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Objectives: Despite the guidelines in effect, too few women in France receive folic acid supplementation. The principal objective of this study was to identify the factors associated with the inadequacy of this supplementation in the periconceptional period. The secondary objective was to assess women's knowledge about the prevention of neural tube defects (NTDs)., Methods: This study included 400 women and took place in 8 Parisian maternity. Folic acid supplementation was inadequate when started after the beginning of the pregnancy., Results: Among the women questioned, 68% had inadequate folic acid supplementation. They were significantly younger (ORa= 1,8; 95% IC [1,1-2,8]), didn't had health insurance (ORa=3,9; 95% IC [1,5-10,1]), had not studied after high school (ORa=2,9; 95% IC [1,2-6,9]) and had regular gynecological care less often than the women with adequate supplementation (ORa=3,0; 95% IC [1,6-5,6]). More than half (55.5%) had insufficient knowledge of the benefits of folic acid; the factors related to this lack of knowledge were the absence of regular gynecological care and of health insurance., Conclusion: Individual factors associated with a lack of supplementation have been identified. These results provide health professionals and supervisors with useful information for developing strategies adapted to certain subgroups of women for better prevention of AFTN in these populations., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

This article examines the role of public health registries, based on the example of congenital abnormalities. In addition to their main role in epidemiological surveillance, registries can be useful for conducting research and for evaluating public health interventions such as primary prevention and prenatal diagnosis. Congenital abnormalities are relatively frequent, affecting about 3% of births, but many are due to rare diseases. Known teratogens increase the risk of one or afew specific, often rare anomalies. Consequently, continuous monitoring of large, geographically defined populations is needed, particularly to establish the "baseline "prevalence of birth defects. Networks of registries can make an important contribution to this goal, as exemplified by the EUROCAT network, which plays a key role in coordinating surveillance and research on birth defects in Europe.

Objectives: To assess overall and malformation-specific trends in the prevalence and prenatal diagnosis of congenital anomalies in the Parisian population., Methods: The Paris Registry of Congenital Malformations is population-based and since 1981 has registered all cases with structural birth defects or chromosomal anomalies in the Parisian population. The total and livebirth prevalence and the proportion of cases with prenatal diagnosis were calculated for all anomalies and 20 malformations selected based on their higher frequency and their impact on health outcomes., Results: The overall prevalence was 3.30% (95% CI 3.27-3.33), and the livebirth prevalence 2.42% (95% CI 2.39-2.45). The proportion of cases diagnosed prenatally increased from 16.5% (95% CI 14.1-19.1) in 1983 to 70.7% (95% CI 68.3-73.1) in 2007. Terminations of pregnancy for fetal anomaly (TOPFA) increased from 8.8% (95% CI 7.0-10.8) in 1983 to 35.6% (95% CI 33.1-38.1) in 2007. These results varied substantially for the 20 congenital anomalies studied., Conclusion: We found an increase in the overall prevalence of all anomalies, especially for chromosomal abnormalities. The observed increase is at least to a large extent due to trends in delayed childbearing and an increase in both pre- and postnatal diagnosis of congenital anomalies in our population., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

