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Kayem G, Seco A, Vendittelli F, Crenn Hebert C, Dupont C, Branger B, Huissoud C, Fresson J, Winer N, Langer B, Rozenberg P, Morel O, Bonnet MP, Perrotin F, Azria E, Carbillon L, Chiesa C, Raynal P, Rudigoz RC, Patrier S, Beucher G, Dreyfus M, Sentilhes L, Deneux-Tharaux C. Risk factors for placenta accreta spectrum disorders in women with any prior cesarean and a placenta previa or low lying: a prospective population-based study. Sci Rep 2024; 14:6564. [PMID: 38503816 PMCID: PMC10951207 DOI: 10.1038/s41598-024-56964-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
This study aimed to identify the risk factors for placenta accreta spectrum (PAS) in women who had at least one previous cesarean delivery and a placenta previa or low-lying. The PACCRETA prospective population-based study took place in 12 regional perinatal networks from 2013 through 2015. All women with one or more prior cesareans and a placenta previa or low lying were included. Placenta accreta spectrum (PAS) was diagnosed at delivery according to standardized clinical and histological criteria. Of the 520,114 deliveries, 396 fulfilled inclusion criteria; 108 were classified with PAS at delivery. Combining the number of prior cesareans and the placental location yielded a rate ranging from 5% for one prior cesarean combined with a posterior low-lying placenta to 63% for three or more prior cesareans combined with placenta previa. The factors independently associated with PAS disorders were BMI ≥ 30, previous uterine surgery, previous postpartum hemorrhage, a higher number of prior cesareans, and a placenta previa. Finally, in this high-risk population, the rate of PAS disorders varies greatly, not only with the number of prior cesareans but also with the exact placental location and some of the women's individual characteristics. Risk stratification is thus possible in this population.
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Affiliation(s)
- Gilles Kayem
- Trousseau Hospital, APHP, Sorbonne University, Paris, France.
- CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris University, Paris, France.
| | - Aurélien Seco
- Clinical Research Unit Necker Cochin, APHP, Paris, France
| | - Francoise Vendittelli
- Réseau de Santé en Périnatalité d'Auvergne, Clermont-Ferrand, France
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
| | - Catherine Crenn Hebert
- APHP, Louis Mourier University Hospital, Colombes, France
- Réseau périnatal des Hauts de Seine, PERINAT92, 60 Rue du Général Leclerc, Issy-Les-Moulineaux, France
| | - Corinne Dupont
- University Claude Bernard Lyon 1, RESHAPE INSERM U1290, Univ. Lyon, 7425, Lyon, France
- Réseau Périnatal Aurore, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France
| | - Bernard Branger
- Réseau « Sécurité Naissance - Naître Ensemble » des Pays-de-la-Loire, Nantes, France
| | - Cyril Huissoud
- Réseau Périnatal Aurore, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France
- Maternité de la Croix Rousse, Lyon, France
| | - Jeanne Fresson
- CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris University, Paris, France
- CHRU Nancy, Réseau Périnatal Lorrain, Nancy, France
| | - Norbert Winer
- Service de Gynécologie Obstétrique HME Université de Nantes, NUN, INRA, UMR 1280, Phan, Université de Nantes, 44000, Nantes, France
| | | | | | | | - Marie Pierre Bonnet
- CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris University, Paris, France
- Anesthesia and Critical Care Department, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | | | - Elie Azria
- CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris University, Paris, France
- Maternity Unit, Paris Saint Joseph Hospital, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Lionel Carbillon
- Réseau Périnatal NEF Naître dans l'Est Francilien, Paris 13 University, Villetaneuse, France
| | - Coralie Chiesa
- CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris University, Paris, France
| | - Pierre Raynal
- CH de Versailles, Site Andre Mignot, Versailles, France
| | - René Charles Rudigoz
- Réseau Périnatal Aurore, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France
- Maternité de la Croix Rousse, Lyon, France
| | | | - Gaël Beucher
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Caen, Avenue Côte de Nacre, Caen Cedex 9, France
| | - Michel Dreyfus
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Caen, Avenue Côte de Nacre, Caen Cedex 9, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Catherine Deneux-Tharaux
- CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris University, Paris, France
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Sentilhes L, Sénat MV, Bouchghoul H, Delorme P, Gallot D, Garabedian C, Madar H, Sananès N, Perrotin F, Schmitz T. [Sentilhes L., Sénat M.V., Bouchghoul H., Delorme P., Gallot D., Garabedian C., Madar H., Sananès L., Perrotin F., Schmitz T., in reply to the article by Boujenah J., entitled "La cholestase gravidique : pour une vision holistique de la femme. À propos des examens complémentaires lors du diagnostic". Gynecol Obstet Fertil 2024;52(6). doi:10.1016/j.gofs.2024.02.023]. Gynecol Obstet Fertil Senol 2024:S2468-7189(24)00079-5. [PMID: 38408606 DOI: 10.1016/j.gofs.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 02/28/2024]
Affiliation(s)
- Loïc Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - Marie-Victoire Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Hanane Bouchghoul
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Pierre Delorme
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, Paris, France
| | - Denis Gallot
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Charles Garabedian
- Service de gynécologie-obstétrique, CHU de Lille, université de Lille, ULR 2694-METRICS, 59000 Lille, France
| | - Hugo Madar
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Nicolas Sananès
- Service de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Franck Perrotin
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Tours, Tours, France
| | - Thomas Schmitz
- Service de gynécologie obstétrique, hôpital Robert-Debré, AP-HP, Paris, France
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Besse MC, Perrotin F, Aouba A, Gallou S, Karras A, Pillebout E, Urbanski G, Allain JS, Merlot C, Humbert S, Ramdani Y, Ferreira-Maldent N, Maillot F, Audemard-Verger A. Pregnancy outcome in patients with a medical history of immunoglobulin A vasculitis: a case-control study. Scand J Rheumatol 2024; 53:36-43. [PMID: 37439394 DOI: 10.1080/03009742.2023.2226518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 06/14/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Data on obstetric outcomes in patients with a history of immunoglobulin A vasculitis (IgA-V) are lacking. The aim of this study was to assess maternal, neonatal, and vasculitis outcomes during pregnancy. METHOD We conducted a French retrospective case-control study. Pregnancies of patients with a history of IgA-V (cases) were retrospectively studied and compared to pregnancies in women who developed IgA-V after their pregnancies and to pregnancies in healthy women (controls). RESULTS Twenty-six pregnancies in patients with a history of IgA-V were included and compared to 15 pregnancies in women who later developed IgA-V and 52 pregnancies in healthy women. Both gestational hypertension and pre-eclampsia were more frequent in the case group than in the other groups (23% vs 0% vs 0%, p < 0.01; 12% vs 7% vs 0%, p = 0.04). Hypertensive disorder of pregnancy occurred more frequently in patients with pre-existing kidney disease (78% vs 12%, p < 0.01). Caesarean section was more often performed in the case group than in the other groups (27% vs 0% vs 10%, p = 0.04). No foetal loss or maternal deaths occurred. There were no differences in delivery term or birth weight. No vasculitis flares were observed during pregnancy. CONCLUSION Women with a history of IgA-V appear to be at higher risk for gestational hypertension and pre-eclampsia, especially in cases with renal involvement; however, both mother and newborn outcomes appear to be favourable.
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Affiliation(s)
- M-C Besse
- Department of Internal Medicine and Clinical Immunology, CHU de Tours, Tours, France
- Tours University, Tours, France
| | - F Perrotin
- Tours University, Tours, France
- Department of Obstetrics and Gynecology, CHU de Tours, Tours, France
| | - A Aouba
- Department of Internal Medicine and Clinical Immunology, CHU de Caen, Caen, France
| | - S Gallou
- Department of Internal Medicine and Clinical Immunology, CHU de Caen, Caen, France
| | - A Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance publique des Hôpitaux de Paris, Paris, France
| | - E Pillebout
- Department of Nephrology, Hôpital Saint Louis, Assistance publique des Hôpitaux de Paris, Paris, France
| | - G Urbanski
- Department of Internal Medicine, CHU d'Angers, Angers, France
| | - J-S Allain
- Department of Internal Medicine, CH de Saint Malo, Saint Malo, France
| | - C Merlot
