sailhan
- Orthopedic and traumatology surgery department, Cochin Hospital, APHP, Paris V University, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
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Descamps A, Launay O, Bonnet C, Blondel B. Seasonal influenza vaccine uptake and vaccine refusal among pregnant women in France: results from a national survey. Hum Vaccin Immunother 2019; 16:1093-1100. [PMID: 31725346 DOI: 10.1080/21645515.2019.1688035] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pregnant women and infants are at high risk for severe influenza and many countries, including France, recommend annual influenza immunization during pregnancy. We aimed to estimate influenza vaccination and refusal rates and assess associated factors among pregnant women during the 2015-16 season in France. We used data from a national representative sample of women who gave birth in March 2016 and were interviewed before hospital discharge (N = 11,752). In the multivariable analysis, robust Poisson regression models were used to study associations with maternal characteristics and prenatal care characteristics. Influenza vaccine coverage among pregnant women was 7.4% (95% confidence interval [CI]: 6.9-7.9). Only 24.9% (95% CI: 24.2-25.7) of women said that they received a care provider proposal for vaccination and 70.4% (95% CI: 68.7-72.0) of these declined it. Vaccine uptake was associated with low parity (prevalence ratio [PR] = 2.1; 95% CI: 1.4-3.2 for parity 0 vs ≥ 3), high educational level (PR = 2.5; 95% CI: 2.0-3.2), healthcare occupation during pregnancy (PR = 1.8; 95% CI: 1.5-2.1) and preexisting conditions at risk for influenza (PR = 1.7; 95% CI: 1.3-2.2). Women were more frequently vaccinated when their main care provider was a general practitioner. Multiparae women and those with medium or low educational level were significantly more likely than others to decline influenza vaccine after a provider proposal. Influenza vaccine coverage is very low in France, mainly because of infrequent care provider proposals and also frequent women's refusals. Effective interventions should be designed to promote vaccination among medical professionals and reduce vaccine hesitancy among pregnant women.
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Affiliation(s)
- Alexandre Descamps
- CIC Cochin Pasteur, Hôpital Cochin Broca Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Odile Launay
- CIC Cochin Pasteur, Hôpital Cochin Broca Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,INSERM, CIC 1417, F-CRIN, I-REIVAC, Université de Paris, Paris, France
| | - Camille Bonnet
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), CRESS, INSERM, INRA, Université de Paris, Paris, France
| | - Béatrice Blondel
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), CRESS, INSERM, INRA, Université de Paris, Paris, France
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Smith LK, Blondel B, Zeitlin J. Producing valid statistics when legislation, culture and medical practices differ for births at or before the threshold of survival: report of a European workshop. BJOG 2019; 127:314-318. [PMID: 31580509 PMCID: PMC7003918 DOI: 10.1111/1471-0528.15971] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2019] [Indexed: 11/29/2022]
Affiliation(s)
- L K Smith
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - B Blondel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - J Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
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Demiguel V, Blondel B, Bonnet C, Andler R, Saurel-Cubizolles MJ, Regnault N. Tobacco smoking in pregnant women: fifty years of evolution in France. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Smoking during pregnancy is a major modifiable risk factor for maternal and foetal morbidity. We aimed to describe 1/smoking trends in France between 1972 and 2016, 2/ the factors associated with smoking cessation and reduction during pregnancy in 2016.
Methods
French National Perinatal Surveys are routine surveys based on a representative sample of births (N = 11,733 in 2016). Data were collected in face-to-face interviews in postnatal wards and from the mother’s medical record. Smoking rates before pregnancy and during 3rd trimester were estimated for each study year and characteristics associated with smoking reduction (relative percent change in number of cigarettes smoked before and during pregnancy <50% or ≥ 50%) compared with smoking cessation were analysed using multinomial logistic regression.
Results
After significantly decreasing from 1995 onwards, smoking prevalence stagnates since 2010 both before pregnancy and in the 3rd trimester (30.1% and 16.2%, respectively in 2016). In 2016, 45.8% ceased smoking during pregnancy, 37.2% reduced by ≥ 50% their consumption and 16.9% reduced by < 50% or did not reduce at all. The more cigarettes women smoked before pregnancy, the greater this reduction was (p < 0,001). Moderate reduction (<50%) vs stopping was more frequent in multiparae compared to nulliparae (aOR=2,47 [IC95%:1,93-3,15]) and in women with low education (aOR(<High school vs university graduates)=7,20 [4,78-10,82]) and low income (aOR(<1500€per month/>3000€)=2,30 [1,51-3,50]).
Conclusions
Smoking rates were high before and during pregnancy in France in 2016. Socio-demographic factors should be considered when targeting women most at risk of continuing smoking during pregnancy.
