[Observational study of a social device for women in precarious situations during pregnancy and post-partum]. / Étude observationnelle d'un dispositif d'aide aux femmes en situation de précarité pendant la grossesse et le post-partum.

OBJECTIVES: To assess the impact of the Regional experimental accompanying nutrition and breast-feeding for pregnant women (PRENAP) 75 social device on the duration of postpartum hospitalization and breast-feeding for pregnant women in precarious situation. METHODS: A retrospective observational study took place between November 2013 and May 2015 in a type III Parisian maternity. Comparison of sociodemographic, perinatal and postpartum characteristics of women in precarious situations (no stable housing and no social care or universal medical coverage or state medical aid) was done according to whether they were included in the system PRENAP or not. RESULTS: Over the study period, 344 (4.6%) women in precarious situations gave birth in this maternity. Among these women, the women included in the PRENAP system were more frequently in a very unfavorable social situation than those who were not included. The inclusion in the PRENAP device did not reduce the hospitalization in post-partum. Breast-feeding was chosen more frequently by the women included in the PRENAP device. CONCLUSION: The PRENAP device seems to favor the use of breast-feeding, but is not associated with a diminution of the hospitalization time in post-partum. This social device, which seems to be beneficial in terms of social and medical support for women in precarious situations, deserves to be evaluated prospectively.

Risk factors of preterm birth in France in 2010 and changes since 1995: Results from the French National Perinatal Surveys.

OBJECTIVES: To investigate risk factors of total, spontaneous and induced preterm birth in 2010 and differences between 1995 and 2010. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.

[Repeat induced abortion: A multicenter study on medical abortions in France in 2014]. / Caractéristiques des femmes ayant eu recours à plusieurs IVG ­ Enquête multicentrique sur les IVG médicamenteuses en France en 2014.

OBJECTIVES: To describe the social characteristics of women seeking a medical abortion, and the conditions of that abortion, according to whether they had one or more previous induced abortions. METHODS: An observational study was carried out in 11 French units in 2013-2014, among women 18 years or older. A self-administered questionnaire on the abortion context and social situation was given to them, as well as a diary to record the pain level for each of five days following the mifepristone intake. The sample included 453 women. RESULTS: Among the respondents, 22% had had one previous abortion and 8% had had two or more. Women having had a previous voluntary abortion were more often isolated and in a poorer social situation than women having their first abortion. CONCLUSION: Better support for contraception after abortion could reduce the number of repeated abortions.

Trends in urinary incontinence in women between 4 and 24 months postpartum in the EDEN cohort.

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. TWEETABLE ABSTRACT: Postnatal urinary incontinence progression is mostly related with mode of delivery and subsequent pregnancy.

Maternal tobacco smoking in pregnancy and children's socio-emotional development at age 5: The EDEN mother-child birth cohort study.

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.

Prevalence and characteristics of women reporting poor mental health during pregnancy: Findings from the 2010 French National Perinatal Survey.

BACKGROUND: Self-rated mental health is a useful indicator to examine the positive dimension of mental health and psychological well-being. The primary objective of this study was to estimate the prevalence of poor self-rated mental health during pregnancy in a nationally representative population in France. The second objective was to assess the sociodemographic and medical characteristics associated with this condition and with a health professional's consultation for psychological problems. METHODS: The study was based on the 2010 French National Perinatal Survey, which included all singleton live births in French maternity units during a 1-week period (n=14,326 women). Self-rated mental health was assessed using the following single-item question: "During your pregnancy, how did you feel from a psychological point of view: good - fairly good - rather poor - poor?" Women were also asked if they had visited a healthcare professional for psychological problems. They were interviewed between delivery and discharge to collect information on mental health, sociodemographic and medical characteristics, the context of their pregnancy, and their prenatal care. RESULTS: Of the women interviewed, 8.9% [95% CI, 8.5-9.5%] reported poor self-rated mental health during pregnancy. Among them, 18.7% consulted a healthcare professional for psychological problems. Sociodemographic characteristics indicative of social disadvantage were associated with a higher-risk of poor self-rated mental health, and a social gradient was observed. However, more favorable social characteristics were associated with consultation with a healthcare professional for these psychological difficulties. The reaction to the discovery of pregnancy and prenatal care differed significantly depending on self-rated mental health. Women with poor mental health had more complicated pregnancies. CONCLUSION: This study showed strong associations between many socially disadvantaged characteristics and a positive dimension of mental health. The findings suggest that well-being measures such as self-rated mental health should be routinely assessed during pregnancy so that women can be offered more appropriate support.

Predictors of persistent maternal depression trajectories in early childhood: results from the EDEN mother-child cohort study in France.

BACKGROUND: Maternal depression in the pre- and postpartum period may set women on a course of chronic depressive symptoms. Little is known about predictors of persistently elevated depressive symptoms in mothers from pregnancy onwards. The aims of this study are to determine maternal depression trajectories from pregnancy to the child's fifth birthday and identify associated risk factors. METHOD: Mothers (N = 1807) from the EDEN mother-child birth cohort study based in France (2003-2011) were followed from 24-28 weeks of pregnancy to their child's fifth birthday. Maternal depression trajectories were determined with a semi-parametric group-based modelling strategy. Sociodemographic, psychosocial and psychiatric predictors were explored for their association with trajectory class membership. RESULTS: Five trajectories of maternal symptoms of depression from pregnancy onwards were identified: no symptoms (60.2%); persistent intermediate-level depressive symptoms (25.2%); persistent high depressive symptoms (5.0%); high symptoms in pregnancy only (4.7%); high symptoms in the child's preschool period only (4.9%). Socio-demographic predictors associated with persistent depression were non-French origin; psychosocial predictors were childhood adversities, life events during pregnancy and work overinvestment; psychiatric predictors were previous mental health problems, psychological help, and high anxiety during pregnancy. CONCLUSIONS: Persistent depression in mothers of young children is associated to several risk factors present prior to or during pregnancy, notably anxiety. These characteristics precede depression trajectories and offer a possible entry point to enhance mother's mental health and reduce its burden on children.

