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Background:Chlordecone is a highly persistent organochlorine insecticide that was intensively used in banana fields in the French West Indies, therefore resulting in a widespread contamination of soils, water sources and foodstuff. Neurotoxicity of acute exposures in adults is well recognized, and empirical data suggests that prenatal exposure affects visual recognition memory and fine motor development during infancy, and visual contrast sensitivity at school age, with greater susceptibility in boys. Objective:To assess the associations between pre- and postnatal exposures to chlordecone and intellectual and behavioral functions in school-aged children from Guadeloupe. Methods:We examined 576 children from the TIMOUN mother-child cohort in Guadeloupe at 7 years of age. Concentrations of chlordecone and other environmental contaminants were measured in cord- and children’s blood at age 7 years. Intellectual abilities of children were assessed with the Wechsler Intelligence Scale for Children-IV (WISC-IV), and externalizing and internalizing problem behaviors documented with the Strengths and Difficulties Questionnaire (SDQ) completed by the child’s mother. We estimated covariate-adjusted associations between cord- and 7-years chlordecone concentrations and child outcomes using structural equations modeling, and tested effect modification by sex. Results: Blood chlordecone concentrations were 0.13 µg/L in cord blood and 0.06 µg/L in children’s blood at age 7 years (geometric means [GM]). A twofold increase in cord blood concentrations was associated with 0.05 standard deviation (SD) (95% Confidence Interval [CI]: 0.0, 0.10) higher internalizing problem scores, whereas 7-years chlordecone concentrations were associated with lower Full-Scale IQ scores (FSIQ) and greater externalized behavioral problem scores. A twofold increase in 7-year chlordecone concentrations was associated with a decrease of 0.67 point (95% CI: -1.13, -0.22) on FSIQ and an increase of 0.04 SD (95% CI: 0.0, 0.07) on externalizing problems. These associations with intellectual abilities were driven by decreases in perceptive reasoning, working memory and verbal comprehension. In sex-stratified analyses, associations between 7-year exposure and perceptive reasoning, working memory, and the FSIQ were stronger in boys, whereas cord blood and child blood associations with internalizing problems were stronger in girls. Conclusions: These results suggests that intellectual abilities and externalizing behavior problems at school age are impaired by childhood, but not in utero, exposure to chlordecone, and that prenatal exposure is related to greater internalizing behavioral problems. The persistence of these effects at later age remains to be elucidated.

International audience; BACKGROUND: Chlordecone is an organochlorine that was largely used as an insecticide to control a species of root borers, the Banana weevil (Cosmopolites sordidus), in the French West Indies, Guadeloupe and Martinique. Its molecules have been shown to be very persistent in the environment as pollution in soils leading to contamination of water sources and foodstuff will last for several decades. Our team previously reported associations between prenatal chlordecone exposure and poorer fine motor development at two points in time during infancy. OBJECTIVE: To document whether effects of prenatal exposure to chlordecone previously reported persists until middle-childhood, and whether deleterious effects are observed in domain of visual processing. Associations with postnatal exposure and sex-specific vulnerabilities were also investigated. METHODS: We examined 410 children from the TIMOUN mother-child cohort in Guadeloupe at 7 years of age. Concentrations of chlordecone and other environmental contaminants were measured in cord- and children’s blood at age 7 years. Fine motor function was assessed using the Bruininks Oseretsky Test of Motor Proficiency Second Edition (BOT-2). The Computerized Adaptive Testing System (CATSYS) was used to evaluated postural hand tremor, while non-verbal visuospatial processing was measured using the Stanford Binet copying (S-B copying) test. We used adjusted multiple linear regressions to test the relationship between children’s scores and both continuous and categorical blood chlordecone concentrations, adding child sex as a moderator in continuous models. RESULTS: Cord chlordecone concentrations are associated with a regular frequency pattern of subtle hand tremors in both hands, and not related to visual processing and fine motor precision. Chlordecone concentrations in blood sample collected at testing time are associated with poorer visual processing when copying geometric figures, but not significantly related to poorer fine movement precision in tasks requiring pencil, scissors and paper. No sex-specific vulnerability was reported in any of the outcomes. CONCLUSIONS: These results at school aged expand those previously reported in the same cohort during infancy at age 7- and 18 months, and corroborate the negative effects of chlordecone exposure on fine motor function in absence of intoxication. Our results support the need to continue public health efforts aimed at reducing exposure especially among women of child bearing age and young children.

Chlordecone is an organochlorine pesticide that was extensively used to control the banana root borer population in the French West Indies until 1993. Its persistence in soil has led to widespread pollution of the environment, and human beings, including pregnant women, are still exposed to this chemical. High levels of exposure to chlordecone during gestation have been shown to cause congenital anomalies, including undescended testes in rodents. We assessed the associations between chlordecone concentrations in maternal and cord plasma and the risk of congenital anomalies in the Timoun Mother-Child Cohort Study (2004-2007) that included 1068 pregnant women in Guadeloupe. Odds ratios were estimated using unconditional logistic regression analysis, controlling for confounding factors. The median plasma concentrations in maternal and cord plasma were 0.39 μg/L and 0.20 μg/L, respectively. Thirty-six children were diagnosed with malformations according to the European Registration of Congenital Anomalies guidelines and 25 with undescended testes. There was no association between maternal or cord plasma concentration of chlordecone and the risk of overall malformations nor undescended testes. These results suggest that prenatal exposure to the currently observed environmental levels of chlordecone in French West Indies does not increase the risk of birth defects.