Key messages
After significantly decreasing from 1995 onwards, smoking prevalence stagnates since 2010 both before pregnancy and in the 3rd trimester in France. Supporting female smokers of childbearing age in their attempts to quit and remain non-smokers even after pregnancy is crucial, especially in multiparae and women in poor social condition.
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Affiliation(s)
- V Demiguel
- Non Communicable Diseases and Trauma Direction, Santé Publique France, St Maurice, France
| | - B Blondel
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidem, Centre for Epidemiology and Statistics, Paris Descartes University, Paris, France
| | - C Bonnet
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidem, Centre for Epidemiology and Statistics, Paris Descartes University, Paris, France
| | - R Andler
- Prevention and Health Promotion Direction, Santé Publique France, St Maurice, France
| | - M J Saurel-Cubizolles
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidem, Centre for Epidemiology and Statistics, Paris Descartes University, Paris, France
| | - N Regnault
- Non Communicable Diseases and Trauma Direction, Santé Publique France, St Maurice, France
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Merrer J, Chantry AA, Khoshnood B, Blondel B, Le Ray C, Bonnet MP. Factors associated with the use of non-pharmacological analgesia for labor pain management. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
For a decade, pain labor management has evolved: if neuraxial analgesia remains the gold standard, non-pharmacological methods are developing. We aimed to identify individual and organizational factors associated with the use of non-pharmacological analgesia, combined or not with neuraxial analgesia.
Methods
Women who attempted vaginal delivery with labor analgesia were selected from the 13,147 participants of the 2016 National Perinatal Survey. Labor analgesia was studied as follows: neuraxial analgesia only (NA), non-pharmacological analgesia only (NPA) or neuraxial and non-pharmacological methods combined (NA+NPA). Associations between individual and organizational characteristics were studied using a multilevel multinomial logistic regression.
Results
Among the 9 231 women included, 62.4% had NA only, 6.5% had NPA only and 31.1% had NA+NPA. Both NPA and NA+NPA were associated with multiparity with antenatal classes, educational level ≥ 5 years post graduate, antenatal preference to deliver without NA, and delivery in public maternity units. The use of NPA only was positively associated with non-permanent availability of the anesthesiologist and with a high number of midwives per shift in maternity units. Contrastingly, NPA only was negatively associated with foreign nationality and oxytocin use for induction or augmentation of obstetrical labor. NA+NPA was positively associated with primiparity with antenatal classes, but negatively with inadequate prenatal care.
Conclusions
Less than 40% of parturients used non-pharmacological analgesia during labor and for the most of them as complementary methods to neuraxial analgesia. NPA and NA+NPA were associated with individual characteristics as well as characteristics of management of labor and organization of maternity units. Non-pharmacological analgesia appears to be dedicated to high educated and well-integrated women in perinatal health care system.
Key messages
Less than 40% of parturients used non-pharmacological analgesia during labor and for the most of them as complementary methods to neuraxial analgesia. Non-pharmacological analgesia appears to be dedicated to high educated and well-integrated women in perinatal health care system.
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Affiliation(s)
- J Merrer
- UMR 1153, Epope Team, CRESS, INSERM, Paris Descartes University, Paris, France
- DHU Risk in Pregnancy, Paris Descartes University, Paris, France
| | - A A Chantry
- UMR 1153, Epope Team, CRESS, INSERM, Paris Descartes University, Paris, France
- DHU Risk in Pregnancy, Paris Descartes University, Paris, France
- Midwifery School of Baudelocque, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - B Khoshnood
- UMR 1153, Epope Team, CRESS, INSERM, Paris Descartes University, Paris, France
- DHU Risk in Pregnancy, Paris Descartes University, Paris, France
| | - B Blondel
- UMR 1153, Epope Team, CRESS, INSERM, Paris Descartes University, Paris, France
- DHU Risk in Pregnancy, Paris Descartes University, Paris, France
| | - C Le Ray
- UMR 1153, Epope Team, CRESS, INSERM, Paris Descartes University, Paris, France
- DHU Risk in Pregnancy, Paris Descartes University, Paris, France
- Port Royal Maternity Unit, Department of Obstetrics, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - M P Bonnet
- UMR 1153, Epope Team, CRESS, INSERM, Paris Descartes University, Paris, France
- DHU Risk in Pregnancy, Paris Descartes University, Paris, France
- Trousseau Hospital, Department of Anesthesia-Intensive Care, Assistance Publique-Hôpitaux de Paris, Paris, France
