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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.Tweetable Abstract: Postnatal faecal incontinence was associated with depression; postnatal screening should be encouraged and psychological support offered. [ABSTRACT FROM AUTHOR]

The incidence of ectopic pregnancy has risen substantially during the past two decades, but the aetiology of a third of cases remains unknown. We have used data from a survey of nurses in Paris, France, to examine the relation between ectopic pregnancy and various occupational exposures. We studied two groups of women--operating-theatre staff and nurses from other departments. The women were asked about outcomes of all pregnancies and occupational exposure to anaesthetic gases, formol, ionising radiation, and antineoplastic drugs during the first trimester of pregnancy. Of 734 pregnancies reported, 15 (2%) had been ectopic. In chi-square analysis, there were significant associations (p < 0.02) between ectopic pregnancy and exposure to antineoplastic drugs, the woman's age, and the number of previous pregnancies. Other occupational exposures and working in an operating theatre did not show significant associations. In logistic regression analysis with adjustment for gravidity, the odds ratio (by the exact method) for ectopic pregnancy associated with occupational exposure to antineoplastic drugs was 10.0 (95% CI 2.1-56.2). Because we had only small numbers of ectopic pregnancies, the odds ratios we estimated have wide confidence intervals. Our findings should be confirmed by a larger study specifically designed to investigate the relation between antineoplastic exposure and ectopic pregnancy. [ABSTRACT FROM AUTHOR]

Background: Maternal problems in the postpartum period may lead to suboptimal long-term health for women and could affect mother-child attachment. Social disadvantage is a risk factor for preterm birth, which carries its own burden of health issues and stress. The main aim of this study was to investigate the role for social factors in mothers' physical and emotional health-related quality of life (HRQoL) at 1 year after a preterm birth., Methods: EPIPAGE-2 is a French nationwide, prospective, population-based cohort of preterm children born before 35 weeks' gestation (N=3614 women). At birth, detailed data on the family's social status were collected. At 1 year after birth, mothers completed a mailed questionnaire to report information on their HRQoL, assessed by the Medical Outcomes Study 12-item Short Form. We used multivariate linear regression models to assess the association between social factors and maternal HRQoL., Results: At 1 year after childbirth, the emotional HRQoL of mothers of preterm children was worse than their physical HRQoL, even in women without any previous signs of psychological distress at the infant's discharge from hospital. Baseline social characteristics were the most important factors influencing the physical component of HRQoL. None of the studied social factors had any clear association with the mental component of HRQoL., Conclusion: Our study underlines the importance of social disadvantage during pregnancy as risk factors for poor physical HRQoL at 1 year after a preterm birth., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Rationale: Having same-sex partners is linked to poor psychological health and increased risk of suicide attempt. This link seems to be stronger for men than women. However, in France, there have been few studies of population samples, and the size of these studies does not always allow an in-depth analysis of these associations., Methods and Results: This study explored these associations by analysing data from a large epidemiological survey conducted in France from 2012 to 2019 that included 84,791 women and 75,530 men. The frequencies and risk ratios of depression, suicide attempts, alcohol dependence and regular cannabis use were calculated regarding two groups: those with only the other sex partners and those with any same sex partners. Risk of alcohol addiction and cannabis use was greatly increased for women who had homosexual relations, even after adjustment for social, demographic and sexual life factors, which was not the case for men. However, risk of depression and suicide attempts was increased for men who had homosexual relations; this was also true for women but to a lesser extent. The estimates remained unchanged after stratifying the population by three distinct social groups defined by education level., Conclusions: The analysis of these differences was possible because of the large sample size of the CONSTANCES survey and its recruitment in the general population. This study helps increase knowledge of the health of sexual minorities. It can help clinicians pay more attention to the potential distress of their patients and can continue to inform policymakers of the effects of discrimination and stigmatisation linked to homosexual behaviour., (©2023PublishedbyElsevierLtd.)

Background: Despite an improvement in preventive care and perinatal health in previous decades, social inequalities persist, particularly to the disadvantage of isolated or unemployed women. The objective was to analyse the evolution between 1998 and 2016 of the association between women's occupational status and perinatal outcomes., Methods: Data came from four national surveys performed in 1998, 2003, 2010 and 2016. Occupational status was defined by maternal employment status and type of occupation during pregnancy. Preventive behaviours (initiation of antenatal care, antenatal classes, breast feeding) and health outcomes (hospitalization, preterm birth, birth weight below the 10th percentile) were analysed by occupational status adjusted for other maternal characteristics, for each study year., Results: The studied sample included 12,497 women in 1998, 13,290 in 2003, 13,209 in 2010 and 11,179 in 2016. The proportion of employed women increased from 66% to 75% between 1998 and 2016, and that of housewives decreased from 22% to 12%. The proportion of preterm births globally increased between 1998 and 2016, especially for housewives. The proportion of low birthweight for gestational age (LBWGA) remained similar over the years. From 1998 to 2016, the differences between occupational groups persisted for preterm births and LBWGA., Conclusions: Occupational groups exhibited strong social differences in preventive care over the entire study period and persisted in the recent data. As a major social indicator, women's occupational status during pregnancy has to be considered as a risk factor of poor preventive behaviour and unfavourable perinatal outcomes., Competing Interests: Declaration of competing interests None., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