BackgroundChlordecone is an endocrine-disrupting chemical with well recognized estrogenic and progestagenic properties. This organochlorine insecticide was extensively used in the French West Indies from 1973 to 1993 to control the banana root borer. Due to its poor degradation in the environment, permanently polluted soil is responsible for the current contamination of the food chain and human beings. We aimed to examine the relationship of in utero exposure to chlordecone and thyroid (thyroid stimulating hormone [TSH], free tri-iodothyronine [FT3], free thyroxine [FT4]), metabolic (insulin growth-factor 1, leptin, adiponectin), and sex-steroid (dehydroepiandrosterone [DHEA], total testosterone [TT], dihydrotestosterone [DHT], estradiol [E2]) hormone levels in children at the age of seven years who participated in TIMOUN, an ongoing birth cohort in Guadeloupe.MethodsChlordecone concentrations were measured in cord-blood at delivery. Thyroid, metabolic, and sex-steroid hormone levels were determined in the blood of children at seven years of age. Associations between in utero chlordecone exposure and hormone levels at seven years of age were assessed by multiple linear or logistic regression, controlling for confounding factors.ResultsAmong the study population (210 boys and 228 girls), chlordecone and hormone measurements were available for 124 boys and 161 girls. We found the third quartile of in utero chlordecone exposure relative to the lowest quartile to be associated with elevated TSH levels in girls and elevated DHEA, TT, and DHT levels in both sexes. Complementary non-linear analysis (spline regression) confirmed a significant non-linear trend for TSH in girls and DHEA and DHT in boys.ConclusionIn utero chlordecone exposure was associated with elevated levels of selected thyroid (TSH) and sex-steroid (DHEA, TT, and DHT) hormones at seven years in a non-monotonic dose response (inverted U) relationship. The implications for future health and reproductive function in puberty and adulthood should be determined.

International audience; Chlordecone was used intensively as an insecticide in the French West Indies. Because of its high persistence, the resulting contamination of food and water has led to chronic exposure of the general population as evidenced by its presence in the blood of people of Guadeloupe, in particular in pregnant women and newborns, and in maternal breast milk. Chlordecone is recognized as a reproductive and developmental toxicant, is neurotoxic and carcinogenic in rodents, and is considered as an endocrine-disrupting compound with well-established estrogenic and progestogenic properties both in vitro and in vivo. The question arises of its potential consequences on child neurodevelopment following prenatal and childhood exposure, in particular on behavioral sexual dimorphism in childhood. We followed 116 children from the TIMOUN mother–child cohort study in Guadeloupe, who were examined at age 7. These children were invited to participate in a 7-min structured play session in which they could choose between different toys considered as feminine, masculine, or neutral. The play session was video recorded, and the percentage of the time spent playing with feminine or masculine toys was calculated. We estimated associations between playtime and prenatal exposure to chlordecone (assessed by concentration in cord blood) or childhood exposure (determined from concentrations in child blood obtained at the 7-year follow-up), taking into account confounders and co-exposures to other environmental chemicals. We used a two-group regression model to take into account sex differences in play behavior. Our results do not indicate any modification in sex-typed toy preference among 7-year-old children in relation with either prenatal or childhood exposure to chlordecone.

International audience; In the treatment of advanced-stage epithelial ovarian cancer (EOC)-associated surgery and chemotherapy with intravenous platinum/taxane-based therapy most patients had early or late recurrence. Prevention of progression and recurrence is a major objective for the management of EOC. Recently, many clinical studies have evaluated the strategy with hyperthermic intraoperative intraperitoneal (IP) drug delivery. This is an update of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) in EOC and a view for future strategies. Until recently studies on HIPEC in patients with EOC were mostly retrospective and heterogeneous. Thanks to recent clinical trials, it is reasonable to conclude that surgical cytoreduction and HIPEC is an interesting approach in the management of EOC without increasing morbidity. © 2020 Walter de Gruyter GmbH, Berlin/Boston.

The best prognosis for advanced ovarian cancer is provided by no residual disease after primary cytoreductive surgery. It is thus important to be able to predict resectability that will result in complete cytoreduction, while avoiding unnecessary surgery that may leave residual disease. No single procedure appears to be sufficiently accurate and reliable to predict resectability. The process should include a preoperative workup based on clinical examination, biomarkers, especially tumor markers, and imaging, for which computed tomography, as well as sonography, magnetic resonance imaging and positron-emission tomography, can be used. This workup should provide sufficient information to determine whether complete cytoreduction is possible or if not, to propose neoadjuvant chemotherapy which is preferable in this case. For the remaining patients, laparoscopy is broadly recommended as an ultimate triage step. However, its modalities are still debated, and several scores have been proposed for standardization and improving accuracy. The risk of false negatives requires a final assessment of resectability as the first stage of cytoreductive surgery by laparotomy. Composite models, consisting of several criteria of workup and, sometimes, laparoscopy have been proposed to improve the accuracy of the predictive process. Regardless of the modality, the process appears to be accurate and reliable for predicting residual disease but less so for predicting complete cytoreduction and thus avoiding unnecessary surgery and an inappropriate treatment strategy. Overall, the proposed procedures are heterogeneous, sometimes unvalidated, or do not consider advances in surgery. Future techniques and/or models are still needed to improve the prediction of complete resectability.

International audience; Desert dust transported from the Sahara to the Caribbean generates peak exposures to particulate matter ≤ 10 μm (PM). We investigated the impact of dust episodes on severe small for gestational-age births in Guadeloupe. The study sample consisted of 911 pregnant women enrolled in the Timoun mother-child cohort. Desert dust exposure was assessed through the mean daily PM concentrations averaged over the entire pregnancy. Numerous sociodemographic and medical risk factors were considered as covariates and introduced into multinomial logistic regression models. Odds ratios (ORs) were calculated per SD change (3.08 μg/m). Among various outcomes, symmetrically growth-retarded births showed the highest OR (3.28, 95% CI 1.08-10.02). Saharan dust seems to influence weight but not length or head circumference at birth. Given the high OR observed in this study, it is conceivable that Saharan dust plays a role through severe placental insufficiency early in pregnancy.

International audience; Recent evidence suggests that prenatal exposure to chlordecone, a persistent organochlorine pesticide that was used intensively in the French West Indies, affects infant neurodevelopment. The aim of the present study was to evaluate the association between prenatal and postnatal chlordecone exposures on visual contrast sensitivity in 285 children aged from 7.1 to 8 years old (mean age = 7.68 ± 0.21 years; sex ratio = 54 % girls) in a Guadeloupean prospective birth cohort (TIMOUN). The Freiburg Visual Acuity and Contrast Test (FrAcT) was used to assess visual contrast sensitivity. Chlordecone concentrations were measured in blood samples at birth (cord blood) and in children at testing time to estimate pre- and postnatal exposure, respectively. Exposures were categorized into three groups and were also log-transformed and considered as continuous variables. Multiple linear regression models were performed on all children taking into account various potential confounders, including maternal characteristics (age, education, intellectual functioning, alcohol and tobacco use during pregnancy). Potential moderation effect of sex was also examined. Results showed that higher cord plasma chlordecone levels were associated with lower contrast sensitivity. Although child chlordecone levels was not associated with the FrAcT, sex-specific stratified analyses revealed significant associations in boys. Associations between postnatal exposure and FrACT scores in girls were null. This study indicates that exposure to chlordecone in utero and during childhood may impair visual contrast sensitivity at school age, particularly in boys.