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Desplanches T, Blondel B, Morgan AS, Burguet A, Kaminski M, Lecomte B, Marchand-Martin L, Rozé JC, Sagot P, Truffert P, Zeitlin J, Ancel PY, Fresson J. Volume of Neonatal Care and Survival without Disability at 2 Years in Very Preterm Infants: Results of a French National Cohort Study. J Pediatr 2019; 213:22-29.e4. [PMID: 31280891 DOI: 10.1016/j.jpeds.2019.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/10/2019] [Accepted: 06/03/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To investigate the relation between neonatal intensive care unit (NICU) volume and survival, and neuromotor and sensory disabilities at 2 years in very preterm infants. STUDY DESIGN The EPIPAGE-2 (Etude Epidémiologique sur les Petits Âges Gestationnels-2) national prospective population-based cohort study was used to include 2447 babies born alive in 66 level III hospitals between 24 and 30 completed weeks of gestation in 2011. The outcome was survival without disabilities (levels 2-5 of the Gross Motor Function Classification System for cerebral palsy with or without unilateral or bilateral blindness or deafness). Units were grouped in quartiles according to volume, defined as the annual admissions of very preterm babies. Multivariate logistic regression analyses with population average models were used. RESULTS Survival at discharge was lower in hospitals with lower volumes of neonatal activity (aOR 0.55, 95% CI 0.33-0.91). Survival without neuromotor and sensory disabilities at 2 years increased with hospital volume, from 75% to 80.7% in the highest volume units. After adjustment for gestational age, small for gestational age, sex, maternal age, infertility treatment, multiple pregnancy, principal cause of prematurity, parental socioeconomic status, and mother's country of birth, survival without neuromotor or sensory disabilities was significantly lower in hospitals with a lower volume of neonatal activity (aOR 0.60, 95% CI 0.38-0.95) than in the highest quartile hospitals. CONCLUSIONS These results suggest that lower neonatal intensive care unit volume is associated with lower survival without an increase in disabilities at 2 years. These results could be useful to generate improvements of perinatal regionalization.
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Affiliation(s)
- Thomas Desplanches
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France; CHRU Dijon, Department of Gynecology, Obstetrics, Fetal Medicine, and Infertility, University of Burgundy and Franche-Comté, Dijon, France.
| | - Béatrice Blondel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France
| | - Andrei Scott Morgan
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France
| | - Antoine Burguet
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France; Department of Neonatal Pediatrics, Dijon University Hospital, Dijon, France
| | - Monique Kaminski
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France
| | | | - Laetitia Marchand-Martin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France
| | - Jean-Christophe Rozé
- Pediatric Intensive Care Unit, Mothers' and Children's Hospital, Nantes Teaching Hospital, Nantes, France
| | - Paul Sagot
- CHRU Dijon, Department of Gynecology, Obstetrics, Fetal Medicine, and Infertility, University of Burgundy and Franche-Comté, Dijon, France
| | - Patrick Truffert
- Neonatal Intensive Care Unit, Jeanne de Flandre Hospital, CHRU Lille, Lille, France
| | - Jennifer Zeitlin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France
| | - Pierre-Yves Ancel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France; Clinical Research Unit, Center for Clinical Investigation P1419, CHU Cochin Broca Hôtel-Dieu, Paris, France
| | - Jeanne Fresson
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France; CHRU Nancy, Department of Medical Information, Nancy, France
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40
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Mitha A, Piedvache A, Khoshnood B, Fresson J, Glorieux I, Roué JM, Blondel B, Durox M, Burguet A, Ancel PY, Kaminski M, Pierrat V. The impact of neonatal unit policies on breast milk feeding at discharge of moderate preterm infants: The EPIPAGE-2 cohort study. Matern Child Nutr 2019; 15:e12875. [PMID: 31310706 DOI: 10.1111/mcn.12875] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/26/2019] [Accepted: 07/09/2019] [Indexed: 01/30/2023]
Abstract
Facilitating factors and barriers to breast milk feeding (BMF) for preterm infants have been mainly studied in very preterm populations, but little is known about moderate preterm infants. We aimed to analyze hospital unit characteristics and BMF policies associated with BMF at discharge for infants born at 32 to 34 weeks' gestation. EPIPAGE-2, a French national cohort of preterm births, included 883 infants born at 32 to 34 weeks' gestation. We investigated kangaroo care in the first 24 hr, early involvement of parents in feeding support, volume of the unit, BMF information given to mothers hospitalized for threatened preterm delivery, protocols for BMF, presence of a professional trained in human lactation, unit training in neurodevelopmental care, and regional BMF initiation rates in the general population. Multilevel logistic regression analysis was used to investigate associations between unit policies and BMF at discharge, adjusted for individual characteristics and estimating odds ratios (ORs) and 95% confidence intervals (CIs). Overall, 59% (490/828) of infants received BMF at discharge (27% to 87% between units). Rates of BMF at discharge were higher with kangaroo care (adjusted OR 2.03 [95% CI 1.01, 4.10]), early involvement of parents in feeding support (1.94 [1.23, 3.04]), unit training in a neurodevelopmental care programme (2.57 [1.18, 5.60]), and in regions with a high level of BMF initiation in the general population (1.85 [1.05, 3.28]). Creating synergies by interventions at the unit and population level may reduce the variability in BMF rates at discharge for moderate preterm infants.