It is unknown how many women seeking care at French Family Planning Centres (FPCs) endure, or have endured intimate partner violence (IPV). To assess the prevalence of IPV, we surveyed women seeking care at three FPCs in the metropolitan Paris area (Seine-Saint-Denis). We examined the associations between IPV, socio-demographic characteristics and perceptions of health according to six indicators. Of the FPCs included in our survey, two are standalone facilities and one is located in The Women's Home, a multidisciplinary structure dedicated to serving survivors of violence. We conducted an observational survey from December 2018 to February 2019. All women aged 18 years and older were eligible. We solicited data on socio-demographic factors, general stability and history of violence. We measured health status on a 10-point scale for six different symptoms. Of the 274 women who participated, 27% had experienced IPV. Women who reported experiencing, or having experienced IPV were more likely to be between 25 and 44 years old (than under 25), temporarily documented or undocumented, unemployed or seeking employment, and experiencing housing insecurity. Women seeking care at The Women's House were more than twice as likely to report IPV (42%) than those visiting FPC-2 or FPC-3 (20% and 16%, respectively). Reports of violence increase among women with uncertain legal status, housing, employment and lower self-rated health. Results suggest that a FPC located in a structure specifically dedicated to serving women victims-survivors of violence like the Women's House may be more attractive to survivors., (© 2022 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.)

Background: The prevalence of overweight and obesity has increased in various countries. Normal weight before pregnancy is important to protect maternal and newborn health. This study aimed to describe the evolution of body mass index (BMI) before pregnancy in France and explore its association with two measures of socioeconomic status (SES), education and household income., Methods: Data were from four national perinatal surveys in France in 1998, 2003, 2010 and 2016 to describe the time evolution of maternal BMI. We explored the links between BMI and women's characteristics in the most recent period (2010-2016 surveys) since income information was not available before. Risk ratios (RRs) of underweight, overweight and obesity for each measure of SES were computed by using multivariable Poisson regression models., Results: Overweight and obesity prevalence increased between 1998 and 2016, from 6% to 12% for obesity. Both were inversely associated with SES (higher prevalence among least educated and poorest women), with strong variations for each social indicator, even in multivariable analyses including both. Combining education and income revealed a wide gradient; RR for obesity was 6.01 (95% confidence interval 4.89-7.38) with low education and income <2000 euros/month vs. high education and income ≥4000 euros/month., Conclusions: Public policies must implement programs to limit the increase in overweight and its unequal distribution in the population, alongside other policies to address the societal determinants of the obesogenic environment. Health professionals need to advise women to improve their eating and physical activity to limit weight gain from childhood to early adulthood., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Public Health Association.)

Intimate partner violence (IPV) can seriously affect the health of victims. Our aims were to analyze the impact of IPV intensity on psychological symptoms in a sample of 151 victimized women (21-74 years old). We collected data through anonymous-auto-administrated questionnaires from a sample of women attending five Anti-violence centers in Italy, and assessed exposure to psychological, physical, sexual, verbal, and stalking partner violence in the last year. We used multiple logistic regression analysis to examine the probability of reporting psychological symptoms associated with IPV. After controlling for the potential confounders, the increase in the intensity of violence was associated with an increase in reported nightmares, panic attacks, and auditory hallucinations, with a dose-response effect. We think that understanding the impact of IPV on women's mental health is necessary to improve their psychological well-being, support their path to liberation, and prevent chronic and more serious suffering.

This study explores intimate partner violence (IPV) evolution during the lockdown with a sample of 238 women (44% cohabitating and 56% not cohabitating with the perpetrator), attending five antiviolence centers in Italy (June-September 2020). Questions included 12 items on IPV and, for each item, a question about whether violence increased/stayed the same/decreased during lockdown; an indicator of IPV modifications was constructed. Two distinct patterns, confirmed after adjustment for socio-demographic factors, emerged: IPV increased for 28% of cohabitating and decreased for 56% of non-cohabitating women. Such results suggest the efficacy of physical distancing-strictly controlled by the State-in the prevention of IPV.

Objectives: Maternal depression occurs in 13-20% of women from low-income countries, which is associated with negative child health outcomes, including diarrheal disease. However, few studies have investigated its impact on child risk of infectious disease. We studied the impacts of maternal depressive symptoms and parent-child interactions, independently, on the risk of Plasmodium falciparum malaria and soil-transmitted helminth infection in Beninese children., Methods: Our population included mothers and children enrolled in a clinical trial during pregnancy (MiPPAD) in Benin. The Edinburgh Postnatal Depression Scale (EPDS) assessed maternal depressive symptoms and the home observation measurement of the environment (HOME) assessed parent-child interactions. Blood and stool sample analyses diagnosed child malaria and helminth infection at 12, 18, and 24 months. Negative binomial and Poisson regression models with robust variance tested associations., Results: Of the 302 mother-child pairs, 39 (12.9%) mothers had depressive symptoms. Median number of malaria episodes per child was 3 (0-14) and 29.1% children had at least one helminth infection. Higher EPDS scores were associated with lower HOME scores; relative risk (RR) 0.97 (95% confidence interval (CI) 0.95, 0.99), particularly with lower acceptance, involvement, and variety subscales; RR 0.92 (95% CI 0.85, 0.99), RR 0.82 (95% CI 0.77, 0.88), RR 0.93 (95% CI 0.88, 0.99), respectively. However, neither exposure was associated with risk of parasitic infection in children., Conclusions for Practice: Maternal depressive symptoms are associated with poor parent-child interactions, particularly acceptance of behavior, involvement with children, and variety of interactions, but these exposures do not independently impact risk of parasitic infection in children., (© 2021. The Author(s).)