- Department of Internal Medicine, CHR Orléans, Orléans, France
| | - S Humbert
- Department of Internal Medicine, CHRU de Besancon, Besancon, France
| | - Y Ramdani
- Department of Internal Medicine and Clinical Immunology, CHU de Tours, Tours, France
- Tours University, Tours, France
| | - N Ferreira-Maldent
- Department of Internal Medicine and Clinical Immunology, CHU de Tours, Tours, France
| | - F Maillot
- Department of Internal Medicine and Clinical Immunology, CHU de Tours, Tours, France
- Tours University, Tours, France
| | - A Audemard-Verger
- Department of Internal Medicine and Clinical Immunology, CHU de Tours, Tours, France
- Tours University, Tours, France
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Sentilhes L, Sénat MV, Bouchghoul H, Delorme P, Gallot D, Garabedian C, Madar H, Sananès N, Perrotin F, Schmitz T. [Intrahepatic cholestasis of pregnancy: French College of Obstetricians and Gynecologists guidelines for clinical practice]. Gynecol Obstet Fertil Senol 2023; 51:493-510. [PMID: 37806861 DOI: 10.1016/j.gofs.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To identify strategies for reducing neonatal and maternal morbidity associated with intrahepatic cholestasis pregnancy (ICP). MATERIAL AND METHODS The quality of evidence of the literature was assessed following the GRADE methodology with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on PubMed, Cochrane, EMBASE and Google Scholar databases. The quality of the evidence was assessed (high, moderate, low, very low) and a (i) strong or (ii) weak recommendations or (iii) no recommendation were formulated. The recommendations were reviewed in two rounds with external reviewers (Delphi survey) to select the consensus recommendations. RESULTS Of the 14 questions (from 12 PICO questions and one definition question outside the PICO format), there was agreement between the working group and the external reviewers on 14 (100%). The level of evidence of the literature was insufficient to provide a recommendation on two questions. ICP is defined by the occurrence of suggestive pruritus (palmoplantar, nocturnal) associated with a total bile acid level>10μmol/L or an alanine transaminase level above 2N after ruling out differential diagnoses. In the absence of suggestive symptoms of a differential diagnosis, it is recommended not to carry out additional biological or ultrasound tests. In women with CIP, ursodeoxycholic acid is recommended to reduce the intensity of maternal pruritus (Strong recommendation. Quality of the evidence moderate) and to decrease the level of total bile acids and alanine transaminases. (Strong recommendation. Quality of the evidence moderate). S-adenosyl-methionine, dexamethasone, guar gum or activated charcoal should not be used to reduce the intensity of maternal pruritus (Strong recommendation. Quality of evidence low), and there is insufficient data to recommend the use of antihistamines (No recommendation. Quality of evidence low). Rifampicin (Weak recommendation. Very low quality of evidence) or plasma exchange (Strong recommendation. Very low quality of evidence) should not be used to reduce maternal pruritus and perinatal morbidity. Serum monitoring of bile acids is recommended to reduce perinatal morbidity and mortality (stillbirth, prematurity) (Low recommendation. Quality of the evidence low). The level of evidence is insufficient to determine whether fetal heart rate or fetal ultrasound monitoring are useful to reduce perinatal morbidity (No recommendation). Birth is recommended when bile acid level is above 99μmol/L from 36 weeks gestation to reduce perinatal morbidity, in particular stillbirth. When bile acid level is above 99μmol/L is below 100μmol/L, women should be informed that induction of labor could be considered 37 and 39 weeks gestation to reduce perinatal morbidity. (Strong recommendation. Quality of evidence low). In postpartum, total bile acids and alanine transaminases level should be checked and normalized before prescribing estrogen-progestin contraception, ideally with a low estrogen dose (risk of recurrence of pruritus and cytolysis) (Low recommendation. Quality of evidence very low). CONCLUSION Although the quality of evidence regarding ICP gestational cholestasis remains low, there is a strong consensus in France, as shown by our Delphi study, on how to manage women with ICP. The reference first-line treatment is ursodeoxycholic acid.
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Affiliation(s)
- L Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France.