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Affiliation(s)
- Ayoub Mitha
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Department of Neonatal Medicine, CHU Lille, Jeanne de Flandre Hospital, Lille, France
| | - Aurélie Piedvache
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Babak Khoshnood
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Jeanne Fresson
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Department of Clinical Epidemiology and Biostatistics, CHRU Nancy, Nancy, France
| | - Isabelle Glorieux
- Department of Neonatology, Toulouse University Hospital, Toulouse, France
| | - Jean-Michel Roué
- Department of Neonatal Pediatrics and Intensive Care, Brest University Hospital, Brest, France
| | - Béatrice Blondel
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Mélanie Durox
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Antoine Burguet
- Department of Neonatal Pediatrics, Dijon University Hospital, Dijon, France
| | - Pierre-Yves Ancel
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Clinical Research Unit, Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France
| | - Monique Kaminski
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Véronique Pierrat
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Department of Neonatal Medicine, CHU Lille, Jeanne de Flandre Hospital, Lille, France
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Bouthors C, Prost S, Court C, Blondel B, Charles YP, Fuentes S, Mousselard HP, Mazel C, Flouzat-Lachaniette CH, Bonnevialle P, Saihlan F. Outcomes of surgical treatments of spinal metastases: a prospective study. Support Care Cancer 2019; 28:2127-2135. [PMID: 31396747 DOI: 10.1007/s00520-019-05015-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/30/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Owing to recent advances in cancer therapy, updated data are required for clinicians counselling patients on treatment of spinal metastases. OBJECTIVE To analyse the outcomes of surgical treatments of spinal metastases. METHODS Prospective and multicentric study that included consecutively patients operated on for spinal metastases between January 2016 and January 2017. Overall survival was calculated with the Kaplan-Meier method. Cox proportional hazard model was used to calculate hazard ratio (HR) analysing mortality risk according to preoperative Karnofsky performance status (KPS), mobility level and neurological status. RESULTS A total of 252 patients were included (145 males, 107 females) aged a mean 63.3 years. Median survival was 450 days. Primary cancer sites were lung (21%) and breast (19%). Multiple spinal metastases involved 122 patients (48%). Concomitant skeletal and visceral metastases were noted in 90 patients (36%). Main procedure was laminectomy and posterior fixation (57%). Overall, pain and mobility level were improved postoperatively. Most patients had normal preoperative motor function (50%) and remained so postoperatively. Patients "bedbound" on admission were the less likely to recover. In-hospital death rate was 2.4% (three disease progression, one septic shock, one pneumonia, one pulmonary embolism). Complication rate was 33%, deep wound infection was the most frequent aetiology. Higher mortality was observed in patients with poorest preoperative KPS (KPS 0-40%, HR = 3.1, p < 0.001) and mobility level ("bedbound", HR = 2.16, p < 0.001). Survival seemed also to be linked to preoperative neurological function. CONCLUSION Surgical treatments helped maintain reasonable condition for patients with spinal metastases. Intervention should be offered before patients' condition worsen to ensure better outcomes.
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Affiliation(s)
- C Bouthors
- Orthopedic and Traumatology Surgery Department, Bicetre University Hospital, AP-HP, Paris XI University, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France.
