Small for Gestational Age Newborns in French Guiana: The Importance of Health Insurance for Prevention.

Objectives: Small for gestational age (SGA) newborns have a higher risk of poor outcomes. French Guiana (FG) is a territory in South America with poor living conditions. The objectives of this study were to describe risk factors associated with SGA newborns in FG. Methods: We used the birth cohort that compiles data from all pregnancies that ended in FG from 2013 to 2021. We analysed data of newborns born after 22 weeks of gestation and/or weighing more than 500 g and their mothers. Results: 67,962 newborns were included. SGA newborns represented 11.7% of all newborns. Lack of health insurance was associated with SGA newborns (p < 0.001) whereas no difference was found between different types of health insurance and the proportion of SGA newborns (p = 0.86). Mothers aged less than 20 years (aOR = 1.65 [1.55-1.77]), from Haiti (aOR = 1.24 [1.11-1.39]) or Guyana (aOR = 1.30 [1.01-1.68]) and lack of health insurance (aOR = 1.24 [1.10-1.40]) were associated with SGA newborns. Conclusion: Immigration and precariousness appear to be determinants of SGA newborns in FG. Other studies are needed to refine these results.

Meckel-gruber syndrome: About an evocative case in French Guiana-When ultrasound is insufficient for accurate diagnosis in a complex syndrome.

In modern medicine, prenatal diagnosis can no longer be sufficient by ultrasound examination. The genetic technical progress and its contribution may remain a challenge in isolated sites with the consequences that this implies in perinatal health.

Predictive factors of preterm delivery in French Guiana for singleton pregnancies: definition and validation of a predictive score.

Objective: Given the high rate of premature birth in French Guiana (13.5%), and its stability in time, the aim of the present study was to define a predictive score for preterm birth in women with a unique pregnancy in order to help prioritize health resources in the local context.Methods: A retrospective study was conducted on all deliveries of unique pregnancies in French Guiana collected between 1 January 2013 and 31 December 2014 in the Registre d'Issue de Grossesse Informatisé (RIGI), a registry that collects data on live births over 22 weeks of amenorrhea on the territory. Statistically significant predictors (p < .05) of preterm delivery were included in a logistic regression model. The selected variables were chosen to be available during the first trimester. Coefficients were used to establish a score which was categorized and prospectively validated using data from 2015.Results: Seven explanatory variables, all measurable during the first trimester of pregnancy, were significantly associated with preterm birth. The predictive score divided in deciles allowed to establish sensitivity and specificity thresholds. Overall, depending on the chosen threshold the score sensitivity was low and the specificity was high. Lowering the threshold identified half of women as "at risk" for preterm birth.Conclusion: This first trimester score was insufficiently sensitive to identify individual women at risk for preterm delivery.

Risk Factors for Very Preterm Births in French Guiana: The Burden of Induced Preterm Birth.

Background Early preterm births are still represented as a major public health problem in French Guiana. The objective of the present study was to study factors associated with early preterm birth in French Guiana. Methods A monocentric age-matched case control study was conducted at the sole level 3 maternity in French Guiana. In utero fetal deaths and multiple pregnancies were not included. Cases were defined as giving birth prematurely between 22 and 32 weeks of pregnancy. Controls were defined as women delivering on term. For each case three controls were matched on age. In utero deaths, medical pregnancy interruptions and multiple pregnancies (a known major cause of preterm delivery) were excluded from the study. Sociodemographic variables, medical and obstetrical history, the complications of the current pregnancy, and the results of the last vaginal swab before delivery were recorded in the second or the third trimester. Thematic conditional logistic regression models were computed. Results Overall 94 cases and 282 matched controls were included. Preterm delivery was spontaneous in 47.9% (45/94) of the cases and induced in 52.1% (49/94).A history of preterm birth was associated with both spontaneous and induced preterm delivery. The absence of health insurance was associated with spontaneous early preterm delivery AOR (adjusted odd ratio) = 9.1 (2.2-38.3), p = 0.002 but not induced preterm delivery adjusted odd ratio (AOR) = 2.1 (0.6-6.7), p = 0.2. Gravidic hypertension, placenta praevia, intrauterine growth retardation and mostly preeclampsia (66%, 32/49) were linked to induced preterm delivery but not spontaneous delivery. Gardnerellavaginalis and group B Streptococcus infections were significantly associated with induced early preterm delivery but not spontaneous early preterm delivery. Conclusions Social factors were associated with spontaneous early preterm delivery, suggesting that efforts to reduce psychosocial stressors could lead to potential improvements. Vaginal infections were also associated with induced preterm labor suggesting that early diagnosis and treatment could reduce induced early preterm delivery. Preeclampsia was a major contributor to induced early preterm delivery. Reliable routine predictors of preeclampsia are still not available which makes its prevention impossible in first pregnancies.

Risk factors for premature birth in French Guiana: the importance of reducing health inequalities.

OBJECTIVES: French Guiana has the highest birth rate in South America. This French territory also has the highest premature birth rate and perinatal mortality rate of all French territories. The objective was to determine the premature birth rate and to identify the prevalence of risk factors of premature birth in French Guiana. METHODS: A retrospective study of all births in French Guiana was conducted between January 2013 and December 2014 using the computerized registry compiling all live births over 22 weeks of gestation on the territory. RESULTS: During this period 12 983 live births were reported on the territory. 13.5% of newborns were born before 37 (1755/12 983). The study of the registry revealed that common sociodemographic risk factors of prematurity were present. In addition, past obstetrical history was also important: a scarred uterus increased the risk of prematurity adjusted odds ratio =1.4, 95%CI (1.2-1.6). Similarly, obstetrical surveillance, the absence of preparation for birth or of prenatal interview increased the risk of prematurity by 2.4 and 2.3, the excess fraction in the population was 69% and 72.2%, respectively. CONCLUSIONS: Known classical risk factors are important. In the present study excess fractions were calculated in order to prioritize interventions to reduce the prematurity rate.