| | - M-V Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - H Bouchghoul
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - P Delorme
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, Paris, France
| | - D Gallot
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - C Garabedian
- Service de gynécologie-obstétrique, CHU de Lille, université de Lille, ULR 2694-METRICS, 59000 Lille, France
| | - H Madar
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - N Sananès
- Service de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - F Perrotin
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Tours, Tours, France
| | - T Schmitz
- Service de gynécologie obstétrique, hôpital Robert-Debré, AP-HP, Paris, France
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Rozenberg P, Sentilhes L, Goffinet F, Vayssiere C, Senat MV, Haddad B, Morel O, Garabedian C, Vivanti A, Perrotin F, Kayem G, Azria E, Raynal P, Verspyck E, Sananes N, Gallot D, Bretelle F, Seco A, Winer N, Deneux-Tharaux C. Efficacy of early intrauterine balloon tamponade for immediate postpartum hemorrhage after vaginal delivery: a randomized clinical trial. Am J Obstet Gynecol 2023; 229:542.e1-542.e14. [PMID: 37209893 DOI: 10.1016/j.ajog.2023.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/08/2023] [Accepted: 05/14/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Many questions remain about the appropriate use of intrauterine balloon devices in postpartum hemorrhage after vaginal delivery refractory to first-line uterotonics. Available data suggest that early use of intrauterine balloon tamponade might be beneficial. OBJECTIVE This study aimed to compare the effect of intrauterine balloon tamponade used in combination with second-line uterotonics vs intrauterine balloon tamponade used after the failure of second-line uterotonic treatment on the rate of severe postpartum hemorrhage in women with postpartum hemorrhage after vaginal delivery refractory to first-line uterotonics. STUDY DESIGN This multicenter, randomized, controlled, parallel-group, nonblinded trial was conducted at 18 hospitals and enrolled 403 women who had just given birth vaginally at 35 to 42 weeks of gestation. The inclusion criteria were a postpartum hemorrhage refractory to first-line uterotonics (oxytocin) and requiring a second-line uterotonic treatment with sulprostone (E1 prostaglandin). In the study group, the sulprostone infusion was combined with intrauterine tamponade by an ebb balloon performed within 15 minutes of randomization. In the control group, the sulprostone infusion was started alone within 15 minutes of randomization, and if bleeding persisted 30 minutes after the start of sulprostone infusion, intrauterine tamponade using the ebb balloon was performed. In both groups, if the bleeding persisted 30 minutes after the insertion of the balloon, an emergency radiological or surgical invasive procedure was performed. The primary outcome was the proportion of women who either received ≥3 units of packed red blood cells or had a calculated peripartum blood loss of >1000 mL. The prespecified secondary outcomes were the proportions of women who had a calculated blood loss of ≥1500 mL, any transfusion, an invasive procedure and women who were transferred to the intensive care unit. The analysis of the primary outcome with the triangular test was performed sequentially throughout the trial period. RESULTS At the eighth interim analysis, the independent data monitoring committee concluded that the incidence of the primary outcome did not differ between the 2 groups and stopped inclusions. After 11 women were excluded because they met an exclusion criterion or withdrew their consent, 199 and 193 women remained in the study and control groups, respectively, for the intention-to-treat analysis. The women's baseline characteristics were similar in both groups. Peripartum hematocrit level change, which was needed for the calculation of the primary outcome, was missing for 4 women in the study group and 2 women in the control group. The primary outcome occurred in 131 of 195 women (67.2%) in the study group and 142 of 191 women (74.3%) in the control group (risk ratio, 0.90; 95% confidence interval, 0.79-1.03). The groups did not differ substantially for rates of calculated peripartum blood loss pf ≥1500 mL, any transfusion, invasive procedure, and admission to an intensive care unit. Endometritis occurred in 5 women (2.7%) in the study group and none in the control group (P=.06). CONCLUSION The early use of intrauterine balloon tamponade did not reduce the incidence of severe postpartum hemorrhage compared with its use after the failure of second-line uterotonic treatment and before recourse to invasive procedures.
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Affiliation(s)
- Patrick Rozenberg
- Department of Obstetrics and Gynecology, American Hospital of Paris, Neuilly-sur-Seine, France; Université Paris-Saclay, UVSQ, Inserm, Equipe U1018, Epidémiologie clinique, CESP, Montigny-le-Bretonneux, France.
