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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]

Objectives: To assess prenatal changes in the volume of congenital pulmonary malformations (CPM) and examine whether these changes differ in lesions that appear cystic on ultrasound compared with hyperechoic lesions, and to study the relationship between CPM volume and risk of fetal compression.Methods: We conducted a nationally representative, multicenter, prospective cohort study, which included 579 ultrasound examinations in 176 pregnant women with a diagnosis of fetal CPM, between March 2015 and November 2016. Several ultrasound examinations were performed between diagnosis and delivery, including measurement of CPM volume. We modeled changes in CPM volume ratio (CVR) as a function of gestational age, overall and for cystic/mixed vs hyperechoic malformations, and examined the association between CVR and signs of compression during pregnancy.Results: When modeling CVR changes over time, there was a statistically significant decrease in CVR with increasing gestational age (P < 0.001), but the pattern of change differed according to CPM phenotype at first ultrasound examination: cystic/mixed CPM were characterized by a monotonic decrease in CVR with increasing gestational age (P = 0.002), whereas hyperechoic CPM showed an initial increase in CVR up to 27 weeks of gestation, followed by a decrease thereafter (P < 0.001). Peak CVR values were predicted as early as 21-22 weeks for cystic/mixed CPMs compared with 25-26 weeks for hyperechoic malformations. Regardless of CPM phenotype, fetuses that showed no sign of compression at any point had substantially lower CVR at first CVR measurement, and the CVR remained relatively constant thereafter. Among the subpopulation of fetuses with no sign of compression at first CVR measurement, the odds of a subsequent compression was 7-fold higher (adjusted odds ratio, 7.0; 95% CI, 1.6-29.9) if initial CVR was > 0.4 vs CVR ≤ 0.4 cm2 .Conclusions: Predicted changes in CVR during pregnancy differ between cystic and hyperechoic malformations. This may be the result of different pathophysiological mechanisms or differences in the timing of occurrence of these different types of CPM. CVR measured at the initial diagnostic ultrasound examination was strongly associated with the odds of subsequent compression. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Study Question: Are the risks of hypoplastic left heart syndrome, transposition of great arteries, tetralogy of Fallot (TOF) and coarctation of the aorta increased in infants conceived by different assisted reproductive techniques (ARTs)?Study Answer: ARTs, and particularly intracytoplasmic sperm injection (ICSI), are specifically associated with a higher risk of TOF.What Is Already Known: ARTs are associated with an increase in the overall risk of birth defects. The risk for congenital heart defects (CHDs) associated with ARTs has been evaluated as a whole but there is limited information on the risks for specific CHDs. STUDY DESIGN, MATERIAL AND METHODS: We conducted a case-control study using population-based data from the Paris registry of congenital malformations for the period 1987-2009 and a cohort study of CHD (EPICARD) on 1583 cases of CHDs and 4104 malformed controls with no known associations with ARTs. ARTs included ovulation induction only, IVF and ICSI.Results: Exposure to ARTs was significantly higher for TOF than controls (6.6 versus 3.5%, P = 0.002); this was not the case for the other three CHDs. ARTs (all methods combined) were associated with a 2.4-fold higher odds of TOF after adjustment for maternal characteristics, paternal age and year of birth [adjusted odds ratios (OR): 2.4, 95% confidence interval (CI): 1.5-3.7] with the highest risk associated with ICSI (adjusted OR: 3.0, 95% CI: 1.0-8.9). No statistically significant associations were found for the other CHDs.Limitations: Our study cannot disentangle to what extent the observed associations between the risk of TOF and ARTs are due to causal effects of ARTs and/or the underlying infertility problems of couples who conceive following ART.Implications: The developmental basis of the specific association between the risk of TOF and ARTs need to be further investigated. [ABSTRACT FROM AUTHOR]