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), 2003 (n=14,737) and 2010 (n=14,903), and we compared data from these four years., Results: Between 1995 and 2010, maternal age and body mass index increased steadily, but tobacco smoking decreased. In 2010, 39.4% of pregnant women had a visit with a midwife in maternity unit, versus 26.6% in 2003. Deliveries occurred in large public hospitals more and more frequently. The increase in caesarean sections was no longer significant between 2003 and 2010. In general medical decisions during pregnancy and delivery were closer to professional recommendations in 2010 than in the previous years. Live births before 37 weeks increased steadily from 5.4% in 1995 to 6.6% in 2010, but the proportion of births below 2500g or under the 10th percentile stopped increasing since 2003., Conclusion: Routine national perinatal surveys highlight major trends in maternal characteristics, obstetric practice, organisation of services and perinatal health., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Objective: To study trends in smoking before and during pregnancy in national samples of pregnant women and changes in characteristics of smokers over time, and describe the current relation between maternal smoking during pregnancy and fetal growth., Population and Methods: Five nationally representative samples of singleton live births in metropolitan France (1972, 1981, 1995, 1998 and 2003) were used to study the change in smoking rates during pregnancy over the past 30 years. We further examined changes in smoking rates between 1998 and 2003 according to maternal characteristics. Finally, we estimated the effect of smoking on fetal growth in 2003., Results: Prevalence of smoking decreased over time, but the rate remained high, 21 % in 2003. The decrease was more important among women at low risk of adverse pregnancy outcomes, resulting in increased social disparities. We confirmed the strong dose-response relation between tobacco use during pregnancy and fetal growth., Conclusion: It is important to verify that smoking during pregnancy is still decreasing and to develop policies to encourage women to quit smoking during pregnancy, especially for highly exposed groups., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Objective: The aim of this article is to describe conditions of abortions practices in France., Materials and Methods: The study was based on the COCON survey. This survey was carried out among a representative sample of 2863 women aged 18 to 44 living in metropolitan France. Women were interviewed by telephone. The analysis was performed among a sub-sample of 320 women who had had an abortion between 1996 and 2000. Results were compared with those of the national notification of induced abortions., Results: Altogether, the way in which abortions were carried out was appropriate, but differences were observed according to the type of hospital: access to care was easier in the private sector; however a pre-abortion interview was less often carried out and a post-abortion interview less often proposed in the private sector. Besides, in both sectors, women were rarely allowed to choose the abortion technique, or the type of anesthesia in the case of a surgical abortion., Conclusion: The COCON study is the first population based survey describing the characteristics of care regarding voluntary abortion. It shows the persistence of differences in practices between the public and the private sectors.

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.

Objectives: To study the psychological health of the mothers and their difficulties seven years after the birth of triplets and to compare these results with those obtained at four years., Data and Methods: Eleven mothers of triplets were followed up from birth to seven. At four and seven years the psychological status of the mothers and their relationships with the triplets were evaluated using a semi-structured interview and the level of depression was measured using a standardized scale (CES-D). At seven years the scores were compared to those of mothers having a singleton child of the same age., Results: At seven years three mothers of triplets out of 11 still suffered of depressive symptoms. These symptoms were more frequent than among control mothers but non significantly. One mother of triplets out of two (6/11), twice more than at four years, appreciated the increase of her educative tasks and the decrease of practical problems. In the other half of the sample problems still persisted between adults and children., Conclusion: Although the situation seemed to improve at seven years, the mother's psychological distress and quality of relationship with the children remained preoccupying in one family out of two.

A longitudinal survey was carried out in three maternity units in France in 1993-1994. At the first contact, within the four days following the delivery, 761 women were included in the survey with a face-to-face interview. The second and the third contacts took place five and twelve months after the birth. These contacts were postal questionnaires at home, with a first mail followed by three reminders, if necessary. This paper analyses the response rate to a postal survey and the efficiency of repeated mails in the context of a research about women's health after childbirth. The characteristics of non responders and those of late responders are compared with initial stage responders. Twelve months after the birth, 57% of the women had returned the questionnaire after the first mail and 86% after all the mailings. Non responders were younger and were more often in unfavorable family or social conditions than responders. The late responders had more often a non French nationality, they reported more often psychotropic drugs consumption and wished for this pregnancy less often than the initial stage responders. For some characteristics as educational level, employment or financial concerns late responders had an intermediate position between the initial stage responders and the non responders. Repeated mailings strongly improve the final response rate. Nevertheless non responders remain a particular group that is imperfectly represented by the late responders.

Objective: The purpose was to estimate the prevalence of marital violence during the year after childbirth in France., Methods: a survey has been carried out in three maternity units among primipara and secondipara women in 1993-1994. The women were interviewed in the three days after the delivery and they received a postal questionnaire 5 and 12 months later. The analysis includes 706 women., Results: the prevalence of marital violence during the 12 months after childbirth is equal to 4.1% (2.6%-5.6%). This percentage is higher among women living an unstable relationship with their partner or when the partner has not a job. These women who reported marital violence had a higher prevalence of previous miscarriage. They used more often psychotropic drugs and reported more often depressive symptoms than the other women., Conclusion: physicians may be helpful by listening and counseling these women who receive low emotional and social support.

