[Socioeconomic disparities for maternal serum screening of Down's syndrome: trends between 1998 and 2003 in France]. / Disparités socioéconomiques dans le dépistage prénatal de la trisomie 21 par marqueurs sériques: évolution entre 1998 et 2003 en France.

OBJECTIVES: To compare trends in the use of and the opportunity for making an informed choice, regarding maternal serum screening for Down's syndrome. METHODS: Data were based on the national perinatal surveys of 1998 and 2003, which comprise representative samples of births in France. We used logistic regression models and likelihood ratio tests for testing the statistical significance of interactions between time trends and socioeconomic factors. RESULTS: We found a generalized increase between 1998 and 2003 in both the use of screening and in the opportunity for making an informed choice. The use of screening increased more however, for women with primary or no education (OR=3.0; 95% CI, 2.2-4.1) as compared with those with education levels beyond a high school diploma (OR: 1.8; 95% CI, 1.7-2.0). On the contrary, trends in informed choice were comparable across socioeconomic groups. Hence, disparities in the opportunity for informed choice were essentially unchanged. CONCLUSIONS: The use of serum screening, and the opportunity for informed choice regarding the test, became more widespread for women from all socioeconomic categories between 1998 and 2003. These trends were accompanied by a decrease in socioeconomic disparities in the use of screening but not in the opportunity for making an informed choice.

[Trends in perinatal health in metropolitan France between 1995 and 2003: results from the National Perinatal Surveys]. / La santé périnatale en France métropolitaine de 1995 à 2003. Résultats des enquêtes nationales périnatales.

OBJECTIVE: To study trends in the main indicators of health, medical practice and risk factors in France. Population and method. A sample of all births during one week was set up in 1995 (N=13,318), 1998 (N=13,718) et 2003 (N=14,737). We compared data from these three years. RESULTS: Between 1995 and 2003, there was an increase in maternal age, a development of some characteristics of care (HIV screening procedure, maternal serum screening of Down syndrome, in utero transfers) and an increase in the proportion of caesarean sections, epidurals and spinal anesthesia. The proportion of livebirths before 37 weeks of gestation and the proportion of newborns under 2,500 g slightly increased but the differences were mainly between 1995 et 1998. In 2003, obstetrician gynecologists were the main care providers during pregnancy. However 24.3% of women had their first visit with a general practitioner. For the following visits, 15.4% of women had seen a GP at least once and 26.9% had seen a midwife in maternity unit at least once. CONCLUSION: Because of the trends in obstetrical practice and organisation of services, routine national perinatal surveys are useful to show major changes and yield quick answers to specific questions.

[Difficulties with the follow-up of a cohort of very preterm infants: The EPIPAGE Paris-Petite-Couronne population]. / Difficultés de suivi d'une cohorte d'enfants nés grands prématurés : EPIPAGE Paris-Petite-Couronne.

OBJECTIVES: To describe the characteristics of the children of parents who did not respond to a follow-up questionnaire in a cohort of very preterm infants (EPIPAGE study) and to explore the reasons why they did not complete the questionnaires. METHODS: The non-respondents (N = 176) were the parents who did not return the questionnaires at 1 and 2 years. Contacts were organised by telephone calls and at home visits. RESULTS: The families of the non-respondents presented more socioeconomic difficulties and their children were born more preterm than those followed up without difficulties. The efforts made to contact the non-respondents revealed that their families were often confronted with major adverse socioeconomic difficulties, had severe illnesses and psychological troubles. Half of the children of the non-respondents were finally examined at the 5-year assessment. They showed lower performances at the cognitive development test and a poorer health status than the children of the respondents. CONCLUSION: When the follow-up does not include the initial population in its totality, the socioeconomic difficulties are underestimated and probably also the rate of sequelae associated with very preterm delivery.