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - François Goffinet
- Department of Obstetrics and Gynecology, Hôpital Cochin-Port Royal, AP-HP, Paris, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Hôpital Paule de Viguier, CHU, Toulouse, France
| | - Marie-Victoire Senat
- Department of Obstetrics and Gynecology, Hôpital Bicêtre AP-HP, Le Kremlin-Bicêtre, France
| | - Bassam Haddad
- Department of Obstetrics and Gynecology, Hôpital Intercommunal de Créteil, Créteil, France
| | - Olivier Morel
- Department of Obstetrics and Gynecology, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Charles Garabedian
- Department of Obstetrics and Gynecology, Hôpital Jeanne de Flandre, Lille, France
| | - Alexandre Vivanti
- Department of Obstetrics and Gynecology, Hôpital Antoine-Béclère AP-HP, Clamart, France
| | - Franck Perrotin
- Department of Obstetrics and Gynecology, Hôpital Bretonneau, Tours, France
| | - Gilles Kayem
- Department of Obstetrics and Gynecology, Hôpital Armand Trousseau AP-HP, Paris, France
| | - Elie Azria
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, Paris, France
| | - Pierre Raynal
- Department of Obstetrics and Gynecology, Hôpital André Mignot, Le Chesnay-Rocquencourt, France
| | - Eric Verspyck
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Nicolas Sananes
- Department of Obstetrics and Gynecology, Centre Médico-Chirurgical et Obstétrical, Schiltigheim, France
| | - Denis Gallot
- Department of Obstetrics and Gynecology, CHU Clermont-Ferrand Site Estaing, Clermont Ferrand, France
| | - Florence Bretelle
- Department of Obstetrics and Gynecology, Hôpital Nord, Marseille, France
| | - Aurélien Seco
- Clinical Research Unit Necker Cochin, APHP, Paris, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, Hôpital Mère-Enfant, Nantes, France; NUN INRAE UMR 1280, PhAN Nantes University, Nantes, France
| | - Catherine Deneux-Tharaux
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, Université de Paris Cité, CRESS, INSERM, INRA, Paris, France
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Le Gallou B, Pastuszka A, Lemaire C, Perrotin F, Mitanchez D, Lanotte P, Mereghetti L. Long-term surveillance of group B Streptococcus strains isolated from infection and colonization in pregnant women and newborns. J Med Microbiol 2023; 72. [PMID: 37335614 DOI: 10.1099/jmm.0.001717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Introduction. Group B Streptococcus (GBS) remains the leading cause of bacterial neonatal infections worldwide, despite the spread of recommendations on vaginal screening and antibiotic prophylaxis.Hypothesis/Gap Statement. There is a need to evaluate the potential changes in GBS epidemiology over time following the introduction of such guidelines.Aim. Our aim was to perform a descriptive analysis of the epidemiological characteristics of GBS by conducting a long-term surveillance of strains isolated between 2000 and 2018, using molecular typing methods.Methodology. A total of 121 invasive strains, responsible for maternal infections (20 strains), fetal infections (8 strains) and neonatal infections (93 strains), were included in the study, representing all the invasive isolates during the period; in addition, 384 colonization strains isolated from vaginal or newborn samples were randomly selected. The 505 strains were characterized by capsular polysaccharide (CPS) type multiplex PCR assay and the clonal complex (CC) was assigned using a single nucleotide polymorphism PCR assay. Antibiotic susceptibility was also determined.Results. CPS types III (32.1 % of the strains), Ia (24.6 %) and V (19 %) were the most prevalent. The five main CCs observed were CC1 (26.3 % of the strains), CC17 (22.2 %), CC19 (16.2 %), CC23 (15.8 %) and CC10 (13.9 %). Neonatal invasive GBS diseases were predominantly due to CC17 isolates (46.3 % of the strains), which mainly express CPS type III (87.5 %), with a very high prevalence in late-onset diseases (76.2 %).Conclusion. Between 2000 and 2018, we observed a decrease in the proportion of CC1 strains, which mainly express CPS type V, and an increase in the proportion of CC23 strains, mainly expressing CPS type Ia. Conversely, there was no significant change in the proportion of strains resistant to macrolides, lincosamides or tetracyclines. The two molecular techniques used in our study provide almost as much information as classical serotyping and multilocus sequence typing, but are quicker, easy to perform, and avoid long sequencing and analysis steps.