The objective of our study was to investigate differences in the management of men and women treated for hypertension while considering the gender of their physicians. We used the data from the cross-sectional Paris Prevention in General Practice survey, where 59 randomly recruited general practitioners (42 men and 19 women) from the Paris metropolitan area enroled every patient aged 25-79 years taking antihypertensive medication and seen during a 2-week period (520 men and 666 women) in 2005-6. The presence in the medical files of six items recommended for hypertension management (blood pressure measurement, smoking status, cholesterol, creatinine, fasting blood glucose and electrocardiogram) was analysed with mixed models with random intercepts and adjusted for patient and physician characteristics. We found that the presence of all items was lower in the records of female than male patients (3.9 vs. 6.9%, p = 0.01), as was the percentage of items present (58.5 vs. 64.2%, p = 0.003). The latter gender difference was substantially more marked when the physician was a man (69.3 vs. 63.4%, p = 0.0002) rather than a woman (63.5 vs. 61.0%, p = 0.46). Although all guidelines recommend the same management for both genders, the practices of male physicians in hypertension management appear to differ according to patient gender although those of women doctors do not. Male physicians must be made aware of how their gender influences their practices., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited part of Springer Nature.)

Background: Disparities in neuraxial analgesia use for childbirth by maternal origin have been reported in high-resource countries. We explored the association between maternal immigrant status (characterised separately by geographic continental origin and Human Development Index [HDI] of maternal country of birth) and neuraxial analgesia use. We hypothesised that immigrant women from low-resource countries may have more limited access to neuraxial analgesia than native French women., Methods: The study population, extracted from the 2016 National Perinatal Survey, a cross-sectional study of a representative sample of births in France, included only women who initially wished to deliver with neuraxial analgesia. We used multivariable multilevel logistic regression to explore the association between immigrant status and both use of neuraxial analgesia and its timely administration., Results: Among the 6070 women included, 88.1% gave birth with neuraxial analgesia and 15.8% were immigrants. There was no difference in neuraxial analgesia use between native French women and either immigrant women by geographic continental region of origin, or immigrants from countries with low HDI. However, immigrants from countries with very high HDI were more likely to give birth with neuraxial analgesia (adjusted odds ratio [aOR]=2.6; 95% confidence interval (CI), 1.2-5.8; P=0.018) and its timeliness <60 min after admission (aOR=1.8; 95% CI, 1.2-2.7; P=0.005) compared with native French women., Conclusions: In France, immigrant women from low-resource countries have similar access to labour neuraxial analgesia to native French women. Our results suggest differential neuraxial analgesia use in favour of immigrant women from very high HDI countries compared with native women., Competing Interests: Declarations of interest The authors declare that they have no conflicts of interest., (Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Background: To examine disparities by maternal place of birth in the opportunity to make an informed choice about Down syndrome screening, in France, where the national guidelines recommend that physicians offer it to all pregnant women., Methods: We used population-based data from the nationally representative French Perinatal Surveys in 2010 and 2016 (N=24,644 women) to analyze the opportunity for an informed choice for prenatal screening, measured by a composite indicator., Results: Among the 24 644 women in the study, 20 612 (83.6%) were born in France, 861 (3.5%) elsewhere in Europe, 1550 (6.3%) in North Africa, and 960 (3.9%) in sub-Saharan Africa. The probability of screening was lower for women born outside France. After adjustment for survey year, maternal age, parity, education level, and the maternity unit's level of perinatal care, women born outside France had the opportunity to make an informed choice less often than women born in France. This association remained essentially the same even after excluding women without adequate prenatal care., Conclusions: Women born outside France, including those with adequate prenatal care, had less opportunity than women born in France to make an informed choice about prenatal screening for Down syndrome., (© 2021. The Author(s).)

