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Resume Objectifs Malgre les recommandations, le taux de femmes recevant une supplementation en acide folique en France est insuffisant. L’objectif principal etait d’identifier les facteurs associes une supplementation inadequate en acide folique. L’objectif secondaire etaient d’evaluer les connaissances des femmes sur la prevention des anomalies de fermeture du tube neural (AFTN). Methode Nous avons realise une enquete sur 400 femmes de 8 maternites parisiennes. La supplementation en acide folique etait definie comme inadequate lorsqu’elle etait debutee apres le debut de la grossesse. Resultats Parmi les femmes interrogees, 68 % avaient une supplementation inadequate en acide folique. Les facteurs associes a une supplementation inadequate etaient un âge inferieur a 35 ans (ORa = 1,8 ; 95 % IC [1,1–2,8]), l’absence de couverture sociale (ORa = 3,9 ; 95 % IC [1,5–10,1]), un niveau d’etude n’allant pas au-dela du baccalaureat (ORa = 2,9 ; 95 % IC [1,2–6,9]), et l’absence de suivi gynecologique regulier (ORa = 3,0 ; 95 %IC [1,6–5,6]). Plus de la moitie (55,5 %) des femmes de l’etude n’avaient pas une bonne connaissance des benefices de l’acide folique et les facteurs associes etaient l’absence de suivi gynecologique regulier et l’absence de couverture sociale. Conclusion Des facteurs individuels associes a un defaut de supplementation ont ete identifies. Ces resultats apportent aux professionnels et tutelles de sante des elements utiles pour developper des strategies adaptees a certains sous-groupes de femmes pour une meilleure prevention des AFTN dans ces populations.

International audience; Objective: 25-hydroxyvitamin D (25OHD) deficiency has been associated with sleep disorders in adults. Only three cross-sectional studies were performed in children and showed an association between 25OHD deficiency and both obstructive sleep apnea syndrome and primary snoring. No longitudinal study has been performed in children from the general population. We analyzed the association between cord-blood vitamin D level at birth and night-sleep duration trajectories for children between 2 and 5-6 years old in a non-clinical cohort.Method: We included 264 children from the French EDEN mother-child birth-cohort with both cord-blood 25OHD level determined by radio-immunoassay at birth, and night-sleep trajectories for children between 2 and 5-6 years old obtained by the group-based trajectory modeling method. Associations between 25OHD and sleep trajectories were assessed by multinomial logistic regression adjusted for maternal and child characteristics.Results: The trajectories short sleep (

Objective To evaluate the respiratory outcome in children with congenital heart disease (CHD), considering recent management procedures and the CHD pathophysiology. Design and Setting Clinical and functional respiratory outcome were evaluated in 8-year-old children with isolated CHD followed up from birth in the prospective population-based EPICARD cohort. Patients Children were assigned to two groups, based on the pathophysiology of the CHD: CHDs with left-to-right shunt (n = 212) and CHDs with right outflow tract obstruction (n = 113). Results Current wheezing episodes were observed in 15% of the children with isolated CHD and left-to-right shunt, and 11% of the children with isolated CHD and right outflow tract obstruction (not significant). Total lung capacity (TLC) was the only respiratory function parameter that significantly differed between the two groups. It was lower in children with left-to-right shunt (88.72 ± 0.65% predicted) than in those with right outflow tract obstruction (91.84 ± 0.96, p = 0.006). In multivariate analysis, CHD with left-to-right shunt (coeff. [95% CI]: -3.17 [-5.45; -0.89]) and surgery before the age of 2 months (-6.52 [-10.90; -2.15]) were identified as independent factors associated with significantly lower TLC values. Conclusion Lower TLC remains a long-term complication in CHD, particularly in cases with left-to-right shunt and in patients requiring early repair. These findings suggest that an increase in pulmonary blood flow may directly impair lung development.

International audience; Objective. Sleep duration may vary inter-individually and intra-individually over time. We aimed at both identifying night-sleep duration (NSD) trajectories among preschoolers and studying associated factors. Methods. NSD were collected within the French birth-cohort study EDEN at ages 2, 3 and 5-6 years through parental questionnaires, and were used to model NSD trajectories among 1205 children. Familial socioeconomic factors, maternal sociodemographic, health and lifestyle characteristics as well as child health, lifestyle, and sleep characteristics at birth and/or at age 2 years were investigated in association with NSD using multinomial logistic regressions. Results. Five distinct NSD trajectories were identified: short (SS

