Objective
To assess the proportion of small for gestational age (SGA) and normal birthweight infants suspected of fetal growth restriction (FGR) during pregnancy, and to investigate obstetric and ...neonatal outcomes by suspicion of FGR and SGA status at birth.
Design
Population‐based study.
Setting
All French maternity units in 2010.
Population
Representative sample of singleton births (n = 14 100).
Methods
We compared SGA infants with a birthweight of less than the 10th percentile suspected of FGR, defined as mention of FGR in medical charts (true positives), non‐SGA infants suspected of FGR (false positives), SGA infants without suspicion of FGR (false negatives) and non‐SGA infants without suspicion of FGR (true negatives). Multivariable analyses were adjusted for maternal and neonatal characteristics hypothesised to affect closer surveillance for FGR and our outcomes.
Main outcome measures
Obstetric management (caesarean, provider‐initiated preterm and early term delivery) and neonatal outcomes (late fetal death, preterm birth, Apgar score, resuscitation at birth).
Results
21.7% of SGA infants (n = 265) and 2.1% of non‐SGA infants (n = 271) were suspected of FGR during pregnancy. Compared with true negatives, provider‐initiated preterm deliveries were higher for true and false positives (adjusted risk ratio aRR, 6.1 95% CI, 3.8–9.8 and 4.6 95% CI, 3.2–6.7), but not for false negatives (aRR, 1.1 95% CI, 0.6–1.9). Neonatal outcomes were not better for SGA infants if FGR was suspected.
Conclusion
Antenatal suspicion of FGR among SGA infants was low and one‐half of infants suspected of FGR were not SGA. The increased risk of provider‐initiated delivery observed in non‐SGA infants suspected of FGR raises concerns about the iatrogenic consequences of screening.
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.
To study trends in the main indicators of perinatal health, medical practices and risk factors in France since 1995.
All live births during one week in 1995 (n=13,318), 2003 (n=14,737), 2010 ...(n=14,903) and 2016 (n=13,384). Data were from interviews of women in postpartum wards and from medical records and were compared between years.
Between 1995 and 2016, maternal age and body mass index increased steadily. Pregnancies that occurred with use of contraception increased from 7.4% in 2010 to 9.3% in 2016. Smoking during pregnancy (16.6%) did not decrease since 2010. The frequency of more than three ultrasounds during pregnancy was 48.5% in 1995 and 74.7% in 2016. Deliveries in large public hospitals increased steadily. The caesarean section rate has been relatively stable since 2003 (20.4% in 2003, 21.1% in 2010 and 20.4% in 2016). The rate of induction of labour was 22% in 2010 and 2016. Overall, 83.8% of women had epidural analgesia/anaesthesia in 2016. Rates of pre-term birth in 2016 ranged from 7.5% among all live births to 6.0% among live born singletons; for singletons, this rate increased steadily from 1995 to 2016, whereas there was no clear trend for low birth weight. Exclusive breastfeeding decreased from 60.3% in 2010 to 52.2% in 2016.
Routine national perinatal surveys highlight successful policies and recommendations but also point out some health indicators, practices, preventive behaviours and risk factors that need special attention.
Objective
To use data from routine sources to compare rates of obstetric intervention in Europe both overall and for subgroups at higher risk of intervention.
Design
Retrospective analysis of ...aggregated routine data.
Setting
Thirty‐one European countries or regions contributing data on mode of delivery to the Euro‐Peristat project.
Population
Births in participating countries in 2010.
Methods
Countries provided aggregated data about overall rates of obstetric intervention and about caesarean section rates for specified subgroups.
Main outcome measures
Mode of delivery.
Results
Rates of caesarean section ranged from 14.8% to 52.2% of all births and rates of instrumental vaginal delivery ranged from 0.5% to 16.4%. Overall, there was no association between rates of instrumental vaginal delivery and rates of caesarean section, but similarities were observed between some countries that are geographically close and may share common traditions of practice. Associations were observed between caesarean section rates for women with breech and vertex births and with singleton and multiple births but patterns of association for women who had and had not had previous caesarean sections were more complex.