Aim: To analyse the association between maternal periodontitis and preterm birth (<37 weeks' gestation) according to the causes of preterm birth. Materials and Methods: Epipap is a case-control multi-centre study of singleton livebirths. One thousand one hundred and eight women with preterm deliveries and 1094 with deliveries at term (>/=37 weeks) at six French maternity units were included. Periodontal examinations after delivery identified localized and generalized periodontitis. Cases were classified according to four causes of preterm birth. Polytomous logistic regression analysis was used to control for confounders (maternal age, parity, nationality, educational level, marital status, employment during pregnancy, body mass index before pregnancy, smoking status) and the examiner. Results: Localized periodontitis was identified in 129 (11.6%) cases and in 118 (10.8%) control women and generalized periodontitis in 148 (13.4%) and 118 (10.8%), respectively. A significant association was observed between generalized periodontitis and induced preterm birth for pre-eclampsia [adjusted odds ratio 2.46 [95% confidence intervals (95% CI)1.58-3.83]. Periodontitis was not associated with spontaneous preterm birth or preterm premature rupture of membranes or with the other causes. Conclusion: Maternal periodontitis is associated with an increased risk of induced preterm birth due to pre-eclampsia. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the development and behaviour of 7-y-old triplets, who were followed from delivery to 7 y of age. The McCarthy Scales of Children's Abilities (MSCA) and Achenbach's Child Behaviour Checklist (CBCL) were used to assess and compare development and behaviour in the triplets and in a control group of singletons. The sample included 33 sets of triplets and 33 singletons, all 7-y-olds, and comparable for sex and fathers' social class. The triplets' scores on the MSCA were all within normal range. Although their mean scores for all subtests were below those of singletons, they did not differ significantly. The mean CBCL scores, based on mothers' reports, indicated that the triplets had significantly fewer behavioural problems than the controls. In half the triplet sets, one child stood out as having more behavioural problems than the others. Conclusion: Further assessments of the development of triplets are needed; these should be based on larger study samples and should use information from teachers and external observers as well as mothers. [ABSTRACT FROM AUTHOR]

To analyse the relation between unemployment and the psychological distress of mothers one year after childbirth. Multicentric survey concerning births occurring between September 1993 and July 1994. In France: two maternity units in the Parisian area and one in Champagne-Ardennes, in the east of France, comprising both urban and rural areas. Primipara and secondipara women were interviewed three times: at birth by a face to face interview, five months and 12 months after the birth, by postal questionnaires, with a 83% response rate for the two postal questionnaires. The analysis includes 632 women who answered all three stages of the survey. Psychological distress was mainly assessed one year after birth by the 12-item General Health Questionnaire. After adjustment for unwanted pregnancy, marital conflicts, marital status, hospitalisation of the baby during the last year, lack of confiding relationship, depressive or anxious troubles before pregnancy, age, educational level and parity, unemployed women had an excess of psychological distress compared with employed women (OR = 1.87; 95% CI = 1.12, 3.13). The ratios for housewives were very close to those of employed women. Among the unemployed women, 60% had recently been without a job, since a few months before or after the birth. An excess of psychological distress among unemployed compared with employed women was observed in all social groups defined by the current or last occupation, but with various extents. Psychological distress was specially linked to the employment status in the group of women with the more qualified occupations. Even after a birth, when women are very much involved in their maternal role, those seeking a job have worse mental health than those in a stable situation, either employed or housewives. In France, the unemployment rate among young women is high. It is specially important that social regulations protecting employment during and after pregnancy are adequately applied. Employers, legislators, such as medical doctors, have to be aware to this situation. [ABSTRACT FROM AUTHOR]

Conclusions The overall risk of both SGA and severe SGA was higher in isolated CHD with substantial differences across the subtypes of CHD. Congenital heart defects (CHD) and growth restriction at birth are two major causes of infant, childhood and adult morbidity and mortality. To compare the odds of SGA (< 10th percentile) and severe SGA (< 3rd percentile) across five specific isolated CHD, we used ordinal logistic regression using isolated, minor (non-operated) VSD as the control group. [Extracted from the article]

Congenital heart defects (CHD) and growth restriction at birth are two major causes of childhood and adult morbidity and mortality. The aim of this study was to assess the overall risk of growth restriction at birth, as measured by its imperfect proxy small (< 10th percentile) for gestational age (SGA), for newborns with CHD. Using data from a population-based cohort of children born with CHD, we assessed the risk of growth restriction at birth using SGA and severe SGA (3rd percentile). To compare the odds of SGA and severe SGA across five specific major CHD, we used ordinal logistic regression using isolated, minor (non-operated) ventricular septal defect (VSD) as the control group. The overall proportion of SGA for "isolated" CHD (i.e., those not associated with other anomalies) was 13 % (95 % CI, 12 %–15 %), which is 30 % higher than what would be expected in the general population (i.e., 10 %). The risk of severe SGA was 5 % (95 % CI, 4 %–6 %) as compared with the expected 3 % in the general population. There were substantial differences in the risk of overall SGA and more so severe SGA across the different CHD. The highest risk of SGA occurred for Tetralogy of Fallot (adjusted OR 2.7, 95 % CI, 1.3–5.8) and operated VSD (adjusted OR 2.1, 95 % CI, 1.1–3.8) as compared with the control group of minor (non-operated) VSD. The overall risks of both SGA and severe SGA were higher in isolated CHD than what would be expected in the general population with substantial differences across the subtypes of CHD. These Results may provide a clue for understanding the underlying mechanisms of the relation between alternations in fetal circulation associated with different types of CHD and their effects on fetal growth. [ABSTRACT FROM AUTHOR]