| | - S Prost
- Orthopedic and Traumatology Surgery Department, La Timone Hospital, AP-HM, Aix Marseille University, CNRS ISM, 264 rue Saint Pierre, 13005, Marseille, France
| | - C Court
- Orthopedic and Traumatology Surgery Department, Bicetre University Hospital, AP-HP, Paris XI University, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France
| | - B Blondel
- Orthopedic and Traumatology Surgery Department, La Timone Hospital, AP-HM, Aix Marseille University, CNRS ISM, 264 rue Saint Pierre, 13005, Marseille, France
| | - Y P Charles
- Orthopedic and Traumatology Surgery Department, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
| | - S Fuentes
- Neurosurgery Department, La Timone Hospital, AP-HM, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
| | - H P Mousselard
- Orthopedic and traumatology surgery department, La Pitié-Salpétrière Hospital, AP-HP, Parix VI University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - C Mazel
- Orthopedic and traumatology surgery department, Institut Mutualiste Montsouris, Paris V University, 42 Boulevard Jourdan, 75014, Paris, France
| | - C H Flouzat-Lachaniette
- Orthopedic and traumatology surgery department, Mondor Hospital, APHP, Paris XII University, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - P Bonnevialle
- Orthopedic and traumatology surgery department, Riquet Pierre-Paul Hospital, Place du Docteur Baylac,, TSA 40031-31059, Toulouse cedex 9, France
| | - F Saihlan
- Orthopedic and traumatology surgery department, Cochin Hospital, APHP, Paris V University, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
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Zeitlin J, Alexander S, Barros H, Blondel B, Delnord M, Durox M, Gissler M, Hindori-Mohangoo AD, Hocquette A, Szamotulska K, Macfarlane A. Perinatal health monitoring through a European lens: eight lessons from the Euro-Peristat report on 2015 births. BJOG 2019; 126:1518-1522. [PMID: 31260601 DOI: 10.1111/1471-0528.15857] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 12/01/2022]
Affiliation(s)
- J Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - S Alexander
- Perinatal Epidemiology and Reproductive Health Unit, CR2, School of Public Health, ULB, Brussels, Belgium
| | - H Barros
- ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal
| | - B Blondel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - M Delnord
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - M Durox
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - M Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland.,Karolinska Institute, Stockholm, Sweden
| | - A D Hindori-Mohangoo
- Department Child Health, Netherlands Organisation for Applied Scientific Research, TNO Healthy Living, Leiden, the Netherlands.,Perinatal Interventions Suriname, Perisur Foundation, Paramaribo, Suriname.,School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - A Hocquette
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - K Szamotulska
- Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland
| | - A Macfarlane
- Centre for Maternal and Child Health Research, City, University of London, London, UK
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Bruckner TA, Lebreton É, Perrone N, Mortensen LH, Blondel B. Preterm birth and selection in utero among males following the November 2015 Paris attacks. Int J Epidemiol 2019; 48:1614-1622. [DOI: 10.1093/ije/dyz089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Background
On 13 November 2015, coordinated terrorist attacks swept through Paris. This large stressor, like earlier terrorist attacks in the USA, may have perturbed the health of pregnant women. We test whether the attacks preceded an increase in the risk of preterm parturition among live-born males as well as excess male loss in utero. We focused on males on the basis of previous findings of elevated male frailty following population stressors.
Methods
We examined live births in the Paris region (n = 1 049 057) over 70 months, from January 2011 to October 2016. Interrupted time-series methods identified and removed serial correlation in the monthly risk of preterm birth; these methods employed non-linear least-squares estimation. We also repeated analyses using month of conception, and performed sensitivity tests among females as well as among male births outside Paris.
Results
Males exhibited an elevated incidence of preterm birth in November 2015 and January 2016 [risk difference for November 2015 = 0.006, 95% confidence interval (CI): 0.0002—0.012; risk difference for January 2016 = 0.010, 95% CI: 0.004—0.016], which equates to an 11% increase in the count of preterm births. Females, as well as males born outside Paris, showed no change in preterm delivery. The sex ratio also fell below expected values in December 2015, January 2016 and February 2016.
Conclusions
Among males, more preterm births, but fewer live births, occurred after the November 2015 Paris attacks. Future examinations of perinatal health responses to unexpected stressors may benefit from sex-specific analyses.
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Affiliation(s)
- Tim A Bruckner
- Program in Public Health, University of California at Irvine, Irvine, CA, USA
| | - Élodie Lebreton
- Perinat-ARS-IDF, Agence Régionale de Santé d'Île-de-France, Paris, France
| | - Natalie Perrone
- Department of Sociology, New York University, New York, NY, USA
| | - Laust H Mortensen
- Department of Social Medicine, and Statistics Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Béatrice Blondel
- INSERM U1153, Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
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44
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Bardou M, Bornet C, Zamparini E, Blondel B, Graillon T, Pinelli P, Seng P, Stein A. Cotrimoxazole et infections ostéo-articulaires. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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45
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Delnord M, Mortensen L, Hindori-Mohangoo AD, Blondel B, Gissler M, Kramer MR, Richards JL, Deb-Rinker P, Rouleau J, Morisaki N, Nassar N, Bolumar F, Berrut S, Nybo Andersen AM, Kramer MS, Zeitlin J. International variations in the gestational age distribution of births: an ecological study in 34 high-income countries. Eur J Public Health 2019; 28:303-309. [PMID: 29020399 DOI: 10.1093/eurpub/ckx131] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Few studies have investigated international variations in the gestational age (GA) distribution of births. While preterm births (22-36 weeks GA) and early term births (37-38 weeks) are at greater risk of adverse health outcomes compared to full term births (39-40 weeks), it is not known if countries with high preterm birth rates also have high early term birth rates. We examined rate associations between preterm and early term births and mean term GA by mode of delivery onset. Methods We used routine aggregate data on the GA distribution of singleton live births from up to 34 high-income countries/regions in 1996, 2000, 2004, 2008 and 2010 to study preterm and early term births overall and by spontaneous or indicated onset. Pearson correlation coefficients were adjusted for clustering in time trend analyses. Results Preterm and early term births ranged from 4.1% to 8.2% (median 5.5%) and 15.6% to 30.8% (median 22.2%) of live births in 2010, respectively. Countries with higher preterm birth rates in 2004-2010 had higher early term birth rates (r > 0.50, P < 0.01) and changes over time were strongly correlated overall (adjusted-r = 0.55, P < 0.01) and by mode of onset. Conclusion Positive associations between preterm and early term birth rates suggest that common risk factors could underpin shifts in the GA distribution. Targeting modifiable population risk factors for delivery before 39 weeks GA may provide a useful preterm birth prevention paradigm.