Background: Every year, it is estimated that 143 000 French children are exposed to interparental violence (IPV). This exposure may have deleterious lifelong impact on mental health., Objective: To investigate the associations between exposure to IPV in childhood and, as adults, the presence of depressive symptoms during the past year, suicidal thoughts and lifetime suicide attempt., Methods: Our study is based on data from the 2017 French Health Barometer, a general population cross-sectional phone survey. 25 319 adults living in Metropolitan France responded. Data were weighted to obtain a representative sample of the French population. Associations between childhood exposure to IPV and each of three outcomes in adulthood-symptoms of depression, suicidal ideation in the past year and lifetime suicide attempt-were studied by calculating odds ratios (ORs) and their 95% confidence intervals (CIs), stratifying by sex and using multivariate models (logistic regression)., Results: After adjustment for age, social variables, negative life events in childhood and lifetime history of sexual violence, reporting witnessed IPV is significantly associated with the presence of symptoms of depression during the past 12 months (aORmen = 1.88, 95% CI = 1.49-2.38, and aORwomen = 2.00, 1.72-2.32), suicidal thoughts in the past 12 months (aORmen = 1.97, 1.48-2.64, and aORwomen = 2.35, 1.89-2.93), and at least one lifetime suicide attempt (aORmen =2.39, 1.83-3.11 and aORwomen = 2.66, 2.25-3.16)., Conclusion: Associations shown between a history of exposure to IPV and three mental health indicators in adulthood underline the need to study the lifelong impact of IPV., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To describe maternal smoking trends in France between 1972 and 2016, and identify whether maternal characteristics associated with smoking in the 3rd trimester of pregnancy evolved between 2010 and 2016. Methods: Using French National Perinatal Surveys, we estimated proportions of smokers and the number of cigarettes smoked both just before pregnancy and during the 3rd trimester from 1972 to 2016. We used a Poisson model with robust variance to estimate prevalence ratios for smoking during pregnancy. Results: Proportions of mothers quitting smoking were relatively stable (46.0% in 1972 and 45.8% in 2016). The number of cigarettes smoked just before pregnancy and in the 3rd trimester decreased from 1995 onward. However, proportions of smokers remained high before (30.1%) and during the 3rd trimester in 2016 (16.2%). Smoking in the 3rd trimester was associated with a lower education level and lower income in both 2010 and 2016, whereas the association with age, country of birth and parity varied according to the survey year. Conclusion: Early targeted interventions are needed for smokers who plan to have a child and must take smokers' characteristics during pregnancy into account., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Demiguel, Blondel, Bonnet, Nguyen-Thanh, Saurel-Cubizolles and Regnault.)

Objective: The aim of the study was to analyse the relationship between adverse childhood experiences (ACEs) and repeat induced abortion, with regard to the potential effects of social deprivation and intimate partner violence., Methods: An observational cross-sectional survey was conducted across each of the 25 abortion centres in Aquitaine, France, from 15 June to 15 September 2009. The sample comprised 806 women >18 years who had requested an induced abortion. Data were collected through a self-reported anonymous questionnaire on ACEs and experience of previous abortion. The main outcome measure was the percentage of repeat induced abortions., Results: Among the participants, 473 (58.7%) were having their first induced abortion and 333 (41.3%) had already had a previous induced abortion. The abortion rank (first, second, third or more) was inversely related to the proportion of women with no ACE exposure (28%, 20% and 9%, respectively) and positively related to the proportion of women with a high ACE exposure (17%, 27% and 32%, respectively). Compared with women with no ACE exposure who were having a first induced abortion, in those with high ACE exposure, the odds of a third or more request for abortion was high: adjusted odds ratio 7.73 (95% confidence interval 3.56, 16.77)., Conclusion: We found a strong graded link between the extent of ACE exposure and the occurrence of repeat induced abortion.

Aim: To describe maternal employment and the socio-economic status of the household up to 8 years after the very preterm birth of a child, according to the presence and type of motor or cognitive impairment., Method: A total of 1885 families from the French EPIPAGE cohort of children who were born very preterm between 1997 and 1998 were included. Motor and cognitive impairments were identified in children between the ages of 2 and 8 years in 770 families and were classified according to type. The 1115 families with children born very preterm without these impairments were considered the reference group., Results: Mothers of children with severe motor or cognitive impairments were less often working at 5 years after the birth than the reference mothers (21% and 30% vs 57%; p<0.001). Those working before birth returned to work less often and those not working started to work less often after the birth than did reference mothers. At 8 years, mothers of children with severe impairments reported financial difficulties more often than mothers of children without impairments., Interpretation: Despite a fairly protective regulatory framework in France, families of infants born very preterm with severe motor or cognitive impairments are socially underprivileged. Measures to maintain an acceptable standard of living for these families and their children are needed., (© 2020 Mac Keith Press.)

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., Tweetable Abstract: Postnatal faecal incontinence was associated with depression; postnatal screening should be encouraged and psychological support offered., (© 2019 Royal College of Obstetricians and Gynaecologists.)

Objectives Even during pregnancy women may suffer from violence. We estimated the prevalence of physical abuse during pregnancy, we analyzed the main risk factors and described the relationship between physical violence, psychological wellbeing and pregnancy outcome. Methods We used a national representative sample of births, in all public and private maternity units, in 2016 in France. Women were interviewed after delivery, on their living conditions and occurrence of physical violence at least once during pregnancy. The study of risk factors and pregnancy outcome was done with multivariable logistic regressions. Results Of 12,330 women included in the analysis 1.8% (95% CI 1.6-2.0) had been exposed to physical violence during pregnancy. Risk of violence was associated with the couple situation [women without a partner or in couple not cohabiting (OR 2.89, 95% CI 1.96-4.26)], household income (less than 3000 euros monthly), and state medical assistance coverage. Physical violence was more prevalent in case of a history of induced abortion or cannabis use during pregnancy. Psychological distress was more frequent with than without physical violence (e.g., 62% vs. 24% had a sadness period during pregnancy, p < 0.001). The risk of spontaneous preterm birth and transfer of the newborn to a neonatal intensive care unit were significantly higher among women experiencing physical violence during pregnancy compared to other women. Conclusions for Practice Main factors associated with increased risk of violence during pregnancy were socio-economics. The identification by caregivers of women exposed to violence during pregnancy needs to be improved to develop preventive and care strategies.