ObjectivesLarge amounts of mineral dust are transported from their African sources in the Saharan-Sahel region to the Caribbean Sea, generating peak exposures to particulate matter ≤10 µm (PM10). This study aimed to investigate the impact of Saharan dust episodes on preterm births in the Guadeloupe archipelago.MethodsThe study population consisted of 909 pregnant women who were enrolled in the TIMOUN mother-child cohort between 2004 and 2007. Desert dust episodes were assessed from PM10 concentrations recorded at the unique background air quality monitoring station located in Pointe-à-Pitre. For each woman, the daily PM10 concentrations were averaged over the entire pregnancy, and the proportion of days with intense dust episodes (≥55 µg PM10/m3) during pregnancy was calculated. Weighted logistic regression models adjusting for known individual sociomedical risk factors were used to estimate ORs and 95% CIs for preterm birth.ResultsDuring pregnancy, the mean PM10 concentrations ranged from 13.17 to 34.92 µg/m3, whereas the proportion of intense dust events ranged from 0.00% to 19.41%. Increased adjusted ORs were found for both the mean PM10 concentrations and the proportion of intense dust events (OR 1.40, 95% CI 1.08 to 1.81, and OR 1.54, 95% CI 1.21 to 1.98 per SD change, respectively). Restriction to spontaneous preterm births produced similar ORs but with wider 95% CIs.ConclusionConsidering the personal and social burden of this adverse pregnancy outcome, this finding is of importance for both healthcare workers and policy makers to provide necessary preventive measures.

AIM The global increase in the rate of cesarean sections (CS) is currently an issue. We aimed to assess the rate of CS locally and to identify cases in which this procedure may have been avoidable. METHODS In this prospective consecutive series, we analyzed the 478 CS carried out in our unit in 2009. We analyzed the characteristics of each case, and classified each as potentially avoidable or unavoidable. RESULTS The total rate of CS was 24.0%, including 1.7% that was scored as potentially avoidable. Parity, gestational age at birth, birthweight, cases requiring cervical ripening, cases of labor induction, and CS during labor were all significantly higher or more frequent among potentially avoidable CS. Multivariate analysis indicated that the risk of potentially avoidable CS was positively associated with gestational age and tended to be negatively associated with parity. The main indications for potentially avoidable CS were cervical dystocia and abnormal fetal heart rate, and for unavoidable CS they were abnormal fetal heart rate and history of previous CS. CONCLUSION Labor, especially when induced, seems to be the key period for the prevention of 'avoidable' CS. This is particularly important given that potentially avoidable CS are more frequently associated with uncomplicated pregnancies than are unavoidable CS. A woman's first CS increases the likelihood of CS for subsequent deliveries, so the prevention of the first CS is a key aim for reducing the overall rate of CS.

International audience; BACKGROUND:The risk of congenital neurologic defects related to Zika virus (ZIKV) infection has ranged from 6 to 42% in various reports. The aim of this study was to estimate this risk among pregnant women with symptomatic ZIKV infection in French territories in the Americas.METHODS:From March 2016 through November 2016, we enrolled in this prospective cohort study pregnant women with symptomatic ZIKV infection that was confirmed by polymerase-chain-reaction (PCR) assay. The analysis included all data collected up to April 27, 2017, the date of the last delivery in the cohort.RESULTS:Among the 555 fetuses and infants in the 546 pregnancies included in the analysis, 28 (5.0%) were not carried to term or were stillborn, and 527 were born alive. Neurologic and ocular defects possibly associated with ZIKV infection were seen in 39 fetuses and infants (7.0%; 95% confidence interval, 5.0 to 9.5); of these, 10 were not carried to term because of termination of pregnancy for medical reasons, 1 was stillborn, and 28 were live-born. Microcephaly (defined as head circumference more than 2 SD below the mean for sex and gestational age) was detected in 32 fetuses and infants (5.8%), of whom 9 (1.6%) had severe microcephaly (more than 3 SD below the mean). Neurologic and ocular defects were more common when ZIKV infection occurred during the first trimester (24 of 189 fetuses and infants [12.7%]) than when it occurred during the second trimester (9 of 252 [3.6%]) or third trimester (6 of 114 [5.3%]) (P=0.001).CONCLUSIONS:Among pregnant women with symptomatic, PCR-confirmed ZIKV infection, birth defects possibly associated with ZIKV infection were present in 7% of fetuses and infants. Defects occurred more frequently in fetuses and infants whose mothers had been infected early in pregnancy. Longer-term follow-up of infants is required to assess any manifestations not detected at birth. (Funded by the French Ministry of Health and others; ClinicalTrials.gov number, NCT02916732 .).

International audience; Patients frequently ask about the cause of their breast cancer. To answer, physicians refer to breast cancer risk factors based on medical reports. We aim to assess these risk factors for the point of view of survivors, a point of view which seems to differ from that of medical references. We ran a survey with open- and closed-ended questionnaires on patients' opinions about risks factors both for women in general and for their own case. We also collected data on their sources of information on this subject. Most patients had no opinion. The most frequently cited risk factors were stress, then genetic causes, and poor diet. Internet was the leading source of information for patients, followed by physicians and magazines. Our study highlights the mismatch between breast cancer risk factors as perceived by scientists and by survivors. Survivors tend to focus on non-controllable risk factors. Taking into account attribution theories of life events, an awareness of patient opinion may be valuable for psychological support of survivors, and it may be informative to record the way in which patients attribute causality for life events such as breast cancer and, more generally, all type of cancer.

