[Maternal cigarette smoking during pregnancy and malformations]. / Quels sont les risques d'embryo-foetopathie liés à l'exposition au tabagisme pendant la grossesse?

While cigarette smoking continues to increase among women, the influence of maternal smoking during pregnancy on the prevalence of malformations has been widely investigated over the past 30 years. Although many women discontinue smoking during pregnancy, the fetus is still often exposed during first weeks of gestation, including embryological development, raising questions about the teratogenic effect of smoking. We review the literature on this topic highlighting methodological issues. The overall prevalence of malformations does not seem to be increased among offspring of women who smoked during pregnancy. A mild but significant association was found between several specific malformations (oral cleft, gastroschisis and craniosynostosis) and maternal smoking. Though the odds ratios were very low for these associations, the change in absolute number, especially for facial clefts, is important due to high prevalence of smoking during pregnancy. These findings should be taken into account in preconceptional counselling.

[Antiretroviral agents and pregnancy: mitochondrial dysfunction and nucleoside analogs]. / Antirétroviraux et grossesse: cytopathie mitochondriale et analogues nucléosidiques.

An alert was published during 1999 by the French Perinatal Cohort: eight cases of mitochondrial dysfunction were reported among 1754 infants exposed to nucleoside analogues in utero and during the neonatal period. These eight infants were not infected by HIV. Mitochondrial toxicity of nucleoside analogues is clearly described in adult HIV patients receiving NRTI. Zidovudine (the only and the first NRTI studied) induced mitochondrial DNA dysfunction in animals (monkeys) and neurobehavourial effects in mice at a dose similar to the human dose. Practitioners have been informed. Retrospective and prospective studies are in progress. The recommendations for prevention of maternofoetal transmission of HIV are not reassessed. Pregnant women in rich countries are receiving combination antiretroviral therapy. Information of women has to be undertaken and therapeutic strategies for maternal indication have to be discussed case by case. Careful long term follow up of children exposed to antiretroviral agents is a priority.

[Concept of causal implication in unexpected effects of drugs. An example of cardiotoxicity caused by anthracyclines]. / Notion d'imputabilité des effets inattendus des médicaments. Exemple d'un cas de cardiotoxicité aux anthracyclines.

Over the last 30 years, considerable progress have been made in developing methodologies to analyze unwanted drug effects. The aim of this study is to explain the French method utilized to impute the side effects of a drug. An example of anthracycline cardiotoxicity will be discussed.