Objective The aim was to study, with a developmental approach, the longitudinal association between night-waking from age 2 to 5–6 years and behavior at age 5–6 years. Methods Within the French birth cohort study Etude sur les Determinants pre et post natals du developpement et de la sante de l'ENfant (EDEN), repeated measures of children's night-waking were collected at age 2, 3 and 5–6 through parental questionnaires and were used to model night-waking trajectories. Behavior was assessed with the “Strengths and Difficulties Questionnaire,” which provides five subscales measuring a child's conduct problems, emotional symptoms, peer relation problems, antisocial behavior, and hyperactivity/attention problems. The behavioral subscales were dichotomized at the tenth percentile. Multivariable logistic regressions, adjusted for parents' socio-economic factors, parental characteristics, and children's characteristics and sleep habits allowed us to study, in 1143 children, the association between night-waking trajectories from 2 to 5–6 years and behavior at age 5–6 years. Results The “2 to 5–6 rare night-waking” trajectory represented 78% of the included population (n = 896), and the “2 to 5–6 common night-waking” 22% (n = 247%). Children belonging to the “2 to 5–6 common night-waking trajectory” had, at age 5–6, increased risk of presenting emotional symptoms (odds ratio [OR] = 2.17, 95% CI = 1.27–3.70, p = 0.004), conduct problems (OR = 1.63, 95% CI = 1.00–2.65, p = 0.050), and hyperactivity/attention problems (OR = 1.61, 95% CI = 1.00–2.57, p = 0.049). After adjusting for baseline behavior at age two years, only the association with emotional symptoms remained significant (OR = 2.02, 95% CI = 1.15–3.55, p = 0.015). Results did not differ according to sex. Conclusion Results suggest that the persistence of night-waking difficulties in early years is positively associated with emotional symptoms, hyperactivity/inattention, and conduct problems.

Resume But Etudier l’evolution de l’usage du tabac des femmes avant et pendant la grossesse en France a partir d’enquetes en population, decrire l’evolution des caracteristiques sociodemographiques des fumeuses et les liens entre tabac et croissance du nouveau-ne en 2003, compte tenu de cette evolution. Patients et methodes Les enquetes nationales perinatales sont effectuees periodiquement sur des echantillons representatifs des naissances. L’analyse a ete realisee sur les naissances uniques et vivantes en metropole en 1972, 1981, 1995, 1998 et 2003. La premiere partie de l’etude a porte sur l’evolution de l’usage du tabac au cours des 30 dernieres annees, la deuxieme partie sur l’evolution du tabagisme entre 1998 et 2003 en fonction des caracteristiques maternelles. Puis, pour l’annee 2003, nous avons etudie les caracteristiques des fumeuses, les liens entre l’usage du tabac et l’etat de l’enfant a la naissance. Resultats L’usage du tabac chez les femmes enceintes est a la baisse, mais le taux reste eleve, 21 % en 2003. La baisse a principalement concerne les femmes en situation plus favorable pour l’issue de la grossesse et les differences sociales se sont accrues. Une forte relation dose-effet est retrouvee entre l’usage du tabac pendant la grossesse et les mensurations a la naissance. Conclusion Il est necessaire de verifier si la baisse de la consommation de tabac chez les femmes enceintes se confirme et d’encourager le sevrage tabagique, notamment pour les populations les plus exposees.

Objective To compare the probability of prenatal diagnosis (PND) and termination of pregnancy for fetal anomaly (TOPFA) between fetuses conceived by assisted reproductive techniques (ART) and spontaneously-conceived fetuses with congenital heart defects (CHD). Design Population-based observational study. Setting Paris and surrounding suburbs. Population Fetuses with CHD in the Paris registry of congenital malformations and cohort of children with CHD (Epicard). Methods Comparison of ART-conceived and spontaneously conceived fetuses taking into account potential confounders (maternal characteristics, multiplicity and year of birth or TOPFA). Main outcome measures Probability and gestational age at PND and TOPFA for ART-conceived versus spontaneously conceived fetuses. Results The probability of PND (28.1% versus 34.6%, P = 0.077) and TOPFA (36.2% versus 39.2%, P = 0.677) were not statistically different between ART-conceived (n = 171) and spontaneously conceived (n = 4620) fetuses. Estimates were similar after adjustment for potential confounders. Gestational age at PND tended to be earlier for ART fetuses (23.1 versus 24.8 weeks, P = 0.05) but no statistical difference was found after adjustment for confounders. Gestational age at TOPFA was comparable between ART-conceived and spontaneously conceived fetuses. Conclusions In our population, ART conception was not significantly associated with the probability of PND or TOPFA for CHD. One implication of our results is that live births may be adequate for assessing the overall risk of CHD related to ART. However, total prevalence, in particular of severe CHD, would not be adequately assessed if TOPFA are not included.