The aim was to study the relationship between the level of alcohol consumption in pregnancy and craniofacial characteristics of the neonate. This was a prospective survey of a sample of pregnant women, stratified on prepregnancy level of alcohol consumption. The study was carried out at the public antenatal clinic of Roubaix maternity hospital. During an eight month period, 684 women (89% of those eligible) were interviewed in a standardised way at their first antenatal clinic visit. Of these, all who were suspected of being alcoholic or heavy drinkers (at least 21 drinks per week) were selected for follow up, as was a subsample of light (0-6 drinks per week) and moderate (7-20 drinks per week) drinkers. Of 347 women selected in this way, 202 had their infants assessed by a standardised morphological examination. MEASUREMENTS AND AND MAIN RESULTS: Suggestive craniofacial characteristics of the infants, present either in isolation or in association with growth retardation ('fetal alcohol effects'), were compared in relation to maternal alcohol consumption (alcoholic 12%; heavy drinking 24%; moderate drinking 28%; light drinking 36%). No differences were found between light and moderate drinkers. Infants born to alcoholics had a greater number of craniofacial characteristics and the proportion with features compatible with fetal alcohol effects was higher. There was a similar trend for infants of heavy drinkers. Infants of heavy drinkers who had decreased their alcohol consumption during pregnancy had fewer craniofacial features. Infants of heavy smokers were also found to have increased numbers of craniofacial characteristics. Craniofacial morphology could be a sensitive indicator of alcohol exposure in utero. Altered morphology is usually considered specific for alcohol exposure, but the relation observed with smoking needs further exploration. [ABSTRACT FROM AUTHOR]

An abstract of the article "Association between growth restriction and congenital anomalies: myth or reality? A population-based study in France," by S. Hourrier, B. Deloison, N. E. Russel, N. Lelong, B. Khoshnood, F. Goffinet, Y. Ville, and L. J. Salomon is presented.

Abstract Background Classification of the overall spectrum of congenital heart defects (CHD) has always been challenging, in part because of the diversity of the cardiac phenotypes, but also because of the oft-complex associations. The purpose of our study was to establish a comprehensive and easy-to-use classification of CHD for clinical and epidemiological studies based on the long list of the International Paediatric and Congenital Cardiac Code (IPCCC). Methods We coded each individual malformation using six-digit codes from the long list of IPCCC. We then regrouped all lesions into 10 categories and 23 subcategories according to a multi-dimensional approach encompassing anatomic, diagnostic and therapeutic criteria. This anatomic and clinical classification of congenital heart disease (ACC-CHD) was then applied to data acquired from a population-based cohort of patients with CHD in France, made up of 2867 cases (82% live births, 1.8% stillbirths and 16.2% pregnancy terminations). Results The majority of cases (79.5%) could be identified with a single IPCCC code. The category "Heterotaxy, including isomerism and mirror-imagery" was the only one that typically required more than one code for identification of cases. The two largest categories were "ventricular septal defects" (52%) and "anomalies of the outflow tracts and arterial valves" (20% of cases). Conclusion Our proposed classification is not new, but rather a regrouping of the known spectrum of CHD into a manageable number of categories based on anatomic and clinical criteria. The classification is designed to use the code numbers of the long list of IPCCC but can accommodate ICD-10 codes. Its exhaustiveness, simplicity, and anatomic basis make it useful for clinical and epidemiologic studies, including those aimed at assessment of risk factors and outcomes.

An abstract of the article "Assessing the performance of the examination of intracranial translucency and posterior fossa anatomy for the first trimester detection of spina bifida," by R. Mangione, F. Dhombres, N. Lelong, F. Atoub, S. Amat, B. Khoshnood, and J. Jouannic is presented.