Resume Objectif Cette etude a compare deux protocoles de prise en charge des ruptures prematurees des membranes (RPMAT) differant sur le type et la duree d’antibiotherapie. Patientes et methodes L’antibiotherapie de la RPMAT a Fort-de-France (cephalosporine de 1re generation pendant 7 jours) et a Pointe-a-Pitre (amoxicilline jusqu’a l’accouchement) a ete comparee retrospectivement pendant cinq ans. L’issue principale etait l’apparition de bacilles Gram negatif (BGN) dans les prelevements bacteriologiques maternels ou neonataux chez les RPMAT ayant une latence ≥ quatre jours. Resultats Nous avons compare 38 cas de RPMAT en Martinique a 52 cas en Guadeloupe. Nous avons observe une selection des BGN resistants au cours du suivi dans chaque centre. Elle est liee a la duree de latence dans les deux centres. L’apparition d’un BGN apparait aussi liee a la duree d’antibiotherapie en cas de traitement long. Les durees de latences, les termes d’accouchement et la morbi-mortalite neonatale ou maternelle sont identiques. Conclusion Nous avons observe une apparition importante de BGN lors du traitement des RPMAT, d’autant plus que la latence rupture–accouchement et que le traitement sont longs.

International audience; Background: Geographical disparities in breast cancer incidence and outcomes are reported worldwide. Women of African descent show lower incidence, higher mortality rates and earlier age of onset. We analyzed data from the cancer registry of Guadeloupe for the period 2008-2013. Methods: We describe breast cancer characteristics by molecular subtype, as well as estimated observed and net survival. We used Cox proportional hazard models to determine associations between cancer subtypes and death rate, adjusted for variables of interest. Results: Overall, 1275 cases were recorded with a mean age at diagnosis of 57(+/- 14) years. World standardized incidence and mortality were respectively 71.9/100,000 and 14.1/100,000 person-years. Age-specific incidence rates were comparable to European and US populations below the age of 45, and higher in Guadeloupean women aged between 45 and 55 years. Overall, 65.1% of patients were hormone receptor (HR)+ and 20.1% were HR-. Triple negative breast cancers (TNBC) accounted for 14% of all cases, and were more frequent in patients under 40 (21.6% vs. 13.4%, p = 0.02). Five-year net survival was 84.9% [81.4-88.6]. It was higher for HR+/Her2+ and HR+/Her2-subtypes, and lower for HR-/Her2+ and TNBC patients. Conclusion: We found high age-specific incidence rates of breast cancer in women aged 45 to 55 years, which warrants further investigation in our population. However, this population of mainly African descent had good overall survival rates, and data according to subtypes are consistent with those reported internationally. These results may suggest that poorer survival in other African descent populations may not be an inherent feature of the disease but may be amenable to improvement. (C) 2017 Elsevier Ltd. All rights reserved.

Vaginal cesarean section is a uterine incision technique derived from Duhrssen’s incision, with which it is sometimes confused. We report here our experience over 10 years with this technique, with the aim of defining the situations in which it is potentially useful. We retrospectively analyzed 24 cases of vaginal cesarean section (i.e. cervico-segmental incision) carried out from 2002 to 2011 in our tertiary maternity unit. This corresponds to an incidence of 1.1 per thousand deliveries. The main outcome measures were the indications and complications of vaginal cesarean section. The study population included 42 % nulliparous women. The fetuses concerned had a median gestational age of 24 weeks + 5 days (18 to 34 weeks + 1 day) and a median weight of 595 g (340–1,250 g). The indications for vaginal cesarean section were severe maternal morbidity in 54.2 % of cases, failed labor induction in 29.2 % and another indication in 16.7 %. All but one of the fetuses were dead or nonviable. Surgical complications were observed in three cases: two difficulties achieving hemostatic control and one bladder injury. Vaginal cesarean section is sometimes considered obsolete, but it has several advantages: technical simplicity, limited tissue dissection, low risk of hemorrhage and no abdominal scar. These features make it particularly suitable for the extraction of medium-sized dead or nonviable fetuses when pharmacological options are ineffective or not rapid enough in cases of poor maternal condition.

Resume Objectif En France, la contraception est accessible pour tous, pourtant, le nombre d’interruption volontaire de grossesse (IVG) ne regresse pas, notamment chez les jeunes. Le but de notre etude est d’analyser, dans le contexte guadeloupeen, les caracteristiques de la population des mineures demandeuses d’une IVG. Methodes Cette etude retrospective analyse les caracteristiques sociodemographiques et medicales de 129 mineures ayant beneficie d’une IVG en 2010, dans notre centre d’orthogenie. Pour 67 d’entre elles, les resultats d’entretien avec la psychologue sont aussi rapportes. Resultats Issues preferentiellement de familles nombreuses monoparentales, ces jeunes filles avaient un âge moyen de 15,9 ans (± 1,12), 96,1 % etaient nees en France, 10,9 % avaient deja eu une grossesse, 67,2 % avaient un partenaire majeur et 64,4 % utilisaient une contraception avant l’IVG. Les motivations premieres de l’IVG etaient la poursuite des etudes et le jeune âge ; 55,1 % de ces demandes survenaient apres neuf semaines d’amenorrhee et 43,3 % des patientes rapportaient des difficultes d’ordre psychologique liees a l’IVG. Conclusion A partir de ce profil type, notre etude propose des elements de reflexion susceptibles d’aider a la lutte contre les grossesses non desirees dans cette population particuliere des mineures.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 43 - N° 3 - p. 254-262