Background: In all industrialized countries, injuries constitute the primary public health problem during adolescence; study of long-term outcome of injuries to adolescents remains poor., Population and Methods: A longitudinal epidemiological study performed on 8,140 students in 17 secondary schools in Paris and the Department of the Côte-d'Or followed the development over one year of 777 adolescents who had injuries in 1990. All injuries, both within and outside school, were included if they fulfilled the following criteria: school absence or excused from vocational training exceeding or equal to 2 days, or excused from physical education classes for at least 14 days., Results: One year after the injury, 13% of the adolescents were still bothered by their injury, especially those who were older and the girls. Among described impairments, musculo-skeletal problems (88% of cases) were the major difficulty. These impairments were primarily in the lower limbs (53%). Unaesthetic scars were found in 17% of cases, and a psychological impact was found in 16.5% of the adolescents. The presence of sequelae was related to the type of initial lesion (present in 24% of head injuries and in 16% of cases affecting the lower limbs). The most serious difficulties were caused by dislocations, serious sprains and fractures. One year after the injury, sequelae were serious in 10% of those adolescents still experiencing problems; they had some impact on the daily life of the adolescents in 36% of cases, that is, 5% of all adolescents experiencing an injury. These sequelae were responsible for a high level of consumption of medical services., Conclusions: Although observed sequelae were relatively minor, the high frequency of injuries during adolescence, as well as their high economic costs, justify the most appropriate care available for victims of injuries, even those which appear benign. In addition, longitudinal studies should be prepared using adapted tools (scales for the evaluation of the gravity of injury sequelae).

This study is of a 4-year follow-up of two groups of mothers, the first having had caesarean operations and the second vaginal deliveries. We have already published studies of the results after delivery, after two months and after one year. The purpose of this 4-year follow-up after delivery is to determine the effects of caesarean operation on the numbers of future pregnancies and their results and to look at the long-term consequences for the physical and psychological health of the mothers. Fifty-eight mothers who had had caesarean operations and fifty mothers as controls replied to a postal questionnaire. The response level was 52%. From the social and the medical point of view there was no significant difference between those who replied and those who did not. The results indicate that mothers who had had a caesarean operation were less likely to have another baby or did so in lower numbers. They further had more difficulty in conceiving another pregnancy than did the control mothers (the differences were not statistically significant). After four years they were often more tired than the others, apart from objective medical and social differences. The use of health services was not linked to the method of delivery, but 9% of women who had had a caesarean consulted a psychiatrist in the last three years but none of the controls did. The replies show that caesarean section contributed to or re-awoke a labile psychological state. The data do not make it possible for us to say that women who had had a caesarean operation had particular psychological characteristics.(ABSTRACT TRUNCATED AT 250 WORDS)

Semi-directed interviews were conducted with 103 primiparous women between the 3rd and the 6th day after delivery to compare the effects of the two methods of anaesthesia on the way they experienced caesarean operation. Analysis of the contents of the interviews show that the mothers who had caesarean operation under general anaesthesia were more often depressed than those who had an epidural. Overall, the experience of delivery was more satisfying when the caesarean took place under an epidural because it enabled the mother to take part in the delivery. The mothers who were unconscious because they had a general anaesthetic felt sorrow that they deprived of the experience of the delivery. All the same, it must be said that one-third of the women felt ill-at-ease owing to delivery under epidural, both physically and psychologically. The first contacts with the infant are earlier and less disagreeable after epidural analgesia, but in the days following the delivery the interactions between mother and baby and the comments the mothers make about their child do not differ markedly whichever form of anaesthesia has been used.

Eight hundred fifty-four injuries to children under 2 years of age were analysed. Injuries were more frequent in the second year than in younger infants. No major male predominance was observed. Most injuries were related to home accidents and mainly to mechanical trauma. Burns and poisonings were less frequent but their percentage was higher during the second year. Most lesions were benign, except in case of fall from a height (window falls, falls from baby furniture). Medical cost was rather high due to a 17% rate of hospital admissions and a 4 days average length of stay. Two fatal cases were registered. Sequelae appeared to be rare. Child abuse was seldom suspected and reason for that remains unclear. The study of accidents mechanism leads to think that teaching young children the control of hazardous situations should play a large part in prevention.