The aim of this study is to describe sexual harassment among Italian university students and analyze the relationship between harassment and disordered eating behaviors. An observational survey was conducted among university students at Trieste University (Italy) in spring 2014. Students answered an anonymous self-administered questionnaire about sexual harassment, including three domains-sexual harassment, unwanted comments on physical appearance, cyber-harassment-and disordered eating behaviors. The global sexual harassment index was computed with three levels: Level 0, no harassment; Level 1, harassment in at least one of the three domains; and Level 2, harassment in two or three domains. Disordered eating behaviors were classified by at least one of the following: (a) eating without being able to stop or vomiting at least once or twice a month, (b) using laxatives or diuretics at least once or twice a week, (c) monitoring weight every day, and (d) dieting at least very often. The sample included 759 students (347 men and 412 women; 18-29 years old). Experiencing sexual harassment was related to eating disorder symptoms for both genders with a regular gradient: the higher the harassment score, the more frequent the disordered eating behavior symptoms, even after adjusting for age and previous sexual violence. The association was stronger for males than females. Sexual harassment and disordered eating behaviors have long been considered mainly a female problem. Men are not exempt from these problems and in some cases may be more affected than women. The topics should be assessed in men and women.

Only a few studies have analyzed the association between sexual harassment (SH) and mental health controlling for other types of violence. The aim of this study was to describe SH among male and female university students and analyze the association between harassment and mental distress controlling for sexual violence. An observational survey was conducted at Trieste University (Italy). Students answered an anonymous questionnaire about harassment that included three domains-sexual harassment, gender harassment, cyber harassment-and three psychological health indicators. The global harassment index was computed, with three levels: 0, no harassment; level 1, harassment in at least one of the three domains; and level 2, harassment in two or three domains. The symptoms of mental distress were measured by the 12-item General Health Questionnaire (GHQ) for depressive symptoms; a question about panic symptoms; and a question about general health. The sample included 759 students (412 women; 18 to 29 years old). After adjustment for age, birth country, couple relationship, employment status, mother's education, and previous sexual violence, the risk of mental distress was increased with harassment exposure. Men were affected in perceived health and depressive symptoms (GHQ score ≥ 6); women were affected in panic symptoms. Harassment has a strong negative impact on the mental health of victims; in some cases, men may be more affected than women. Clinicians should be aware of the negative impact of SH also on men.

Highly prevalent and typically beginning in childhood, asthma is a burdensome disease, yet the risk factors for this condition are not clarified. To enhance understanding, this study assessed the cohort-specific and pooled risk of maternal education on asthma in children aged 3-8 across 10 European countries. Data on 47,099 children were obtained from prospective birth cohort studies across 10 European countries. We calculated cohort-specific prevalence difference in asthma outcomes using the relative index of inequality (RII) and slope index of inequality (SII). Results from all countries were pooled using random-effects meta-analysis procedures to obtain mean RII and SII scores at the European level. Final models were adjusted for child sex, smoking during pregnancy, parity, mother's age and ethnicity. The higher the score the greater the magnitude of relative (RII, reference 1) and absolute (SII, reference 0) inequity. The pooled RII estimate for asthma risk across all cohorts was 1.46 (95% CI 1.26, 1.71) and the pooled SII estimate was 1.90 (95% CI 0.26, 3.54). Of the countries examined, France, the United Kingdom and the Netherlands had the highest prevalence's of childhood asthma and the largest inequity in asthma risk. Smaller inverse associations were noted for all other countries except Italy, which presented contradictory scores, but with small effect sizes. Tests for heterogeneity yielded significant results for SII scores. Overall, offspring of mothers with a low level of education had an increased relative and absolute risk of asthma compared to offspring of high-educated mothers.

Aims: Menstrual disorders and sexual harassment are common among young women and interfere with their life and activities. We aimed to describe the association of sexual harassment and menstrual disorders among female university students., Methods: This cross-sectional, observational study examined the association between sexual harassment and menstrual disorders in a sample of 349 university students in Italy. Students answered an anonymous self-administered questionnaire. Descriptive bivariate analyses and logistic regression analyses were performed. Main outcome measures were associations between levels of exposure to sexual harassment (none, levels 1 and 2) and five menstrual disorders (premenstrual symptoms, heavy bleeding, pain, irregular cycles, and amenorrhea)., Results: Among the women interviewed (mean age 20.4 ± 1.45 years), 146 (41.8%) had experienced sexual harassment in the previous 12 months: 91 (26.1%) level 1 and 55 (15.7%) level 2. The frequency of premenstrual symptoms was 31.9% ( n=110); heavy bleeding, 35.3% ( n=124); pain, 51.4% ( n=181); irregular cycles, 55.5% ( n=195); and amenorrhea, 6.7% ( n=23). After adjustment for age, place of birth, being in a couple relationship and receiving hormone therapy, the frequency of menstrual disorders, except for amenorrhea, was increased with sexual harassment, with a regular gradient from no harassment to level 2 harassment. Introducing factors of depression, specific gynaecological problems and lifetime sexual violence did not change the results. For instance, the adjusted odds ratios of premenstrual symptoms were 2.10 [1.19-3.68] for women with level 1 harassment and 3.58 [1.83-7.03] for women with level 2 compared with women without harassment exposure., Conclusions: Sexual harassment is related to the prevalence of menstrual disorders. Healthcare providers should encourage dialogue with patients and address the issue of sexual violence or harassment.