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Affiliation(s)
- Marie Delnord
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Laust Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ashna D Hindori-Mohangoo
- Department Child Health, TNO, The Netherlands Organisation for Applied Scientific Research, Leiden, The Netherlands.,Department Public Health, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname.,Perinatal Interventions Suriname (Perisur) Foundation, Paramaribo, Suriname
| | - Béatrice Blondel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Mika Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland.,Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer L Richards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Paromita Deb-Rinker
- Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jocelyn Rouleau
- Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Naho Morisaki
- Department of Lifecourse Epidemiology, Department of Social Medicine, National Center for Child Health and Development, Setagayaku, Tokyo, Japan
| | - Natasha Nassar
- MenziesKids, Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | | | - Sylvie Berrut
- Federal Department of Home Affairs FDHA, Federal Statistical Office FSO, Health Section, Neuchâtel, Switzerland
| | | | - Michael S Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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Sautet P, Giorgi H, Chabrand P, Tropiano P, Argenson JN, Parratte S, Blondel B. Corrigendum to "Is anatomic acetabular orientation related to pelvic morphology? CT analysis of 150 healthy pelvises" [Orthop. Traumatol. Surg. Res. 104 (2018) 347-351]. Orthop Traumatol Surg Res 2019; 105:195. [PMID: 30630739 DOI: 10.1016/j.otsr.2018.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- P Sautet
- Institut du mouvement et de l'appareil locomoteur, groupe interdisciplinaire en biomécanique, hôpital Sainte-Marguerite, Aix-Marseille université, 270, boulevard Sainte-Marguerite, 13009 Marseille, France.
| | - H Giorgi
- Unité chirurgie vertébrale et orthopédique, Aix-Marseille université, CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - P Chabrand
- Institut du mouvement et de l'appareil locomoteur, groupe interdisciplinaire en biomécanique, hôpital Sainte-Marguerite, Aix-Marseille université, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - P Tropiano
- Unité chirurgie vertébrale et orthopédique, Aix-Marseille université, CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - J-N Argenson
- Institut du mouvement et de l'appareil locomoteur, groupe interdisciplinaire en biomécanique, hôpital Sainte-Marguerite, Aix-Marseille université, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - S Parratte
- Institut du mouvement et de l'appareil locomoteur, groupe interdisciplinaire en biomécanique, hôpital Sainte-Marguerite, Aix-Marseille université, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - B Blondel
- Unité chirurgie vertébrale et orthopédique, Aix-Marseille université, CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France
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Schmidt S, Norman M, Misselwitz B, Piedvache A, Huusom LD, Varendi H, Barros H, Cammu H, Blondel B, Dudenhausen J, Zeitlin J, Weber T. Mode of delivery and mortality and morbidity for very preterm singleton infants in a breech position: A European cohort study. Eur J Obstet Gynecol Reprod Biol 2019; 234:96-102. [PMID: 30682601 DOI: 10.1016/j.ejogrb.2019.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/29/2018] [Accepted: 01/03/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Caesarean section (CS) may reduce mortality and morbidity for very preterm breech infants, but evidence is inconclusive. We evaluated neonatal outcomes for singleton breech infants by mode of delivery in a European cohort. STUDY DESIGN Data come from the EPICE population-based cohort of very preterm births in 19 regions in 11 European countries (7770 live births). The study population was singleton spontaneous-onset breech births at 24-31 weeks gestational age (GA) without antenatal medical complications requiring caesarean delivery (N = 572). Mixed-effects regression models adjusting for maternal and pregnancy covariates and propensity score matching was used to examine the effect of (1) CS and (2) a unit policy of systematic CS for breech presentation by GA. The primary outcome was a composite of in-hospital mortality, intraventricular haemorrhage grades III & IV or cystic periventricular leukomalacia. Secondary outcomes were each component separately, five minute Apgar score below seven and mortality within six hours of delivery. RESULTS 64.4% of infants were delivered by CS with a range across regions from 41% to 100%; these infants had higher GA and were more likely to be small for gestational age, receive antenatal steroids, and have mothers who were hospitalised for more than one day before delivery compared to those delivered vaginally. CS was associated with lower risks of all outcomes in mixed-effects adjusted models (odds ratio (OR) for the composite outcome: 0.50, 95% confidence interval (CI): 0.30-0.81), but not in propensity score matched models (OR: 0.72, 95% CI: 0.41; 1.29). A systematic CS policy was associated with lower mortality and morbidity in unadjusted, but not adjusted models (OR for composite outcome: 0.76, 95% CI: 0.44; 1.28). 35% of births 24-25 weeks were delivered by CS and protective effects were consistently stronger, but not statistically significant. CONCLUSIONS Point estimates indicated protective effects of caesarean delivery for very preterm breech infants in conventional statistical models. However, analyses using propensity scores and based on unit policies did not confirm statistically significant associations. Prospective large-scale studies are needed to establish best practice and could be implemented in European regions where vaginal delivery remains an option.