Introduction Dans les Territoires Francais d’Amerique (TFA), le risque d’anomalies congenitales associees a une infection a virus Zika (ZIKV) a ete estime a 7 % des enfants/fœtus dans une cohorte de 546 femmes ayant presente une infection symptomatique a ZIKV confirmee par RT-PCR (NEJM 2018 ;378 :985). Comme nous ne disposions pas de cohorte de femmes enceintes non infectees par ZIKV pour constituer un groupe non expose, nous avons constitue a posteriori un groupe de femmes enceintes non infectees a ZIKV au cours de la grossesse. Materiels et methodes En Guadeloupe, l’un des 3 TFA ayant participe a l’etude de cohorte prospective, des femmes enceintes n’ayant pas eu de symptomes d’infection a ZIKV au cours de leur grossesse ont eu une serologie ZIKV au moment de l’accouchement. Les femmes dont la serologie ZIKV-IgG etait negative a l’accouchement, ont ete considerees comme non-infectees par ZIKV. L’historique de la grossesse a ete reconstitue et les anomalies congenitales des nouveau-nes vivants de ces femmes ont ete decrites en utilisant les memes definitions que celles utilisees pour la cohorte prospective. Les pourcentages d’anomalies congenitales observees chez ces nouveau-nes vivants non exposes a ZIKV ont ete compares a ceux observes chez les 241 nouveau-nes vivants guadeloupeens issus de la cohorte prospective. Resultats Sur les 490 nouveau-nes vivants guadeloupeens non exposes a ZIKV, 42 (8,6 %) presentaient des anomalies neurologiques considerees comme « possiblement liees a une infection a ZIKV » ; tous les cas saufs un etaient des microcephalies moderees sans autre anomalie. Le pourcentage de ces anomalies n’etait pas different de celui observe chez les 241 nouveau-nes vivants guadeloupeens exposes a ZIKV (6,6 %, p = 0,36). En regroupant les 8 fœtus morts et les 241 nouveau-nes vivants des femmes guadeloupeennes infectees par ZIKV issues de la cohorte prospective, seuls 2 nouveau-nes vivants (0,8 %) et 3 fœtus morts issus d’interruptions medicales de grossesse (1,2 %) avaient des anomalies compatibles avec une infection a ZIKV. Conclusion Les microcephalies isolees et d’autres anomalies neurologiques mineures ont ete observees avec la meme prevalence chez les nouveau-nes vivants, qu’ils aient ete ou non exposes a ZIKV in utero. La prevalence elevee des microcephalies isolees observees dans les deux groupes suggere que la definition utilisee pour le diagnostic de microcephalie (perimetre crânien

Background: Recent studies suggest that a Mediterranean dietary pattern during pregnancy may influence pregnancy outcomes. The aim of this study was to evaluate the effect of adherence to a Mediterranean diet (MD) during pregnancy on fetal growth restriction (FGR) and preterm delivery (PTD) in a French Caribbean island where the population is largely of African descent and presents dietary patterns similar to MD. Methods: Using data from the TIMOUN Mother‐Child Cohort Study conducted in Guadeloupe (French West Indies) between 2004 and 2007, we analysed data for 728 pregnant women who delivered liveborn singletons without any major congenital malformations. Degree of adherence to MD during pregnancy was evaluated with a semi-quantitative food frequency questionnaire based on nine dietary criteria. Multiple logistic regression models were used to analyse birth outcomes while taking potential confounders into account. Results: Overall there was no association between MD adherence during pregnancy and the risk of PTD or FGR. However, pre-pregnancy body mass index was a strong effect modifier, and MD adherence was associated with a decreased risk of PTD specifically in overweight and obese women (adjusted odds ratio 0.7, 95% confidence interval 0.6, 0.9) (P heterogeneity

Resume But En Guadeloupe, le taux de fecondite des adolescentes est superieur a celui de la Metropole. Le but de notre travail etait d’analyser les caracteristiques sociodemographiques et les indicateurs de perinatalite chez les gestantes mineures dans notre maternite, et de les comparer a ceux d’une etude realisee en 1993 a 1994 dans le meme etablissement. Materiels et methodes Les donnees sociodemographiques, medicales, obstetricales et neonatales de 163 mineures ayant accouche en 2009 et 2010 au CHRU de Pointe a Pitre/Abymes ont ete recueillies retrospectivement, et comparees a la precedente etude. Resultats En 16 ans, si les indicateurs de perinatalite n’ont pas significativement evolue, les caracteristiques sociodemographiques de cette population se sont modifiees. De plus, le suivi obstetrical encore insuffisant et d’initiation trop tardive semble etre lie a une morbidite neonatale accrue. Conclusion Nos resultats sont proches de ceux decrits dans d’autres regions francaises. Les differences retrouvees pour les risques obstetricaux et perinatals semblent etre liees aux facteurs sociodemographiques entourant ces gestantes mineures. Ces derniers devraient etre pris en compte dans toute demarche de prevention du nombre et des complications des grossesses chez les mineures.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 42 - N° 2 - p. 137-142

Resume Objectif Le but de cette etude etait d’evaluer, en Guadeloupe, l’evolution de l’âge des principales etapes de vie reproductive et, notamment, du premier rapport sexuel. Patient(e)s et methodes Nous avons realise une etude transversale sur trois generations de femmes et d’hommes de plus de 20 ans. Ont ete recueillis pour tous les sujets : l’âge au premier rapport sexuel et au premier enfant ; de plus, pour les femmes : l’âge a la menarche, a la premiere grossesse et a la menopause. Resultats Nous avons rassemble les informations sur 803 femmes et 169 hommes. Chez les femmes, l’âge median a la menarche et au premier rapport sexuel ont baisse significativement pour atteindre respectivement 12 et 17 ans dans la plus jeune generation. Le risque de premier rapport avant la mediane etait significativement augmente en cas de precocite de la menarche. L’âge a la premiere grossesse, a la menopause chez la femme et au premier rapport chez les hommes restait relativement stable. L’âge au premier enfant tendait a augmenter non significativement dans les deux sexes. Discussion et conclusion Les indicateurs d’âge des principales etapes de vie reproductive en Guadeloupe suivent les tendances evolutives decrites en France metropolitaine. Ces âges restent, pour la plupart, inferieurs aux donnees de la metropole. Le lien retrouve entre âge a la menarche et precocite sexuelle devrait justifier des actions de sensibilisation ciblees.

International audience; The unexpected diagnosis of a leiomyosarcoma from a surgical specimen of a presumed leiomyoma is rare, but with deleterious consequences, especially if morcellation techniques are used. There are currently no effective methods for such a preoperative diagnosis. Ulipristal acetate has demonstrated efficacy for the preoperative treatment of leiomyomas, but not for all patients. We report two cases of leiomyosarcomas in patients treated with ulipristal acetate for a presumed leiomyoma. We propose that ineffective ulipristal acetate treatment may indicate a population in which uterine leiomyosarcoma is more prevalent. Attention should be given to any features of clinical and imaging examinations which raise the suspicion of a leiomyosarcomas in this population. Such suspicion should guide appropriate measures to avoid seeding the tumor, postponing the diagnosis, upstaging the patient and delaying the treatment (SPUD). (C) 2017 Elsevier Masson SAS. All rights reserved.

