Objective
Our aim was to study risk factors associated with the prevalence, incidence and remission of urinary incontinence (UI) between 4 and 24 months postpartum.
Design
Longitudinal study (EDEN ...cohort).
Setting
Two French university hospitals.
Population
1643 women completed the questionnaire at 4 months and 1409 at 24 months, including 1354 who completed it both times.
Methods
Multivariate analyses identified risk factors for UI prevalence at 24 months postpartum, persistent UI versus remission, de novo UI versus continence, de novo UI versus persistent UI, and changes in IU severity between 4 and 24 months postpartum.
Main outcome measures
Postnatal UI and Sandvik UI severity score.
Results
UI prevalence was 20.7% (340/1643) at 4 months and 19.9% (280/1409) at 24 months. Significant factors associated with UI at 24 months were older age OR = 1.07/year (95%CI 1.04–1.11), BMI 2.35 (1.44–3.85) ≥30 versus <25 kg/m², higher parity 1.77 (1.14–2.76) ≥3 versus 1, breastfeeding 1.54 (1.08–2.19) ≥3 versus < 3 months, pregnant at follow up 3.44 (2.25–5.26), and caesarean delivery 0.62 (0.40–0.97) versus vaginal OR, odds ratio (CI, confidence interval). The likelihood of UI remission at 24 months was 51.9% (149/287). Caesarean delivery was associated with increased likelihood of UI remission 0.43 (0.19–0.97). The risk of de novo UI at 24 months was 12.5% (135/1067) and was associated with a new pregnancy 3.63 (2.13–6.20).
Conclusions
Between 4 and 24 months postpartum UI, remission occurred in half of the cases. These postnatal UI changes were essentially related to mode of delivery and subsequent pregnancy.
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Postnatal urinary incontinence progression is mostly related with mode of delivery and subsequent pregnancy.
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Postnatal urinary incontinence progression is mostly related with mode of delivery and subsequent pregnancy.
Abstract Background There is debate as to whether maternal tobacco use in pregnancy is related to offspring behaviour later on. We tested this association examining multiple aspects of children's ...behaviour at age 5 and accounting for parental smoking outside of pregnancy, as well as child and family characteristics. Methods Data come from a prospective community based birth cohort study (EDEN; n = 1113 families in France followed since pregnancy in 2003–2005 until the child's 5th birthday). Maternal tobacco use in pregnancy was self-reported. Children's socio-emotional development (emotional symptoms, conduct problems, symptoms of hyperactivity/inattention, peer relationship problems, prosocial behaviour) was assessed by mothers using the Strengths and Difficulties Questionnaire (SDQ) at age 5 years. Logistic regression analyses controlled for Inverse Probability Weights (IPW) of maternal tobacco use calculated based on study center, children's characteristics (sex, premature birth, low birth weight, breastfeeding), maternal characteristics (age at the child's birth, psychological difficulties and alcohol use in pregnancy, post-pregnancy depression, and smoking), paternal smoking in and post-pregnancy, parental educational attainment, family income, parental separation, and maternal negative life events. Results Maternal smoking in pregnancy only predicted children's high symptoms of hyperactivity/inattention (sex and study center-adjusted ORs: maternal smoking in the 1st trimester: 1.95, 95%CI: 1.13–3.38; maternal smoking throughout pregnancy: OR = 2.11, 95%CI: 1.36–3.27). In IPW-controlled regression models, only children of mothers who smoked throughout pregnancy had significantly elevated levels of hyperactivity/inattention (OR = 2.20, 95%CI: 1.21–4.00). Conclusions Maternal tobacco smoking in pregnancy may contribute directly or through epigenetic mechanisms to children's symptoms of hyperactivity/inattention.
Early eating patterns and behaviors can determine later eating habits and food preferences and they have been related to the development of childhood overweight and obesity. We aimed to identify ...patterns of feeding in the first year of life and to examine their associations with family characteristics.
Our analysis included 1004 infants from the EDEN mother-child cohort. Feeding practices were assessed through maternal self-report at birth, 4, 8 and 12 months. Principal component analysis was applied to derive patterns from breastfeeding duration, age at complementary food (CF) introduction and type of food used at 1 year. Associations between patterns and family characteristics were analyzed by linear regressions.