Background: This study assessed the association between timing and course of maternal depression from pregnancy onwards and children's cognitive development at ages 5 to 6. Potential interaction effects with child sex and family socioeconomic status were explored., Methods: One thousand thirty-nine mother-child pairs from the French EDEN mother-child birth cohort were followed from 24 to 28 weeks of pregnancy onwards. Based on Center for Epidemiological Studies Depression (CES-D) and Edinburgh Postnatal Depression Scale (EPDS) scores assessed at six timepoints, longitudinal maternal depressive symptom trajectories were calculated with a group-based semiparametric method. Children's cognitive function was assessed at ages 5 to 6 by trained interviewers with the Wechsler Preschool and Primary Scale of Intelligence Third Edition (WPPSI-III), resulting in three composite scores: Verbal IQ (VIQ), Performance IQ (PIQ), and Full-Scale IQ (FSIQ)., Results: Five trajectories of maternal symptoms of depression could be distinguished: no symptoms, persistent intermediate-level depressive symptoms, persistent high depressive symptoms, high symptoms in pregnancy only, and high symptoms in the child's preschool period only. Multiple linear regression analyses showed that, compared to children of mothers who were never depressed, children of mothers with persistent high levels of depressive symptoms had reduced VIQ, PIQ, and FSIQ scores. This association was moderated by the child's sex, boys appearing especially vulnerable in case of persistent maternal depression., Conclusions: Chronicity of maternal depression predicts children's cognitive development at school entry age, particularly in boys. As maternal mental health is an early modifiable influence on child development, addressing the treatment needs of depressed mothers may help reduce the associated burden on the next generation., (© 2016 Wiley Periodicals, Inc.)

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/m 2 (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., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background: In France, most women of childbearing age work. The prenatal leave law in France protects women during pregnancy and their employment. We aimed to describe how long before delivery women stopped working and analyse the association between occupational, social and medical factors and early prenatal leave (before 24 weeks' gestation)., Methods: The sample was extracted from the 2010 French National Perinatal Survey. Women were interviewed in French maternity units during a 1-week period. We focused on all women with a singleton live birth who were working during pregnancy (n = 10 149). Women were interviewed between delivery and discharge to collect information on employment, date of leave, sociodemographic and medical characteristics., Results: Among women who worked during pregnancy, 27.5% reported early occupational leave (before 24 weeks' gestation). Early occupational leave was more frequent among women with unstable jobs (fixed-term vs. non-fixed-term contract: adjusted odds ratio aOR = 1.60 [95% confidence interval 1.40-1.84]) and with less-qualified occupational categories (manual workers vs. managers and upper-intellectual positions: aOR = 2.96 [2.30-3.82]), even after adjusting for sociodemographic and other employment characteristics. Women with a pathological or at risk pregnancy left work earlier than other women. After stratification on type of pregnancy there was still a higher rate of early leave for women with less qualified occupational group., Conclusion: In France, social vulnerability of pregnant women, linked to low sociodemographic situation or low occupational categories, is associated with early leave during pregnancy, even after stratification on type of pregnancy., (© The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: Breastfeeding is associated with multiple domains of health for both mothers and children. Nevertheless, breastfeeding initiation is low within certain developed countries. Furthermore, comparative studies of initiation rates using harmonised data across multiple regions is scarce., Objective: The aim of the present study was to investigate and compare individual-level determinants of breastfeeding initiation using two French-speaking cohorts., Methods: Participants included ~ 3,900 mothers enrolled in two cohort studies in Canada and France. Interviews, questionnaires, and medical records were utilised to collect information on maternal, family, and medical factors associated with breastfeeding initiation., Results: Rates of breastfeeding initiation were similar across cohorts, slightly above 70%. Women in both Canada and France who had higher levels of maternal education, were born outside of their respective countries and who did not smoke during pregnancy were more likely to initiate breastfeeding with the cohort infant. Notably, cohort effects of maternal education at the university level were found, whereby having 'some university' was not statistically significant for mothers in France. Further, younger mothers in Canada, who delivered by caesarean section and who had previous children, had reduced odds of breastfeeding initiation. These results were not found for mothers in France., Conclusions and Implications for Practice: While some similar determinants were observed, programming efforts to increase breastfeeding initiation should be tailored to the characteristics of specific geographical regions which may be heavily impacted by the social, cultural and political climate of the region, in addition to individual and family level factors., Competing Interests: The authors have declared that no competing interests exist.

Introduction The prenatal leave law in France protects women during pregnancy and their employment. We aimed to estimate the proportion of women who worked late in their pregnancy, to analyze the occupational, social and medical factors associated with late prenatal leave and to compare the pregnancy outcome of these women and those who left earlier in the pregnancy. Methods The sample was extracted from the 2010 French National Perinatal Survey. All women who delivered within a 1-week period were interviewed before discharge from the maternity unit. Women with a singleton live birth at or after 37 weeks' gestation and who were working during pregnancy (n = 8463) were included. Data were collected on employment, date of leave, and sociodemographic and medical characteristics. Results Overall, 328 women (3.9 %) took a late prenatal leave (at or after 37 weeks' gestation). Women who left late were older than 30 years old, with a high educational level and were living in an urban area. Being self-employed and having a managerial or upper-intellectual occupation was highly associated with late leave, before and after controlling for relevant variables. Perinatal and delivery outcomes were similar for women who took a late leave and those who left before 37 weeks' gestation. Discussion Occupational characteristics are the main determinants of late prenatal leave. Women working in the last month of pregnancy had a favorable social and occupational situation and did not did not experience an adverse pregnancy or birth outcome. Other studies are needed to understand the reasons for late leave and evaluate the post-partum fatigue and health of these women.

