Showing papers by "Béatrice Blondel published in 2014"

Qualité des données périnatales issues du PMSI : comparaison avec l’état civil et l’enquête nationale périnatale 2010

Abstract: Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 43 - N° 9 - p. 680-690

Preterm Birth Time Trends in Europe: A Study of 19 Countries

Abstract: Objective To investigate time trends in preterm birth in Europe by multiplicity, gestational age, and onset of delivery. Design Analysis of aggregate data from routine sources. Setting Nineteen European countries. Population Live births in 1996, 2000, 2004, and 2008. Methods Annual risk ratios of preterm birth in each country were estimated with year as a continuous variable for all births and by subgroup using log-binomial regression models. Main outcome measures Overall preterm birth rate and rate by multiplicity, gestational age group, and spontaneous versus non-spontaneous (induced or prelabour caesarean section) onset of labour. Results Preterm birth rates rose in most countries, but the magnitude of these increases varied. Rises in the multiple birth rate as well as in the preterm birth rate for multiple births contributed to increases in the overall preterm birth rate. About half of countries experienced no change or decreases in the rates of singleton preterm birth. Where preterm birth rates rose, increases were no more prominent at 35-36 weeks of gestation than at 32-34 weeks of gestation. Variable trends were observed for spontaneous and non-spontaneous preterm births in the 13 countries with mode of onset data; increases were not solely attributed to non-spontaneous preterm births. Conclusions There was a wide variation in preterm birth trends in European countries. Many countries maintained or reduced rates of singleton preterm birth over the past 15 years, challenging a widespread belief that rising rates are the norm. Understanding these cross-country differences could inform strategies for the prevention of preterm birth. © 2013 The Authors. BJOG: An International Journal of Obstetrics & Gynaecology published by John Wiley and Sons on behalf of the Royal College of Obstetricians and Gynaecologists.

Where does distance matter? Distance to the closest maternity unit and risk of foetal and neonatal mortality in France

Abstract: Background: The number of maternity units has declined in France, raising concerns about the possible impact of increasing travel distances on perinatal health outcomes. We investigated impact of distance to closest maternity unit on perinatal mortality. Methods: Data from the French National Vital Statistics Registry were used to construct foetal and neonatal mortality rates over 2001-08 by distance from mother's municipality of residence and the closest municipality with a maternity unit. Data from French neonatal mortality certificates were used to compute neonatal death rates after out-of-hospital birth. Relative risks by distance were estimated, adjusting for individual and municipal-level characteristics. Results: Seven percent of births occurred to women residing at ≥30 km from a maternity unit and 1% at ≥45 km. Foetal and neonatal mortality rates were highest for women living at <5 km from a maternity unit. For foetal mortality, rates increased at ≥45 km compared with 5-45 km. In adjusted models, long distance to a maternity unit had no impact on overall mortality but women living closer to a maternity unit had a higher risk of neonatal mortality. Neonatal deaths associated with out-of-hospital birth were rare but more frequent at longer distances. At the municipal-level, higher percentages of unemployment and foreign-born residents were associated with increased mortality. Conclusion: Overall mortality was not associated with living far from a maternity unit. Mortality was elevated in municipalities with social risk factors and located closest to a maternity unit, reflecting the location of maternity units in deprived areas with risk factors for poor outcome.

Cannabis Use During Pregnancy in France in 2010

Abstract: Objective The aim was to estimate the proportion of women who reported cannabis use during pregnancy, to analyse the demographic and social characteristics of users, and the link between cannabis use and either preterm or small-for-gestational-age birth. Design Data were obtained from interviews of a representative sample of women giving birth in France in 2010 in the days after delivery, and from their medical records. Setting All maternity units in France. Sample The analysis includes women with live singleton births in metropolitan France who responded to the question about cannabis use during pregnancy: in total, 13 545 women. Methods The percentage of cannabis users during pregnancy was estimated, and variations according to social characteristics were described. Logistic regression analyses were used to investigate any associations between cannabis use and preterm birth or small-for-gestational-age status. Main outcome measures Percentage of cannabis use, preterm birth rate, and small-for-gestational-age rate. Results In all, 1.2% of women reported having used cannabis during pregnancy. This percentage was higher among younger women, women living alone, or women who had a low level of education or low income. It was also associated with tobacco use and drinking alcohol. Cannabis users had higher rates of spontaneous preterm births: 6.4 versus 2.8%, for an adjusted odds ratio (aOR) of 2.15 (95% CI 1.10–4.18). The corresponding aOR was 2.64 (95% CI 1.12–6.22) among tobacco smokers and 1.22 (95% CI 0.29–5.06) among non-tobacco smokers. Conclusions Although the reported rate of cannabis use during pregnancy in France is low, efforts should be continued to inform women and healthcare providers about the potential consequences of its use.