International audience; Background: Mass breast cancer screening is offered to French women between the ages of 50 and 74. In the French overseas department of Guadeloupe, where the population is of mostly African ancestry, a low age at diagnosis of breast cancer has been reported, as for African-Americans. This raises the question of whether breast cancer is more aggressive in the age group preceding that eligible for mass screening (4049) in Guadeloupe. Methods: We compared the tumor-related prognostic factors, first line therapy and overall survival rates of breast cancer cases diagnosed between the 40-49 and 50-74 age groups, based on reports of the cancer registry of Guadeloupe for the period 2008-2013. Results: The characteristics studied, risk of death after breast cancer (HR 0.84 [95% CI: 0.58-1.22] and overall survival, did not differ significantly between the two groups, except for higher tumor size (28.8 vs 24.0; p = 0.004) in the younger group. Conclusion: These results do not show a pattern of more aggressive breast cancer in the age group preceding that eligible for mass screening in Guadeloupe. (C) 2017 Elsevier Ltd. All rights reserved.

International audience; Background Chlordecone is a persistent organochlorine insecticide with well-defined estrogenic properties. It was intensively used in the French West Indies until 1993 to control the banana root borer. Because of the long-term contamination of soils and water, the population is currently exposed to chlordecone through food consumption. Chlordecone has been found in the blood of pregnant women and in cord blood. It has been shown to be an endocrine-disrupting chemical and exposure during pregnancy may affect fetal growth. Objectives The objective of our study was to examine the association between prenatal exposure to chlordecone and fetal growth based on the TIMOUN birth cohort conducted in Guadeloupe, with a focus on the potential modification of this relationship by maternal body mass index (BMI) and gestational weight gain (GWG). Methods Chlordecone was determined in cord plasma at birth in 593 babies. Birth weight was the indicator of fetal growth. Maternal pre-pregnancy BMI and GWG were determined. Adherence to GWG recommendations of the US Institute of Medicine based on maternal pre-pregnancy BMI was assessed. Birth weight was analyzed relative to cord blood chlordecone levels using linear and non-linear regression models. Results Overall chlordecone in cord blood was not associated with birth weight, but we found an interaction between chlordecone exposure with GWG and adherence to GWG recommendations. After stratification by GWG, we found a significant U-shaped association between birth weight and chlordecone exposure, within the upper quartiles of GWG or excessive GWG. Conclusion Chlordecone exposure may affect fetal growth, particularly when excessive GWG is present. © 2016 Elsevier Inc.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 41 - N° 7 - p. 657-663

The principal gynaecological cancers (breast, ovary, uterus, and cervix) account for over 40% of cancers found in women worldwide. However, large differences exist, in both their incidence and geographical distribution. The French West Indies, through their location, environment, socio-economic development, lifestyle, nutrition and the origins of their populations, constitute territories with a very particular character in the heart of the Caribbean. These characteristics have an impact on public health and can affect the incidence of tumours. We report for the first time the incidence of these major gynaecological cancers in Guadeloupe. Breast, ovary and uterine cancers have lower incidences in Guadeloupe than in mainland France. By contrast, cervical cancer is more frequent in Guadeloupe than in mainland France. The mortality rates associated with breast cancer, ovary and uterine cancer are also lower in Guadeloupe than in mainland France, whereas the opposite pattern is observed for cervical cancer. These observations may be accounted for in part by a difference in the prevalence of established or suspected risk factors for each of these types of cancer.

Depuis quelques annees, l'expression " perturbateur endocrinien " fait partie du langage commun scientifique et populaire. Cette expression fait reference aux substances chimiques, d'origine anthropique ou naturelle, susceptibles de generer des effets nocifs sur la sante humaine et animale par le biais de leurs proprietes hormonales. Mais la definition meme des perturbateurs endocriniens fait encore l'objet de discussions. De tres nombreux processus physiologiques font intervenir des systemes de communication hormonale. Les substances chimiques pouvant interferer avec ces systemes sont tres diverses. Les systemes endocriniens sont multiples. De ce fait, les consequences sanitaires potentielles peuvent etre tres variees. A ce jour et a quelques rares exceptions, les consequences deleteres des expositions aux perturbateurs endocriniens sur la sante humaine n'ont pas ete prouvees. La science qui s'est developpee autour des perturbateurs endocriniens presente des contours particulierement larges et flous. Cette science en pleine evolution est donc soumise a de nombreuses incertitudes, Cependant, sur le plan strictement scientifique, c'est une opportunite d'accroitre les connaissances du fonctionnement des systemes endocriniens et de leurs pathologies. Sur un plan societal, c'est l'occasion de s'interroger sur les activites de l'homme et sur ses consequences nefastes sur sa sante, son devenir et son environnement.

International audience; Background - Perinatal exposure to endocrine-disrupting chemicals may affect thyroid hormones homeostasis and impair brain development. Chlordecone, an organochlorine insecticide widely used in the French West Indies has known estrogenic and progestin properties, but no data is available, human or animal, on its action on thyroid hormone system. Objectives - Our aim was to evaluate the impact of perinatal exposure to chlordecone on the thyroid hormone system of a sample of infants from the Timoun mother-child cohort in Guadeloupe and their further neurodevelopment. Methods - Chlordecone was measured in cord blood and breast milk samples. Thyroid stimulating hormone (TSH), free tri-iodothyronine (FT3), free thyroxine (FT4) were determined in child blood at 3 months (n=111). Toddlers were further assessed at 18 months using an adapted version of the Ages and Stages Questionnaire (ASQ). Results - Cord chlordecone was associated with an increase in TSH in boys, whereas postnatal exposure was associated with a decrease in FT3 overall, and in FT4 among girls. Higher TSH level at 3 months was positively associated with the ASQ score of fine motor development at 18 months among boys, but TSH did not modify the association between prenatal chlordecone exposure and poorer ASQ fine motor score. Conclusions - Perinatal exposure to chlordecone may affect TSH and thyroid hormone levels at 3 months, differently according to the sex of the infant. This disruption however did not appear to intervene in the pathway between prenatal chlordecone exposure and fine motor child development.