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., (© 2015 Royal College of Obstetricians and Gynaecologists.)

Background: Comparable evidence on adiposity inequalities in early life is lacking across a range of European countries. This study investigates whether low maternal education is associated with overweight and obesity risk in children from distinct European settings during early childhood., Methods: Prospective data of 45 413 children from 11 European cohorts were used. Children's height and weight obtained at ages 4-7 years were used to assess prevalent overweight and obesity according to the International Obesity Task Force definition. The Relative/Slope Indices of Inequality (RII/SII) were estimated within each cohort and by gender to investigate adiposity risk among children born to mothers with low education as compared to counterparts born to mothers with high education. Individual-data meta-analyses were conducted to obtain aggregate estimates and to assess heterogeneity between cohorts., Results: Low maternal education yielded a substantial risk of early childhood adiposity across 11 European countries. Low maternal education yielded a mean risk ratio of 1.58 (95% confidence interval (CI) 1.34, 1.85) and a mean risk difference of 7.78% (5.34, 10.22) in early childhood overweight, respectively, measured by the RII and SII. Early childhood obesity risk by low maternal education was as substantial for all cohorts combined (RII = 2.61 (2.10, 3.23)) and (SII = 4.01% (3.14, 4.88)). Inequalities in early childhood adiposity were consistent among boys, but varied among girls in a few cohorts., Conclusions: Considerable inequalities in overweight and obesity are evident among European children in early life. Tackling early childhood adiposity is necessary to promote children's immediate health and well-being and throughout the life course., (© 2016 John Wiley & Sons Ltd.)

Objectives: To identify precariousness markers in pregnant women that differ from the usual socioeconomic variables., Methods: Data were obtained from the National Perinatal Survey, a representative sample of women giving birth in France in 2010. From six indicators of social vulnerability, four were selected by multiple correspondence analysis. The first axis of this analysis was used, characterised by the following contributory variables: receiving RSA (Revenu de Solidarité Active) allowance; benefitting from the CMU (Couverture Maladie Universelle) system (French social security) or not being insured; not living in own accommodation; and not living with a partner. These four variables were summed to create a deprivation index., Results: This index was strongly associated with social maternal characteristics and correctly identified women who were socially vulnerable. Furthermore, it was highly related to the psychosocial context, access to care, behaviours during pregnancy, and pregnancy outcomes. These associations remained significant after adjustment for social variables: compared with no deprivation (no factors), a high level of deprivation (≥3 factors) was associated with late prenatal care (OR 5.8, 95% CI 4.6 to 7.2) and small for gestational age (OR 1.5, 95% CI 1.1 to 1.9)., Conclusions: This index of social deprivation was associated with health issues and behaviours during pregnancy, even after adjustment for social variables, revealing a dimension not measured by the usual variables. Moreover, it is simple to use and easily reproducible., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objective: Our objective was to clarify whether de novo urinary incontinence (UI) in the postpartum period is associated with depressive symptoms or antidepressant drug consumption., Study Design: 2002 pregnant women were recruited between 2003 and 2006 for the EDEN mother-child cohort. This analysis included 1413 women who reported no UI before pregnancy. Severity of UI was assessed by the Sandvik index. At 4 and 12 months postpartum, depressive symptoms were assessed by the Edinburgh Postpartum Depression Scale (EPDS≥10 defines depressive symptoms) and consumption of antidepressant drugs was reported., Results: At 4 months postpartum, 198 women (14%) reported de novo UI; 74% (n=146) reported mild UI, 26% (n=52) moderate, and none severe; prevalence of depressive symptoms was higher in women with than without UI (22.1% vs. 15.9%, p=0.045), and consumption of antidepressant drugs was more frequent (4.7% vs. 1.4%, p=0.005). At 12 months postpartum, the mean (±SD) EPDS score differed between women with than without UI (7.30±3.46 vs. 6.57±3.72, p=0.016) but was half that at 4 months postpartum. The incidence of new cases of depressive symptoms or antidepressant consumption at 12 months was greater with than without UI (23.8% vs. 15.3%, p=0.012)., Conclusions: Although UI is mild in most cases at 4 months postpartum, it is followed by more new cases of depressive symptoms or antidepressant consumption at 12 months., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Introduction: Tobacco and alcohol use in pregnancy are modifiable yet frequent risk factors of poor perinatal outcomes. We examined whether characteristics associated with substance use in pregnancy vary between native and migrant women, who often differ in terms of socio-demographic characteristics., Methods: Data come from a nationally representative sample of children born in France in 2011 (ELFE study, n=18,014). Maternal substance use in pregnancy (tobacco: ≥1 cigarette/day, alcohol: ≥1 time, binge drinking: ≥3 units of alcohol on one occasion) was assessed using survey methodology by a) trained interviewers and b) self-reports. Migration status was determined based on country of birth (native-born vs. migrant). The sample included 2330 migrant women, predominantly from North Africa (35.4% - primarily Algeria and Morocco), Sub-Saharan Africa (27.3% - primarily Senegal, Ivory Coast, the Congo and Cameroun), Europe (20.2% - primarily Portugal and Germany) and Asia (10.2% - primarily Turkey). Characteristics potentially associated with substance use included socio-demographics (maternal age, number of children, relationship status, educational attainment, employment status), health (psychological difficulties, incomplete prenatal care) and partner's characteristics (migration status, employment)., Results: Compared to the native-born, migrant women had lower levels of tobacco smoking (8.8 vs. 21.9%) and alcohol use (23.4 vs. 40.7%), but not binge drinking (2.9 vs. 3.3%). Unfavorable socioeconomic circumstances were associated with tobacco smoking in native-born women only. Single parenthood was associated with alcohol use only in migrant women. In migrant women, co-occurring use of another substance and psychological difficulties were more strongly associated with use of tobacco, alcohol or binge drinking than in native-born women., Conclusions: Migrant women have less favorable socioeconomic characteristics than native women but are generally less likely to use tobacco and alcohol in pregnancy. However those who experience single-parenthood need special attention, as they are disproportionately likely to use psychoactive substances which put them and their children at risk of poor health outcomes., (Copyright © 2015. Published by Elsevier Ltd.)