Conclusions
The persisting wide variations in caesarean section and instrumental vaginal delivery rates point to a lack of consensus about practice and raise questions for further investigation. Further research is needed to explore the impact of differences in clinical guidelines, healthcare systems and their financing and parents’ and professionals’ attitudes to care at delivery.
Cannabis use during pregnancy in France in 2010 Saurel‐Cubizolles, M‐J; Prunet, C; Blondel, B
BJOG : an international journal of obstetrics and gynaecology,
July 2014, Letnik:
121, Številka:
8
Journal Article
Recenzirano
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.
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
Choice of growth chart strongly affected identification of high‐risk fetuses at the third trimester ultrasound.
Tweetable
Choice of growth chart strongly affected identification of high‐risk fetuses at the third trimester ultrasound.
Linked article This article is commented on by F Figueras, pp. 949 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17108.
Objectives
To estimate the national prevalence and analyse the factors associated with preconceptional folic acid supplementation, including maternal sociodemographic characteristics, region of ...residence, birth control use and chronic diseases requiring medical care before conception.
Design
Cross‐sectional population‐based study.
Setting
All maternity units in France.
Population
A nationally representative sample of women giving birth in 2010 (n = 12,646).
Methods
Data came from mothers' interviews 2–3 days after delivery. Statistical analyses included multivariable logistic regressions.
Main outcome measure
Folic acid supplementation starting at least 1 month before conception.
Results
14.8% (95% confidence interval 95% CI 14.2–15.4) of women used folic acid before pregnancy; this percentage varied from 10.4% to 18.7% across regions. Supplementation was more frequent in primiparae, French citizens, women with higher educational levels and those needing medical monitoring or treatment before conception. Women who stopped contraception to become pregnant (75% of our population) used folic acid more often (intrauterine device or implant: 19%, pill: 17%, other methods which did not need medical monitoring: 17%) than other women (7%). The adjusted odds ratios were 3.3 (95% CI 2.6–4.3) for intrauterine device and implant, 2.2 (95% CI 1.8–2.6) for pill and 1.9 (95% CI 1.5–2.4) for other methods, compared with women who did not use birth control.
Conclusion
The absence of preconceptional folic acid supplementation for most women, even those needing consultations with healthcare professionals before pregnancy, shows that campaigns to promote folic acid supplementation should address not only women but also healthcare professionals involved in birth control and obstetric care before pregnancy.
Stabilising the caesarean rate: which target population? Le Ray, C; Blondel, B; Prunet, C ...
BJOG : an international journal of obstetrics and gynaecology,
April 2015, 2015-Apr, 2015-04-00, 20150401, Letnik:
122, Številka:
5
Journal Article
Recenzirano
Objective
Caesarean rate increased in France between 1995 and 2003, but remained stable between 2003 and 2010. Our objective was to analyse these trends by identifying the groups of women who ...contributed to the increase and those who contributed to the stabilisation.
Design
Cross‐sectional population‐based study from the French national perinatal surveys.
Setting
All maternity units in France.
Population
Representative samples of women delivering in 1995 (n = 13 147), 2003 (n = 14 482), and 2010 (n = 14 681).
Methods
Robson classification, based on pregnancy and delivery characteristics, was used for each group.
Main outcome measures
Caesarean rate for each group, its contribution to the overall caesarean rate, and the differences (Δ) in these contributions between 1995 and 2003 and between 2003 and 2010.
Results
Overall caesarean rates were 15.4% in 1995, 19.7% in 2003 and 20.5% in 2010. Between 1995 and 2003, the contribution to the overall caesarean rate of all groups but one rose. Between 2003 and 2010, the contribution of all groups but three stabilised or decreased: nulliparous women in spontaneous labour with singleton cephalic fetuses at term (Δ = + 0.5%, 95% CI 0.1–0.9%), an increase explained by their higher caesarean rate; nulliparous women with induced labour at term (Δ = + 1.1%, 95% CI 0.8–1.4%) caused by an increase in both the caesarean rate and the relative size of this group; and women with previous caesarean (Δ = + 0.8%, 95% CI 0.3–1.3%), because of the growing size of this group.
Conclusion
Proposing and evaluating interventions for improving the management of labour in nulliparous women could help to maintain caesarean rates and mitigate increases among multiparous women in the future.
PDF