Les femmes de Seine-Saint-Denis ont-elles un suivi prénatal différent de celui des autres femmes d’Île-de-France ? ☆

Abstract: Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 44 - N° 3 - p. 258-268

Facteurs associés à la non-utilisation de la PCEA pour l’analgésie péridurale obstétricale en France

Abstract: Introduction En France, le taux d’analgesie peridurale au cours du travail obstetrical est parmi les plus eleves au monde (80 % des parturientes en 2010). Le mode d’administration peridural autocontrole (PCEA) est la technique qui presente le plus de benefices dans ce contexte, mais qui reste encore moderement utilisee puisque moins de la moitie des parturientes en France en beneficient actuellement [1] . L’objectif de cette etude etait d’identifier les determinants associes a la non-utilisation de l’analgesie peridurale par PCEA en France au cours du travail obstetrical. Materiel et methodes La population d’etude etait issue de l’enquete nationale perinatale de 2010, echantillon representatif des naissances en France metropolitaine ( n = 14 681 femmes). Nous avons selectionne les femmes ayant accouche dans une maternite ou la PCEA etait disponible et qui avaient beneficie d’une analgesie peridurale. Les femmes accouchant par cesarienne en dehors du travail, les interruptions medicales de grossesse et les morts fœtales in utero etaient exclues. Nous avons calcule la frequence d’utilisation de la PCEA dans cette population. L’association entre la non-utilisation de la PCEA et les caracteristiques maternelles, de la grossesse, du travail et des maternites a ete etudiee par des analyses univariees, puis multivariees a l’aide de modeles de regression logistiques multiniveaux. Resultats Parmi les 6931 femmes ayant accouche avec une peridurale dans une maternite equipee en PCEA, 3820 (55,1 %) ont accouche sans PCEA. En analyse univariee, l’utilisation du mode PCEA etait significativement moins frequente chez les parturientes multipares et de nationalite etrangere. Elle etait egalement significativement moins observee dans les centres hospitaliers non-universitaires et les structures privees, dans les maternites de types 1 et 2, dans les maternites de petite taille et lorsque l’anesthesiste etait present 24 h sur 24 dans la structure hospitaliere ou la maternite. La maitrise de la langue francaise et le niveau d’etudes n’etaient pas significativement associes a la non-utilisation du mode PCEA. En analyses multivariees multiniveaux, apres ajustement sur les facteurs significativement associes au seuil de 20 % en univarie et sur le centre, les facteurs significativement associes a la non-utilisation du mode PCEA, etaient : la multiparite (ORa 1,5, IC 95 % 1,2–1,8), la nationalite etrangere (ORa 1,5, IC95 % 1,1–2,0) et la presence permanente d’un anesthesiste pour le site et pour la maternite (respectivement ORa 19,7, IC95 % 2,3–166,1 et ORa13,4, IC95 % 1,5–119,9). Il existait une variabilite elevee, significativement associee a un « effet-centre », mais non expliquee par les caracteristiques incluses dans notre modele. Discussion En France, plus de la moitie des femmes accouchant avec une peridurale dans une maternite ou la PCEA est disponible n’en beneficient pas. Les determinants de la non-utilisation du mode PCEA semblent principalement associes au lieu d’accouchement et tres peu aux caracteristiques individuelles et structurelles. C’est donc probablement uniquement l’equipement en PCEA a l’echelle de la maternite qui conditionne son utilisation chez les parturientes.