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Affiliation(s)
- Brice Le Gallou
- UMR1282 ISP, INRAE, Université de Tours, Tours, France
- Service de Bactériologie-Virologie-Hygiène, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Adeline Pastuszka
- UMR1282 ISP, INRAE, Université de Tours, Tours, France
- Service de Bactériologie-Virologie-Hygiène, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Coralie Lemaire
- UMR1282 ISP, INRAE, Université de Tours, Tours, France
- Service de Bactériologie-Virologie-Hygiène, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Franck Perrotin
- Service d'Obstétrique, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Delphine Mitanchez
- Service de Néonatologie, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Philippe Lanotte
- UMR1282 ISP, INRAE, Université de Tours, Tours, France
- Service de Bactériologie-Virologie-Hygiène, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Laurent Mereghetti
- UMR1282 ISP, INRAE, Université de Tours, Tours, France
- Service de Bactériologie-Virologie-Hygiène, Centre Hospitalier Universitaire de Tours, Tours, France
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De Berti M, Le Gouge A, Monmousseau F, Gallot D, Sentilhes L, Winer N, Legendre G, Desbriere R, Girault A, Pozzi J, Gachon B, Barjat T, Perrotin F, Brunet-Houdard S, Diguisto C. Oxytocin versus prostaglandins for labour Induction of women with an unfavourable cervix after 24 hours of cervical ripening (OPIC): protocol for an open multicentre randomised non-inferiority trial. BMJ Open 2023; 13:e058282. [PMID: 37068892 PMCID: PMC10111897 DOI: 10.1136/bmjopen-2021-058282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/30/2022] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION It remains uncertain whether the most appropriate management for women with an unfavourable cervix after 24 hours of cervical ripening is repeating the ripening procedure or proceeding directly to induction by oxytocin. No adequately powered trial has compared these strategies. We hypothesise that induction of labour with oxytocin among women who have just undergone an ineffective first ripening procedure is not associated with a higher risk of caesarean delivery than a repeated cervical ripening with prostaglandins. METHODS AND ANALYSIS We will conduct a multicentre, non-inferiority, open-label, randomised controlled trial aimed at comparing labour induction by oxytocin with a second cervical ripening that uses prostaglandins (slow-release vaginal dinoprostone; oral misoprostol 25 µg; dinoprostone vaginal gel 2 mg). Women (n=1494) randomised in a 1:1 ratio in 10 French maternity units must be ≥18 years with a singleton fetus in vertex presentation, at a term from ≥37+0 weeks of gestation, and have just completed a 24-hour cervical ripening procedure by any method (pharmacological or mechanical) with a Bishop score ≤6. Exclusion criteria comprise being in labour, having more than 3 contractions per 10 min, or a prior caesarean delivery or a history of uterine surgery, or a fetus with antenatally suspected severe congenital abnormalities or a non-reassuring fetal heart rate. The primary endpoint will be the caesarean delivery rate, regardless of indication. Secondary outcomes concern delivery, perinatal morbidity, maternal satisfaction and health economic evaluations. The nature of the assessed procedures prevents masking the study investigators and patients to group assignment. ETHICS AND DISSEMINATION All participants will provide written informed consent. The ethics committee 'Comité de Protection des Personnes Ile de France VII' approved this study on 2 April 2021 (No 2021-000989-15). Study findings will be submitted for publication and presented at relevant conferences. TRIAL REGISTRATION NUMBER NCT04949633.
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Affiliation(s)
- Marion De Berti
- Maternité Olympe de Gouges, Centre Hospitalier Régional Universitaire Tours, Université de Tours, Tours, France
| | | | - Fanny Monmousseau
- Tours University Hospital - Health-Economic Evaluation Unit, CHRU de Tours, Tours Area, France
- University of Tours - EA 7505-Education Ethics Health, Tours Area, France
| | - Denis Gallot
- Service de Gynécologie-Obstétrique, Hôpital d'Estaing, CHU de Clermont-Ferrand, Maternité Clermont Ferrand, France
| | - Loïc Sentilhes
- Service de Gynécologie-Obstétrique, Groupe Hospitalier Pellegrin, CHRU de Bordeaux, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, University Hospital of Nantes, 44093 Nantes, NUN, INRAE, UMR 1280, PhAN, F-44000 Université de Nantes, France
| | - Guillaume Legendre
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Raoul Desbriere
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, Marseille, France
| | - Aude Girault
- Maternité Port-Royal, AP-HP, Hôpital Cochin, FHU PREMA, F-75014, Paris, France
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE,F-75004, Paris, France
| | - Jordan Pozzi
- CHU Brest, Hôpital Morvan, service de gynécologie-obstétrique, Brest, France
| | - Bertrand Gachon
- Department of Obstetrics and Gynaecology, La Milétrie University Hospital, Poitiers France; Nantes University, Movement - Interactions - Performance, MIP, EA 4334, F-44000 Nantes, France; INSERM CIC-P 1402, La Milétrie University Hospital, Poitiers, France
| | - Thiphaine Barjat
- Service de Gynécologie Obstétrique, CHU de Saint Etienne, Saint Etienne, France
| | - Franck Perrotin
- Maternité Olympe de Gouges, Centre Hospitalier Régional Universitaire Tours, Université de Tours, Tours, France