Une morbidité obstétricale plus importante chez les femmes atteintes de PR est suggérée dans la littérature, mais aucune comparaison avec des femmes en population générale n'existe pour la France [1]. L'objectif de l'étude était de comparer la morbidité obstétricale chez les femmes atteintes de PR dans la cohorte GR2 à celle de femmes témoins issues de l'Enquête Nationale Périnatale (ENP) [2]. Nous avons effectué une étude comparative appariée des patientes atteintes de PR incluses dans la cohorte multicentrique nationale GR2 (Groupe de recherche pour la grossesse) de 2014 à juin 2021 et des femmes ayant participé à l'ENP. Cette dernière est une enquête périnatale nationale française menée tous les 5 ans qui recense environ 13 000 naissances. Les naissances avant 22 semaines d'aménorrhée (SA) et les poids de naissance < 500 grammes étant exclus de l'ENP, les mêmes critères d'exclusion ont été appliqués aux femmes atteintes de PR. Chaque grossesse chez les femmes atteintes de PR a été appariée à 4 grossesses chez les femmes ayant participé à l'ENP sur le groupe d'âge (≤ 29, 30–34, 35–39, ou ≥ 40 ans), la parité, la zone de résidence (région française), et la gémellité. Ces variables d'appariement ont été choisies en raison de leur association avec un risque d'issue défavorable de la grossesse. La fréquence de chaque issue défavorable de la grossesse a été comparée entre les deux groupes à l'aide d'un test exact de Fisher ou d'un Chi2. Les odds ratio (OR) et leur intervalle de confiance (IC) à 95 % ont été calculés pour chaque variable. Parmi les 92 patientes atteintes de PR incluses dans la cohorte GR2, 83 (dont une grossesse gémellaire) ont été retenues après exclusion des naissances avant 22 SA et/ou des poids de naissance < 500 grammes. Elles ont été appariées à 332 grossesses contrôles à partir de l'ENP. Les patientes du GR2 ont en moyenne 33,7 (± 5,06) ans et 53 % sont nullipares. La prématurité est significativement supérieure chez les femmes atteintes de PR par rapport aux témoins (16,9 % versus 6,3 %, p < 0,01). Il n'a en revanche pas été retrouvé de différence significative pour les autres complications obstétricales, y compris en termes de diabète gestationnel ou de macrosomie (malgré le recours à la corticothérapie ≥ une fois pendant la grossesse dans 42,1 % des cas chez les femmes atteintes de PR) (Tableau 1). Cette étude retrouve un surrisque de prématurité chez les nouveau-nés de femmes atteintes de PR en comparaison à des femmes témoins en population générale française, appelant à une attention particulière pour le suivi obstétrical chez ces patientes. [ABSTRACT FROM AUTHOR]

Une morbidité obstétricale plus importante chez les femmes atteintes de SpA est suggérée dans la littérature [1] , mais aucune comparaison avec des femmes en population générale n'existe pour la France. L'objectif de l'étude était de comparer le recours à la PMA et la morbidité obstétricale chez les femmes atteintes de SpA de la cohorte GR2 à celle de femmes témoins issues de l'Enquête Nationale Périnatale (ENP) [2]. Nous avons effectué une étude comparative appariée des patientes atteintes de SpA incluses dans la cohorte multicentrique nationale GR2 (Groupe de Recherche pour la Grossesse) de 2014 à 2021 et des femmes ayant participé à l'ENP. Cette dernière est une enquête périnatale nationale française menée tous les 5 ans qui recense environ 13 000 naissances. Les naissances avant 22 semaines d'aménorrhée (SA) et les poids de naissance < 500 grammes étant exclus de l'ENP, les mêmes critères de sélection ont été appliqués aux femmes atteintes de SpA dans cette étude. Chaque grossesse chez les femmes atteintes de SpA a été appariée à 4 grossesses chez les femmes ayant participé à l'ENP sur le groupe d'âge (≤ 29, 30–34, 35–39, ou ≥ 40 ans), la parité, la zone de résidence (région française), et la gémellité. Ces variables d'appariement ont été choisies en raison de leur association avec un risque d'issue défavorable de la grossesse. La fréquence de chaque issue défavorable de la grossesse a été comparée entre les deux groupes à l'aide d'un test exact de Fisher ou d'un Chi2. Les odds ratio (OR) et leur intervalle de confiance (IC) à 95 % ont été calculés pour chaque variable. Parmi les 126 patientes atteintes de SpA incluses dans la cohorte GR2, 116 grossesses ont été retenues après exclusion des naissances avant 22 SA et/ou des poids de naissance < 500 grammes. Elles ont été appariées à 464 grossesses contrôles de l'ENP. Les patientes du GR2 ont en moyenne 32,0 (± 4,1) ans et 54,3 % sont nullipares. 54,8 % d'entre elles étaient traitées par biothérapie au cours de la grossesse. Il a été retrouvé un recours à la PMA supérieur chez les femmes atteintes de SpA (OR 1,95 IC 95 % [1,02–3,76]). Il n'a en revanche pas été retrouvé de différence significative sur les critères de morbidité obstétricale (Tableau 1). Les femmes atteintes de SpA suivies dans la cohorte GR2 présentent davantage de troubles de la fertilité comparativement à des femmes contrôles issues de la population générale française. Le risque obstétrical est en revanche comparable dans cette population sélectionnée de femmes majoritairement sous anti-TNF pendant la grossesse. [ABSTRACT FROM AUTHOR]