The main source of variability in infant feeding was characterized by a pattern labeled 'late CF introduction and use of ready-prepared baby foods'. Older, more educated, primiparous women with high monthly income ranked high on this pattern. The second pattern, labeled 'longer breastfeeding, late CF introduction and use of home-made foods' was the closest to infant feeding guidelines. Mothers ranking high on this pattern were older and more educated. The third pattern, labeled 'use of adults' foods' suggests a less age-specific diet for the infants. Mothers ranking high on this pattern were often younger and multiparous. Recruitment center was related to all patterns.
Not only maternal education level and age, but also parity and region are important contributors to the variability in patterns. Further studies are needed to describe associations between these patterns and infant growth and later food preferences.
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 estimate the prevalence of flatus‐only and faecal incontinence, to describe their risk factors and to analyse the association between anal incontinence and psychological distress over ...the first year postpartum.
Design
Cohort study from pregnancy to 12 months postpartum.
Setting
Two university hospital maternity wards in France.
Population
A total of 2002 pregnant women were recruited between 2003 and 2006. Data on anal incontinence were available for the 1632 women who comprise the sample for analysis.
Methods
Women were enrolled during pregnancy. A postal questionnaire was sent at 4 and 12 months postpartum.
Main outcome measures
Anal (flatus‐only and faecal) incontinence was assessed at 4 months postpartum. Mental health was assessed at 4 and 12 months postpartum by the Edinburgh Postpartum Depression Scale (EPDS) and use of antidepressant drugs as well as by self‐rated mental health.
Results
At 4 months postpartum, the prevalence for flatus‐only incontinence was 14.4% and for faecal incontinence 1.7%; multivariate analysis, restricted to women reporting no anal incontinence before the index pregnancy, showed that continuing breastfeeding at 4 months was related to a higher risk of de novo postpartum anal incontinence (OR = 2.23). Women who reported anal incontinence at 4 months were more frequently depressed (EPDS ≥10 or antidepressant use) at 12 months postpartum: 36.0% of those with faecal incontinence were depressed, 23.3% of those with flatus‐only incontinence and only 14.8% of the continent women.
Conclusion
Postnatal faecal incontinence was rare but associated with poorer maternal mental health. Postnatal screening should be encouraged, and psychological support offered.
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Postnatal faecal incontinence was associated with depression; postnatal screening should be encouraged and psychological support offered.
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Postnatal faecal incontinence was associated with depression; postnatal screening should be encouraged and psychological support offered.
Abstract Objective Social inequalities in cervical cancer screening may be related to either lack of access to care or inadequate delivery of preventive care by providers. We sought to characterize ...social inequalities among women consulting general practitioners with a wide range of social position indicators. Methods In 2005–06, 59 randomly recruited general practitioners from the Paris metropolitan area enrolled every woman aged 50–69 years seen during a two-week period. Cervical cancer screening status (overdue if the last cervical cancer screening had been more than 3 years earlier) was analyzed for 858 women in a logistic mixed model that considered: occupational class (in 5 levels, based on last occupation), education, income, characteristics related to family, housing, neighborhood, household wealth (social allocations, perceived financial difficulties in 4 levels, income tax), employment status, supplementary health insurance, and social network (4 levels). Results The rate of overdue patients did not vary between general practitioners (21%). social position indicators associated with overdue status (odds ratio between 2 adjacent decreasing social levels) were occupational class (1.20, 95% CI: 1.03–1.41), social network (1.52, 95% CI: 1.18–1.94), financial difficulties (1.42, 95% CI: 1.07–1.88), neighborhood safety (2.15, 95% CI: 1.10–4.20), and allocations (3.34, 95% CI: 1.12–9.96). Conclusions Even among women visiting general practitioners we observed marked social inequalities that persist above and beyond occupational class.
Study objective: To analyse the relation between preterm birth and working conditions in Europe using common measures of exposure and to test whether employment related risks varied by country of ...residence. Design: A case-control study in which cases included all consecutive singleton preterm births and controls included one of every ten singleton term births in each participating maternity unit. Data about working conditions were obtained by interview from women after delivery. Setting: Sixteen European countries. Participants: The analysis included 5145 preterm and 7911 term births of which 2369 preterm and 4098 term births were to women employed during pregnancy. Analyses of working conditions were carried out for women working through at least the third month of pregnancy. Main results: Employed women did not have an excess risk of preterm birth. Among working women, a moderate excess risk was observed for women working more than 42 hours a week (OR = 1.33, CI = 1.1 to 1.6), standing more than six hours a day (OR = 1.26, CI = 1.1 to 1.5), and for women with low job satisfaction (OR = 1.27, CI = 1.1 to 1.5). There were stronger links in countries with a lower overall level of perinatal health and a common practice of long prenatal leaves. Conclusion: These findings show that specific working conditions affect the risk of preterm birth. They also suggest employment related risks could be mediated by the social and legislative context.