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Affiliation(s)
- Stephan Schmidt
- Department of Obstetrics, University Hospital, Philipps University, Marburg, D-35043, Germany
| | - Mikael Norman
- Department of Clinical Science, Intervention & Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Lene D Huusom
- Department of Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - Heili Varendi
- University of Tartu, Tartu University Hospital, Tartu, Estonia
| | - Henrique Barros
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Hendrik Cammu
- H Cammu, Study centre of Perinatal Epidemiology & Vrije Universiteit Brussel, Belgium
| | - Béatrice Blondel
- Inserm UMR 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
| | | | - Jennifer Zeitlin
- Inserm UMR 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.
| | - Tom Weber
- Department of Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark
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Mitha A, Piedvache A, Glorieux I, Zeitlin J, Roué JM, Blondel B, Durox M, Burguet A, Kaminski M, Ancel PY, Pierrat V. Unit policies and breast milk feeding at discharge of very preterm infants: The EPIPAGE-2 cohort study. Paediatr Perinat Epidemiol 2019; 33:59-69. [PMID: 30698887 DOI: 10.1111/ppe.12536] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/02/2017] [Accepted: 12/10/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Facilitating factors and barriers to breast milk feeding (BMF) very preterm (VP) infants have been widely studied at the individual level. We aimed to describe and analyse factors associated with BMF at discharge for VP infants, with a special focus on unit policies aiming to support BMF. METHODS We described BMF at discharge in 3108 VP infants enrolled in EPIPAGE-2, a French national cohort. Variables of interest were kangaroo care during the 1st week of life (KC); unit's policies supporting BMF initiation (BMF information systematically given to mothers hospitalised for threatened preterm delivery and breast milk expression proposed within 6 hours after birth) and BMF maintenance (availability of protocols for BMF and a special room for mothers to pump milk); the presence in units of a professional trained in human lactation and regional BMF initiation rates in the general population. Associations were investigated by multilevel logistic regression analysis, with adjustment on individual factors. RESULTS In total, 47.2% of VP infants received BMF at discharge (range among units 21.1%-84.0%). Unit policies partly explained this variation, regardless of individual factors. BMF at discharge was associated with KC (adjusted odds ratio (aOR) 2.26 (95% confidence interval (CI) 1.40, 3.65)), with policies supporting BMF initiation (aOR 2.19 (95% CI 1.27, 3.77)) and maintenance (aOR 2.03 (95% CI 1.17, 3.55)), but not with BMF initiation rates in the general population. CONCLUSION Adopting policies of higher performing units could be an effective strategy for increasing BMF rates at discharge among VP infants.
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Affiliation(s)
- Ayoub Mitha
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France.,Paris Descartes University, Paris, France.,CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
| | - Aurélie Piedvache
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France
| | - Isabelle Glorieux
- Department of Neonatology, Toulouse University Hospital, Toulouse, France
| | - Jennifer Zeitlin
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France
| | - Jean-Michel Roué
- Department of Neonatal Pediatrics and Intensive Care, Brest University Hospital, Brest, France
| | - Béatrice Blondel
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France
| | - Mélanie Durox
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France
| | - Antoine Burguet
- Department of Neonatal Pediatrics, Dijon University Hospital Dijon, France
| | - Monique Kaminski
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France
| | - Pierre-Yves Ancel
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France.,Paris Descartes University, Paris, France.,Clinical Research Unit, Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France
| | - Véronique Pierrat
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France.,CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
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Pilkington H, Prunet C, Blondel B, Charreire H, Combier E, Le Vaillant M, Amat-Roze JM, Zeitlin J. Travel Time to Hospital for Childbirth: Comparing Calculated Versus Reported Travel Times in France. Matern Child Health J 2018; 22:101-110. [PMID: 28780684 DOI: 10.1007/s10995-017-2359-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives Timely access to health care is critical in obstetrics. Yet obtaining reliable estimates of travel times to hospital for childbirth poses methodological challenges. We compared two measures of travel time, self-reported and calculated, to assess concordance and to identify determinants of long travel time to hospital for childbirth. Methods Data came from the 2010 French National Perinatal Survey, a national representative sample of births (N = 14 681). We compared both travel time measures by maternal, maternity unit and geographic characteristics in rural, peri-urban and urban areas. Logistic regression models were used to study factors associated with reported and calculated times ≥30 min. Cohen's kappa coefficients were also calculated to estimate the agreement between reported and calculated times according to women's characteristics. Results In urban areas, the proportion of women with travel times ≥30 min was higher when reported rather than calculated times were used (11.0 vs. 3.6%). Longer reported times were associated with non-French nationality [adjusted odds ratio (aOR) 1.3 (95% CI 1.0-1.7)] and inadequate prenatal care [aOR 1.5 (95% CI 1.2-2.0)], but not for calculated times. Concordance between the two measures was higher in peri-urban and rural areas (52.4 vs. 52.3% for rural areas). Delivery in a specialised level 2 or 3 maternity unit was a principal determinant of long reported and measured times in peri-urban and rural areas. Conclusions for Practice The level of agreement between reported and calculated times varies according to geographic context. Poor measurement of travel time in urban areas may mask problems in accessibility.