Objective: To compare the level of pain reported by women by dose of mifepristone, 200 or 600mg, and describe the main factors related to the pain level in the 5 days after a medical abortion., Study Design: Observational study in 11 medical centers in France between October 2013 and September 2014. The protocols were 200 or 600mg orally mifepristone on day 1 of the medical abortion and 400, 600 or 800μg orally misoprostol on day 3. Women returned a questionnaire that they completed during 5 days following the abortion; pain was recorded on a visual analog scale (0-10) daily., Results: 453 women were included; the mean age was 29 years (range 18-49 years). Pain was greater with 200 than 600mg mifepristone: 33% of women reported a pain level of ≥8 on day 3 with 200mg as compared with 16% with 600mg. This difference remained after controlling for age, gestational age, gravidity, usual painful menstruation and misoprostol dose. Percentages of symptoms as vomiting or diarrhea were also lower with 600mg mifépristone than 200mg., Conclusion: The mean pain severity experienced by women undergoing medical abortion is high; it is higher with a regimen of 200mg mifepristone. The findings emphasize the need to improve analgesic strategies and invite to opt for a protocol of 600mg instead of 200mg mifepristone., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: The association between socioeconomic position and diet in early childhood has mainly been addressed based on maternal education and household income. We aimed to assess the influence of a variety of social factors from different socio-ecological levels (parents, household and child-care) on multi-time point dietary patterns identified from 2 to 5 y., Method: This study included 974 children from the French EDEN mother-child cohort. Two multi-time point dietary patterns were derived in a previous study: they correspond to consistent exposures to either core- or non-core foods across 2, 3 and 5 y and were labelled "Guidelines" and "Processed, fast-foods". The associations of various social factors collected during pregnancy (age, education level) or at 2-y follow-up (mother's single status, occupation, work commitments, household financial disadvantage, presence of older siblings and child-care arrangements) with each of the two dietary patterns, were assessed by multivariable linear regression analysis., Results: The adherence to a diet close to "Guidelines" was positively and independently associated with both maternal and paternal education levels. The adherence to a diet consistently composed of processed and fast-foods was essentially linked with maternal variables (younger age and lower education level), household financial disadvantage, the presence of older sibling (s) and being cared for at home by someone other than the mother., Conclusions: Multiple social factors operating at different levels (parents, household, and child-care) were found to be associated with the diet of young children. Different independent predictors were found for each of the two longitudinal dietary patterns, suggesting distinct pathways of influence. Our findings further suggest that interventions promoting healthier dietary choices for young children should involve both parents and take into account not only household financial disadvantage but also maternal age, family size and options for child-care.

Background: A healthy start to life is a major priority in efforts to reduce health inequalities across Europe, with important implications for the health of future generations. There is limited combined evidence on inequalities in health among newborns across a range of European countries., Methods: Prospective cohort data of 75 296 newborns from 12 European countries were used. Maternal education, preterm and small for gestational age births were determined at baseline along with covariate data. Regression models were estimated within each cohort and meta-analyses were conducted to compare and measure heterogeneity between cohorts., Results: Mother's education was linked to an appreciable risk of preterm and small for gestational age (SGA) births across 12 European countries. The excess risk of preterm births associated with low maternal education was 1.48 (1.29 to 1.69) and 1.84 (0.99 to 2.69) in relative and absolute terms (Relative/Slope Index of Inequality, RII/SII) for all cohorts combined. Similar effects were found for SGA births, but absolute inequalities were greater, with an SII score of 3.64 (1.74 to 5.54). Inequalities at birth were strong in the Netherlands, the UK, Sweden and Spain and marginal in other countries studied., Conclusions: This study highlights the value of comparative cohort analysis to better understand the relationship between maternal education and markers of fetal growth in different settings across Europe., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)