| | - Solène Brunet-Houdard
- Tours University Hospital - Health-Economic Evaluation Unit, CHRU de Tours, Tours Area, France
- University of Tours - EA 7505-Education Ethics Health, Tours Area, France
| | - Caroline Diguisto
- Maternité Olympe de Gouges, Centre Hospitalier Régional Universitaire Tours, Université de Tours, Tours, France
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE,F-75004, Paris, France
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Sentilhes L, Madar H, Le Lous M, Sénat MV, Winer N, Rozenberg P, Kayem G, Verspyck E, Fuchs F, Azria E, Gallot D, Korb D, Desbrière R, Le Ray C, Chauleur C, de Marcillac F, Perrotin F, Parant O, Salomon LJ, Gauchotte E, Bretelle F, Sananès N, Bohec C, Mottet N, Legendre G, Letouzey V, Haddad B, Vardon D, Mattuizzi A, Froeliger A, Bouchghoul H, Daniel V, Regueme S, Roussillon C, Georget A, Darsonval A, Benard A, Deneux-Tharaux C. Tranexamic acid for the prevention of blood loss after cesarean among women with twins: a secondary analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery randomized clinical trial. Am J Obstet Gynecol 2022; 227:889.e1-889.e17. [PMID: 35724759 DOI: 10.1016/j.ajog.2022.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Although prophylactic tranexamic acid administration after cesarean delivery resulted in a lower incidence of calculated estimated blood loss of >1000 mL or red cell transfusion by day 2, its failure to reduce the incidence of hemorrhage-related secondary clinical outcomes (TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery trial) makes its use questionable. The magnitude of its effect may differ in women at higher risk of blood loss, including those with multiple pregnancies. OBJECTIVE This study aimed to compare the effect of tranexamic acid vs placebo to prevent blood loss after cesarean delivery among women with multiple pregnancies. STUDY DESIGN This was a secondary analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery trial data, a double-blind, randomized controlled trial from March 2018 to January 2020 in 27 French maternity hospitals, that included 319 women with multiple pregnancies. Women with a cesarean delivery before or during labor at ≥34 weeks of gestation were randomized to receive intravenously 1 g of tranexamic acid (n=160) or placebo (n=159), both with prophylactic uterotonics. The primary outcome was a calculated estimated blood loss of >1000 mL or a red blood cell transfusion by 2 days after delivery. The secondary outcomes included clinical and laboratory blood loss measurements. RESULTS Of the 4551 women randomized in this trial, 319 had a multiple pregnancy and cesarean delivery, and 298 (93.4%) had primary outcome data available. This outcome occurred in 62 of 147 women (42.2%) in the tranexamic acid group and 67 of 152 (44.1%) receiving placebo (adjusted risk ratio, 0.97; 95% confidence interval, 0.68-1.38; P=.86). No significant between-group differences occurred for any hemorrhage-related clinical outcomes: gravimetrically estimated blood loss, provider-assessed clinically significant hemorrhage, additional uterotonics, postpartum blood transfusion, arterial embolization, and emergency surgery (P>.05 for all comparisons). CONCLUSION Among women with a multiple pregnancy and cesarean delivery, prophylactic tranexamic acid did not reduce the incidence of any blood loss-related outcomes.
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Affiliation(s)
- Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.
| | - Hugo Madar
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Maëla Le Lous
- Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes, France
| | - Marie Victoire Sénat
- Department of Obstetrics and Gynecology, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, Nantes, France; National Institute of Agricultural Research, Unité Mixte de Recherche 1280, Physiology of Nutritional Adaptations, University of Nantes, Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine-Ouest, Nantes, France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy, France
| | - Gilles Kayem
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre de Recherche en Épidémiologie et StatistiqueS, Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Universitary Hospital Departement - Risks in Pregnancy, Université de Paris, Paris, France; Department of Obstetrics and Gynecology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Verspyck
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France
| | - Florent Fuchs
- Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier, France; Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development, Villejuif, France
| | - Elie Azria
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre de Recherche en Épidémiologie et StatistiqueS, Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Universitary Hospital Departement - Risks in Pregnancy, Université de Paris, Paris, France; Maternity Unit, Paris Saint-Joseph Hospital, Paris Descartes University, Paris, France
| | - Denis Gallot
- Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Diane Korb
- Department of Obstetrics and Gynecology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raoul Desbrière
- Department of Obstetrics and Gynecology, Saint-Joseph Hospital, Marseille, France
| | - Camille Le Ray
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre de Recherche en Épidémiologie et StatistiqueS, Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Universitary Hospital Departement - Risks in Pregnancy, Université de Paris, Paris, France; Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Universitéde Paris, Fighting Prematurity University Hospital Federation, Paris, France