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Affiliation(s)
- Hugo Pilkington
- Département de Géographie, Université Paris 8 Vincennes-Saint-Denis, UMR7533 Ladyss, 2 rue de la Liberté, 93526, Saint-Denis, France.
| | - Caroline Prunet
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
| | - Béatrice Blondel
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
| | - Hélène Charreire
- Université Paris-Est, LabUrba, Ecole d'urbanisme de Paris, Créteil, France
| | - Evelyne Combier
- Centre d'épidémiologie des populations (CEP), University of Burgundy, EA4184 CHU, Hôpital du Bocage, Dijon, France
| | - Marc Le Vaillant
- Centre de Recherche, médecine, sciences, santé, santé mentale, société (CERMES3) INSERM U988 - CNRS UMR 8211, Villejuif Cedex, France
| | | | - Jennifer Zeitlin
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
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50
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Monier I, Lelong N, Ancel PY, Benachi A, Khoshnood B, Zeitlin J, Blondel B. Indications leading to termination of pregnancy between 22 +0 and 31 +6 weeks of gestational age in France: A population-based cohort study. Eur J Obstet Gynecol Reprod Biol 2018; 233:12-18. [PMID: 30544027 DOI: 10.1016/j.ejogrb.2018.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/22/2018] [Accepted: 11/26/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To estimate the prevalence and indications of terminations of pregnancy (TOP) between 22+0 and 31+6 weeks of gestational age in France and to examine the characteristics of women by indication of TOP. STUDY DESIGN From the EPIPAGE 2 population-based cohort study of preterm births in France in 2011, we selected 5009 singleton live births, stillbirths and TOP that occurred between 22 and 31 weeks. We estimated the proportion of TOP by gestational age. We then classified terminations by indications into 4 categories: fetal anomalies (TOPFA), preterm premature rupture of the membranes (PPROM), maternal conditions and fetal growth restriction (FGR). We also classified TOPFA by type of anomaly. Maternal characteristics were compared between TOPFA and TOP for maternal or fetal conditions without congenital anomaly. RESULTS 23.1% of all births and 54.3% of stillbirths were terminations. The proportion of terminations was 36.9% of all births at 22 weeks, 50.2% at 24 weeks and <10% at 30-31 weeks. 85.8% of terminations were for fetal anomaly, 4.4% for PPROM, 6.1% for maternal complications and 3.7% for severe FGR. Compared to women with a TOPFA, those with a termination for maternal or fetal conditions were more often nulliparous, single, African, obese, smokers and covered by non-standard insurance for women in socially deprived circumstances. CONCLUSION In France, there is a high proportion of TOP of which 14% are for indications other than congenital anomalies. Because rates of terminations have an impact on very preterm birth and perinatal mortality rates, studies on pregnancy outcome should report all terminations, not only those for congenital anomalies.
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Affiliation(s)
- Isabelle Monier
- Inserm UMR 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; Antoine Beclere Maternity Unit, Department of Obstetrics and Gynaecology, University Paris Sud, AP-HP, Paris, France.
| | - Nathalie Lelong
- Inserm UMR 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
| | - Pierre-Yves Ancel
- Inserm UMR 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
| | - Alexandra Benachi
- Antoine Beclere Maternity Unit, Department of Obstetrics and Gynaecology, University Paris Sud, AP-HP, Paris, France
| | - Babak Khoshnood
- Inserm UMR 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
| | - Jennifer Zeitlin
- Inserm UMR 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
| | - Béatrice Blondel
- Inserm UMR 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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