Background The intensive use of chlordecone (an organochlorine insecticide) in the French West Indies until 1993 resulted in a long-term soil and water contamination. Chlordecone has known hormonal properties and exposure through contaminated food during critical periods of development (gestation and early infancy) may affect growth. Objectives We aimed to assess the impact of prenatal and postnatal exposure to chlordecone on the growth of children from the TIMOUN mother–child cohort. Methods Chlordecone was determined in cord plasma at birth (N=222) and in breast milk samples (at 3 months). Dietary chlordecone intake was estimated at 7 and 18 months, with food-frequency questionnaires and food-specific contamination data. Anthropometric measurements were taken at the 3-, 7- and 18-month visits and measurements reported in the infants' health records were noted. Structured Jenss–Bayley growth models were fitted to individual height and weight growth trajectories. The impact of exposure on growth curve parameters was estimated directly with adjusted mixed non-linear models. Weight, height and body mass index (BMI), and instantaneous height and weight growth velocities at specific ages were also analyzed relative to exposure. Results Chlordecone in cord blood was associated with a higher BMI in boys at 3 months, due to greater weight and lower height, and in girls at 8 and 18 months, mostly due to lower height. Postnatal exposure was associated with lower height, weight and BMI at 3, 8 and 18 months, particularly in girls. Conclusion Chlordecone exposure may affect growth trajectories in children aged 0 to 18 months.

International audience; Based on US national cancer registry data, age differences at breast cancer diagnosis have been reported between African-American women and European-American women. Such differences between populations of African and European ancestry have not been studied in other countries at a nationwide level. Here, we report and compare descriptive nationwide epidemiological indicators of invasive breast cancer for the populations of European ancestry living in the US and in mainland France and for women of African ancestry living in the US and in the French West Indies (Martinique and Guadeloupe). Based on the available data, we determined age frequency distributions, world age-standardized incidence, and the distribution of expected cases of breast cancer in a standard population of women by age. The age frequency distributions revealed that women of African ancestry were younger at diagnosis than women of European ancestry. By contrast, compared with the US regardless of ancestry and mainland France, the standardized incidences appeared lower, and the largest numbers of expected cases younger, in the French West Indies. The populations with African ancestry were not homogeneous in terms of epidemiologic indicators of age-related breast cancer. These descriptive findings suggest that populations of African ancestry cannot be considered uniform when determining whether it would be appropriate to decrease the age of entry into screening programs for breast cancer.

International audience; Persistent organic pollutants have not been conclusively associated with length of gestation or with preterm birth. Chlordecone is an organochlorine pesticide that has been extensively used to control the banana root borer population in the French West Indies. Data from the Timoun Mother-Child Cohort Study conducted in Guadeloupe between 2004 and 2007 were used to examine the associations of chlordecone concentrations in maternal plasma with the length of gestation and the rate preterm birth in 818 pregnant women. Data were analyzed using multivariate linear regression for length of gestation and a Cox model for preterm birth. The median plasma chlordecone concentration was 0.39 µg/L (interquartile range, 0.18-0.83). No correlation was observed with plasma concentrations of p,p'-dichlorodiphenyl dichloroethene (ρ = 0.017) or polychlorinated biphenyl 153 (ρ = -0.016), the other main organochlorine compounds detected. A 1-log10 increase in chlordecone concentration was associated with a decreased length of gestation (-0.27 weeks; 95% confidence interval: -0.50, -0.03) and an increased risk of preterm birth (60%; 95% confidence interval: 10, 130). These associations may result from the estrogen-like and progestin-like properties of chlordecone. These results are of public health relevance because of the prolonged persistence of chlordecone in the environment and the high background rate of preterm births in this population.

Few studies have explored the consequences of environmental exposure to organochlorine pesticides for gestational hypertension (GH), preeclampsia (PE) and gestational diabetes mellitus (GDM). Chlordecone is a persistent organochlorine pesticide that was used intensively, and almost exclusively, in the French West Indies until 1993. We investigated the impact of prenatal exposure to chlordecone on the occurrence of GDM, GH and PE by studying 779 pregnant women enrolled in a prospective mother–child cohort (Timoun Study) in Guadeloupe between 2004 and 2007. Chlordecone exposure was determined by assaying maternal plasma and information about pregnancy complications was obtained from midwives, pediatricians and hospital medical records after delivery. The risks of GH (n = 65), PE (n = 31) and GDM (n = 71) were estimated by multiple logistic regression including potential confounders. Levels of chlordecone plasma concentration in the third (OR = 0.2; 95% confidence interval (CI): 0.1, 0.5) and fourth quartiles (OR = 0.3; 95% CI: 0.2, 0.7) were associated with a statistically significant decrease in the risk of GH. A log10 increase in chlordecone concentration was significantly associated with lower risk of GH (OR = 0.4; 95% CI: 0.2, 0.6). No significant associations were observed between the chlordecone exposure and the risk of PE or GDM. This study suggests an inverse association between chlordecone exposure during pregnancy and GH. Further studies are required to determine the underlying mechanism, or the potential unknown confounding factors, resulting in this association. Keywords: Chlordecone, Endocrine disruptor, Gestational diabetes, Gestational hypertension, Organochlorine pesticides, Preeclampsia

International audience; There appears to be an incompressible high rate of preterm births among populations of African origin irrespective of their geographic location. The objective of this study was to assess the risk factors for preterm birth in a French Caribbean population of African descent, offered medical care comparable to that on the French mainland, but presenting a higher rate of preterm birth. The study was based on a birth cohort at maternity hospitals in Guadeloupe (French West Indies) including 911 singleton pregnancies enrolled during their third trimester check-up visits. Associations between risk factors and the risk of preterm delivery (spontaneous and induced) were assessed using a multivariate Cox model. In addition, prevalences of sociodemographic and medical factors in Guadeloupe were compared with those on the French mainland. 144 women (15.8 %) delivered preterm, medically induced in 52 %. Women delivering preterm were more often over 35 years old (37 %), single (54 %), and had higher prevalence of prior preterm birth (20 %), prior miscarriage (37 %), lupus (3 %), asthma (14 %), gestational hypertension (26 %), gestational diabetes (13 %) and urinary tract infection (24 %) than women with term births. In the whole cohort, these risk factors were also more frequent than in mainland France. Our results suggest highly prevalent medical risk factors for preterm births in Guadeloupe. This observation combined with specific social risk factors (older maternal age, single living) less frequent on the French mainland probably explains a large part of a higher prevalence of preterm births in this population despite similar medical provision.