Resume But L’objet de cet article est de decrire les conditions de prise en charge de l’IVG en France. Materiel et methodes Les donnees proviennent de l’enquete COCON, realisee aupres d’un echantillon representatif de 2 863 femmes âgees de 18 a 44 ans, residant en France metropolitaine. Les femmes ont ete interrogees par telephone. L’analyse porte sur un sous-echantillon de 320 femmes ayant eu une IVG entre 1996 et 2000. Les resultats ont ete compares a ceux du bulletin statistique d’IVG (BIG). Resultats Dans l’ensemble, les conditions de prise en charge de l’IVG sont bonnes, mais des differences de pratiques sont observees selon le type d’etablissement : l’acces a l’IVG est plus facile dans le secteur prive, mais ce dernier realise moins souvent l’entretien pre-IVG et propose moins souvent un entretien post-IVG. Par ailleurs, en public comme en prive, les femmes sont rarement associees au choix de la technique d’IVG ou au mode d’anesthesie, en cas d’IVG chirurgicale. Conclusion L’enquete COCON est la premiere enquete en population generale a etudier les conditions de prise en charge de l’IVG et montre la persistance de differences de pratiques entre le secteur public et le secteur prive.

To evaluate the contribution of examination of specific anatomical features of the fetal posterior brain on mid-sagittal first-trimester ultrasound examination to the early detection of open spina bifida.Four independent observers reviewed a series of 260 mid-sagittal first-trimester ultrasound images from 52 cases of open spina bifida and 208 normal fetuses. The following analysis was performed by each reviewer for each image: Herman score calculation, intracranial translucency score (CFEF-IT) calculation and determination of presence or absence of three anatomical criteria: intracranial translucency (IT), caudal displacement of the brainstem and cisterna magna. The sensitivity and the false-positive rate for spina bifida detection were calculated for each of the latter three criteria. A secondary analysis was performed on the subset of images achieving a Herman score ≥ 7.The highest detection rate for spina bifida was achieved by non-visualization of the cisterna magna, with associated sensitivity of 50-73% and 39-76%, respectively, for all images and for the subset of images achieving a Herman score ≥ 7. Posterior shift of the brainstem achieved the highest detection rate (86%), but for a single reviewer only. The level of variation in performance between observers was also greatest for this sign. Absence of IT was associated with a lower detection rate for all observers. Overall, an abnormal posterior brain presenting at least one of these three criteria was associated with a detection rate ranging from 50 to 90%.In the detection of spina bifida, non-visualization of the cisterna magna achieved the best screening performance. Both non-visualization of the IT and posterior shift of the brainstem were associated with acceptable but lower detection rates. A prospective evaluation of changes in the posterior brain is needed to allow assessment of the most pertinent criteria for first-trimester screening for spina bifida.

A partir de donnees en population, nous avons: 1) evalue le risque de cardiopathies congenitales (CC) chez les fœtus concus par assistance medicale a la procreation (AMP); et 2) determine les effets de l’AMP sur la prise en charge prenatale et le devenir perinatal des fœtus porteurs de CC. Nous avons observe que l'AMP etait associee a une augmentation de 40% du risque de CC sans anomalies chromosomiques associees (OR ajuste = 1,4 IC95% 1,1-1,7). Nous avons egalement retrouve qu'il existait des associations variables selon la categorie de CC et la methode d'AMP considerees. Nous avons observe que l'AMP etait associee a une multiplication par 2,4 du risque de tetralogie de Fallot (OR ajuste = 2,4 IC95% 1,5-3,7), alors que nous n’avons pas retrouve d’association statistiquement significative pour les trois autres CC specifiques etudiees. Dans notre population, l'exposition a l'AMP ne semblait pas modifier le recours au diagnostic prenatal et a l'interruption medicale de grossesse chez les fœtus porteurs de CC compares aux fœtus porteurs de CC concus spontanement. Nous avons par ailleurs observe que le risque de prematurite des fœtus porteurs de CC concus par AMP etait environ 5 fois plus eleve que celui des fœtus porteurs de CC concus spontanement (OR ajuste = 5,0 IC95% 2,9-8,6). En nous basant sur une methodologie d'analyses de cheminement, nous avons retrouve que les grossesses multiples contribuaient pour environ 20% au risque plus eleve de tetralogie de Fallot associe a l'AMP que nous avons observe. Enfin, les grossesses multiples contribuaient pour environ 2/3 du risque de prematurite associe a l'AMP chez les fœtus porteurs de CC.

A pilot study has been conducted in France to estimate the extent of underreporting of induced abortion and the factors linked to underreporting.A representative random sample of 300 women aged between 18 and 44 years of age who had been pregnant during the previous 2 years and 100 women who had not was selected from the telephone directory. Interviews were conducted by telephone.The annual incidence of induced abortion for the 18-44-year-old age group was 6.9 per 1000 (95% confidence interval 2.2-11.6), while the rate derived from national statistics was 15 per 1000. Five women who reported a therapeutic abortion in their lifetime had confused induced abortion and therapeutic abortion. There was no significant difference in the proportion of women reporting induced abortion in their lifetime between those answering with another adult present and those who were alone when answering (13.1% versus 11.1%, p = 0.8). There was also no significant difference according to the sex of the interviewer (10.0% for men versus 12.2% for women, p = 0.6).The results suggest that the context in which the questions were asked does not affect the validity of the answers and that there is a problem in the comprehension of the terminology used. Extensive rewriting and reformulation of the questions is required to minimize the underreporting of induced abortion.