Cannabis use during pregnancy in France in 2010.

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.

Infant feeding patterns over the first year of life: influence of family characteristics.

BACKGROUND/OBJECTIVES: 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. SUBJECTS/METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Prevalence of breastfeeding in industrialized countries.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Do social inequalities in cervical cancer screening persist among patients who use primary care? The Paris Prevention in General Practice survey.

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.

[Sexual orientation and mental health: a review]. / Orientation sexuelle et santé mentale : une revue de la littérature.

BACKGROUND: The aim of this paper is to review available knowledge on sexual orientation and mental health, especially for women. METHODS: Papers published in English or French, between 1997 and 2007, were selected in PubMed using the following keywords "homosexuality/sexual orientation and mental health/depression/suicide". To be retained, papers had to contain findings from quantitative surveys comparing homosexual and heterosexual adults. In all, this review analyses 22 papers including two that are based on the same survey. RESULTS: This review found a general pattern of poorer mental health for homosexuals and even more so for bisexuals compared to heterosexuals. Results are especially consistent regarding elevated risk of suicide attempts.

Social inequalities in mortality by cause among men and women in France.

BACKGROUND: The aim of this study was to compare inequalities in mortality (all causes and by cause) by occupational group and educational level between men and women living in France in the 1990s. METHODS: Data were analysed from a permanent demographic sample currently including about one million people. The French Institute of Statistics (INSEE) follows the subjects and collects demographic, social and occupational information from the census schedules and vital status forms. Causes of death were obtained from the national file of the French Institute of Health and Medical Research (INSERM). A relative index of inequality (RII) was calculated to quantify inequalities as a function of educational level and occupational group. Overall all-cause mortality, mortality due to cancer, mortality due to cardiovascular disease and mortality due to external causes (accident, suicide, violence) were considered. RESULTS: Overall, social inequalities were found to be wider among men than among women, for all-cause mortality, cancer mortality and external-cause mortality. However, this trend was not observed for cardiovascular mortality, for which the social inequalities were greater for women than for men, particularly for mortality due to ischaemic cardiac diseases. CONCLUSIONS: This study provides evidence for persistent social inequalities in mortality in France, in both men and women. These findings highlight the need for greater attention to social determinants of health. The reduction of cardiovascular disease mortality in low educational level groups should be treated as a major public health priority.

[Women who have sex with women: their sexual biography, reproductive health and experience with violence]. / Les femmes qui ont des relations homosexuelles: leur biographie sexuelle, leur santé reproductive et leur expérience des violences.

OBJECTIVE: To compare sociodemographic characteristics, sexual and reproductive biographies and experience of violence according to the fact that women have or have not had homosexual relationship. PATIENTS AND METHODS: From the national survey on violence against women in France carried out in 2000 by phone, two groups have been compared: 78 women who have had at least one woman sexual partner and 6332 women who have had only male partners during lifetime. RESULTS: Women who have had sexual relationships with women more often have high level social positions and live in large cities. They have a more diverse sexual life that they begin younger and more partners, mainly men. They use contraception less often. They have more sexually transmitted infections and are more often tested for HIV. They visit gynaecologists as often as other women. They are more often victims of violence, especially physical violence as adults. DISCUSSION AND CONCLUSION: These results, in an understudied field in France, are consistent with findings from the international literature. They attest to the difficulties women may be confronted with in situations where autonomy and marginality are combined. Doctors need to be better informed about the diversity of their trajectories in order to provide appropriate medical care.

[Familial violence during pregnancy]. / Violences familiales pendant la grossesse.

After a review of medical literature on domestic violence during pregnancy, this paper shows the results of a survey carried out in 16 European countries. The percentage of women reporting domestic violence during pregnancy varies with the country; it is specially high in Russia, Poland and Czech Republic. Women who live without partner, those whose the couple has been separated during the pregnancy or those living in an overcrowded house have been more often victim of domestic violence. Domestic violence is significantly related to preterm birth risk.

Conformity of Workers' and Occupational Health Physicians' Descriptions of Working Conditions.

To determine whether workers, describing their own work, and occupational physicians, describing typical workstations, would report the same working conditions, and whether the relationships between health status and working conditions described by these two sources would be similar. An epidemiologic survey was carried out in 1987-88 in 17 poultry slaughterhouses and six canneries in France. The data were collected in two ways: workers described their own working conditions, and occupational physicians described the working conditions at workstations in the same factories. The study included 507 workers who worked at fixed workstations that had been described by the 24 occupational physicians. Health data were obtained from the workers by the physicians during their annual visits. The agreement between workers and physicians in the descriptions of seven working conditions was analyzed. On the whole, the prevalences of exposures to the seven selected working conditions estimated by the two sources were similar. Nevertheless, the observed agreement was not necessarily high. When agreement existed about specific working conditions, the relationships observed between those conditions and workers' health were generally similar for the two sources. This result was stronger for physical health problems than for mental health problems. When both sources agreed that the worker was being exposed to a risk factor, the risk estimation was higher compared with the cases of discordant judgment. This study confirms the usefulness of information provided by experts but also the necessity to interview workers themselves about their working conditions.