Myoma is the most common benign tumor in women of childbearing age, with a high frequency in Afro-Caribbean than in other women. Depending on their number, size and location, myomas are suspected to be a cause of infertility. Conservative treatment by myomectomy is possible for symptomatic patients wishing to preserve their fertility. The aim of this study was to evaluate the fertility of patients undergoing myomectomy in the University Hospital of Pointe-a-Pitre, Guadeloupe. We conducted a retrospective study including all patients under age 42 who had conservative surgery from January 1st, 2005 to December 31st, 2009. The main judgment criteria were the occurrence of postoperative pregnancy and its outcome. Of 297 operated patients, 220 were interviewed by phone (74.1 %), 124 (56.3 %) had tried to obtain a pregnancy and 54 patients (43.5 %) had 66 pregnancies (59.1 % being live births and 25.8 % miscarriages). For fertility after surgery, univariate analysis identified the number (more than 6, P = 0.0027) and an intramural location (P = 0.027) of myomas as negative factors and multivariate analysis identified age (over 35 years, RR = 2.45) and the association of other causes of infertility (RR = 2.21) as negative factors for pregnancy. The modest conception rate (43.5 %) after myomectomy among those women trying to obtain a pregnancy may be linked to the specificities of our population, and in particular its relatively high age and the frequent association of multiple causes of infertility.

International audience; Chlordecone is a persistent organochlorine pesticide that was used in the French West Indies until the early 1990s for banana weevil borer control. Human exposure to this chemical in this area still occurs nowadays due to consumption of contaminated food. Although adverse effects on neurodevelopment, including tremors and memory deficits, have been documented in experimental studies conducted with rodents exposed during the gestational and neonatal periods, no study has been conducted yet to determine if chlordecone alters child development. This study examines the relation of gestational and postnatal exposure to chlordecone to infant development at 18 months of age in a birth-cohort of Guadeloupean children. In a prospective longitudinal study conducted in Guadeloupe (Timoun mother-child cohort study), exposure to chlordecone was measured at birth from an umbilical cord blood sample (n=141) and from a breast milk sample collected at 3 months postpartum (n=75). Toddlers were assessed using an adapted version of the Ages and Stages Questionnaire. Higher chlordecone concentrations in cord blood were associated with poorer fine motor scores. When analyses were conducted separately for boys and girls, this effect was only observed among boys. These results suggest that prenatal exposure to chlordecone is associated with specific impairments in fine motor function in boys, and add to the growing evidence that exposure to organochlorine pesticides early in life impairs child development.

International audience; BACKGROUND: The insecticide chlordecone was extensively used in the French West Indies to control banana root borer. Its persistence in soils has led to the widespread pollution of the environment, and human beings are still exposed to this chemical. Chlordecone has been shown to impair neurological and behavioural functions in rodents when exposed gestationally or neonatally. OBJECTIVES: The aim of the study was to evaluate the impact of prenatal and postnatal exposure to chlordecone on the cognitive, visual, and motor development of 7-month-old infants from Guadeloupe. METHODS: Infants were tested at 7 months (n=153). Visual recognition memory and processing speed were assessed with the Fagan Tests of Infant Intelligence (FTII), visual acuity with the Teller Acuity Card, and fine motor development with the Brunet-Lezine. Samples of cord blood and breast milk at 3 months (n=88) were analyzed for chlordecone concentrations. Postnatal exposure was determined through breast feeding and frequency of contaminated food consumption by the infants. RESULTS: Cord chlordecone concentrations in tertiles were associated with reduced novelty preference on the FTII in the highly exposed group (β=-0.19, p=0.02). Postnatal exposure through contaminated food consumption was marginally related to reduced novelty preference (β=-0.14, p=0.07), and longer processing speed (β=0.16, p=0.07). Detectable levels of chlordecone in cord blood were associated with higher risk of obtaining low scores on the fine motor development scale (OR=1.25, p

The possible adverse effects of organochlorine pollutants (OPs) on human fertility are a matter of concern. Direct evaluation of the effects on female fertility was made possible by the advent of in vitro fertilization (IVF). We conducted a systematic review to assess possible associations between OP levels and selected indicators of female fertility in the context of IVF. After harmonization, OP concentrations per unit of lipid varied considerably, OP concentrations were higher in follicular than in serum and conflicting results were obtained. No significant adverse association between OP concentration and female fertility was observed in some studies. In other reports, there were indications of various degrees of significance that oocyte, embryo quality, and implantation may have been impaired. Thus, this review provides no evidence to support the hypothesis that OPs impair female fertility but insufficient evidence to reject this hypothesis. Our conclusions are limited by the diversity of the protocols used, OPs studied, and the quality of the studies selected. The IVF provides a unique context in which to assess the impact of OPs on female fertility, but it is subject to several limitations. Potential frameworks for future studies are proposed.

International audience; PURPOSE: Multiple myeloma, a hematological malignancy generally affecting elderly people, was diagnosed at the beginning of the pregnancy of a 33-year-old woman. We carried out a literature review in order to evaluate the consequences of this cancer on pregnancy and of pregnancy on multiple myeloma, as to determine the specific follow-up required. METHODS: A systematic search for articles of interest published between 1949 and 16 November 2010 was performed in MEDLINE, SCOPUS and EMBASE, using the words "multiple myeloma" and "pregnancy". We identified 398 publications of potential interest, 20 of which were selected and included in the analysis. RESULTS: The selected articles included 26 cases. No specific risk factors were identified in pregnant women. The most common presentations were bone pain and/or anemia, as in the general population. Pregnancy seemed to have no effect on multiple myeloma progression. Most pregnancies went to term, with only two medical terminations and six cesareans performed before term, due to the severity of the cancer. No effect of the cancer or its treatment by chemotherapy during pregnancy was found in the children. CONCLUSION: Pregnancy does not seem to be contraindicated in women with multiple myeloma. Nevertheless, the management of pregnant patients with multiple myeloma is a diagnostic, therapeutic and social challenge, requiring a multidisciplinary approach and regular follow-up. Decisions should be taken based on the severity of the disease, its prognosis and maternal choice.