Outline : 1. Expected psychological consequences today and in the future ; 2. More marked clusters of inequality ; 3. Violence and tragedies ; 4. Forgoing medical care and follow-up ; 5. Daily ...routine at-risk ; 6. Adolescents in difficulty ; 7. From a crisis, additional proof of a global finding from child health professionals.
Given the benefits of breastfeeding (BF), healthcare institutions recommend that a child should be breastfed for the first 6 months of its life. This study provides a review of BF as a function of ...socioeconomic criteria in various industrialized countries.
A review was carried out between 1st January 1998 and 1st March 2009, using Medline and the Public Health Database. The papers were selected independently by two persons, using a methodological grid designed to evaluate the quality of the studies. From 1126 initially selected papers, 26 from 16 different countries were retained for further analysis.
The prevalence of exclusive BF initiation was the highest in Norway, Denmark, and Japan with, respectively, 99, 98.7, and 98.3%. This prevalence was the lowest in the United Kingdom, the United States, and France with, respectively, 70, 69.5, and 62.6%. Women who breastfeed less were most commonly found to be young, single, from a low socioeconomic group, or with a low level of education. Women from immigrant population groups breastfed more than the native-born population during their pregnancy.
Knowledge of the sociodemographic distribution of women who breastfeed is essential for the definition of preventive policies, which are needed to reduce health-related social inequalities. An in-depth analysis of existing primary healthcare programs would allow new strategies to be defined.
To investigate risk factors of total, spontaneous and induced preterm birth in 2010 and differences between 1995 and 2010.
The national perinatal surveys are based on a representative sample of ...births in France. We selected live-born singletons (n=14,326 in 2010 and 12,885 in 1995) and used multiple regression analyses to calculate adjusted odds ratios (aOR) for maternal sociodemographic characteristics, obstetric history, prenatal care and smoking.
The main risk factors in 2010 were parity 1 compared to parity 2 (aOR=1.9 95% CI 1.5–1.3), previous preterm delivery (aOR=6.6 5.0–8.7), pre-pregnancy body mass index<18.5 compared to 18.5–24.9kg/m2 (aOR=1.7 1.4–2.2), level of education completed: high school or less, inadequate prenatal care and cannabis use. Most risk factors of spontaneous and induced preterm births were similar. Compared to 1995, maternal age≥35 years and previous induced abortion were no longer associated with preterm birth in 2010.
Identified risk factors for preterm birth in France in 2010 agree with the literature. Increases in baseline rates for maternal age and medically induced abortions may explain changes in certain preterm birth risk factors.
Étudier les facteurs associés à la prématurité totale, spontanée et induite en 2010, et leurs évolutions depuis 1995.
Les enquêtes nationales périnatales sont fondées sur des échantillons représentatifs des naissances en France. L’analyse a porté sur les singletons nés vivants (n=14 326 en 2010 et 12 885 en 1995). Des odds ratios ajustés (ORa) ont été estimés par des régressions logistiques pour les caractéristiques socio-démographiques, les antécédents obstétricaux, le suivi prénatal et les consommations de substances.
Les principaux facteurs associés à la prématurité en 2010 étaient la primiparité (ORa=1,9 1,5–1,3) par rapport à une parité, les antécédents d’enfants nés prématurés (ORa=6,6 5,0–8,7), un IMC<18,5 kg/m2 (ORa=1,7 1,4–2,2), un niveau d’études inférieur ou égal au lycée, un suivi prénatal inadéquat et la consommation de cannabis. Les principaux facteurs liés à la prématurité spontanée et induite étaient semblables. Un âge de 35ans ou plus et un ou plusieurs antécédents d’IVG étaient associés à la prématurité en 1995, mais pas en 2010.
Les facteurs de risque de prématurité sont très souvent en accord avec la littérature internationale. L’augmentation de l’âge maternel et du recours aux IVG médicamenteuses pourraient expliquer les changements des facteurs de risque.
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