| | - Céline Chauleur
- Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Fanny de Marcillac
- Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg, France
| | - Franck Perrotin
- Department of Obstetrics and Gynecology, Tours University Hospital, Tours, France
| | - Olivier Parant
- Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse, France
| | - Laurent J Salomon
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emilie Gauchotte
- Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy, France
| | - Florence Bretelle
- Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Nicolas Sananès
- Department of Obstetrics and Gynecology, Hôpital Centre Médico-Chirurgical et Obstétrical, Schiltigheim, France
| | - Caroline Bohec
- Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau, France
| | - Nicolas Mottet
- Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon, France
| | - Guillaume Legendre
- Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Vincent Letouzey
- Department of Obstetrics and Gynecology, Carémeau University Hospital, Nimes, France
| | - Bassam Haddad
- Department of Obstetrics, Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Delphine Vardon
- Department of Obstetrics and Gynecology, Caen University Hospital, Caen, France
| | - Aurélien Mattuizzi
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Alizée Froeliger
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Hanane Bouchghoul
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Valérie Daniel
- Department of Pharmacy, Angers University Hospital, Angers, France; Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest, France
| | - Sophie Regueme
- Department of Clinical Research and Innovation, Bordeaux University Hospital, Bordeaux, France
| | - Caroline Roussillon
- European Clinical Trials Platform & Development, French Clinical Research Infrastructure Network, Department of Clinical Research and Innovation, Bordeaux University Hospital, Bordeaux, France
| | - Aurore Georget
- Epidemiology Unit, Public Health Department, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - Astrid Darsonval
- Department of Pharmacy, Angers University Hospital, Angers, France; Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest, France
| | - Antoine Benard
- Epidemiology Unit, Public Health Department, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - Catherine Deneux-Tharaux
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre de Recherche en Épidémiologie et StatistiqueS, Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Universitary Hospital Departement - Risks in Pregnancy, Université de Paris, Paris, France
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Jones MN, Palmer KR, Pathirana MM, Cecatti JG, Filho OBM, Marions L, Edlund M, Prager M, Pennell C, Dickinson JE, Sass N, Jozwiak M, Eikelder MT, Rengerink KO, Bloemenkamp KWM, Henry A, Løkkegaard ECL, Christensen IJ, Szychowski JM, Edwards RK, Beckmann M, Diguisto C, Gouge AL, Perrotin F, Symonds I, O'Leary S, Rolnik DL, Mol BW, Li W. Balloon catheters versus vaginal prostaglandins for labour induction (CPI Collaborative): an individual participant data meta-analysis of randomised controlled trials. Lancet 2022; 400:1681-1692. [PMID: 36366885 DOI: 10.1016/s0140-6736(22)01845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/25/2022] [Accepted: 09/20/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Induction of labour is one of the most common obstetric interventions globally. Balloon catheters and vaginal prostaglandins are widely used to ripen the cervix in labour induction. We aimed to compare the effectiveness and safety profiles of these two induction methods. METHODS We did an individual participant data meta-analysis comparing balloon catheters and vaginal prostaglandins for cervical ripening before labour induction. We systematically identified published and unpublished randomised controlled trials that completed data collection between March 19, 2019, and May 1, 2021, by searching the Cochrane Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and PubMed. Further trials done before March 19, 2019, were identified through a recent Cochrane review. Data relating to the combined use of the two methods were not included, only data from women with a viable, singleton pregnancy were analysed, and no exclusion was made based on parity or membrane status. We contacted authors of individuals trials and participant-level data were harmonised and recoded according to predefined definitions of variables. Risk of bias was assessed with the ROB2 tool. The primary outcomes were caesarean delivery, indication for caesarean delivery, a composite adverse perinatal outcome, and a composite adverse maternal outcome. We followed the intention-to-treat principle for the main analysis. The primary meta-analysis used two-stage random-effects models and the sensitivity analysis used one-stage mixed models. All models were adjusted for maternal age and parity. This meta-analysis is registered with PROSPERO (CRD42020179924). FINDINGS Individual participant data were available from 12 studies with a total of 5460 participants. Balloon catheters, compared with vaginal prostaglandins, did not lead to a significantly different rate of caesarean delivery (12 trials, 5414 women; crude incidence 27·0%; adjusted OR [aOR] 1·09, 95% CI 0·95-1·24; I2=0%), caesarean delivery for failure to progress (11 trials, 4601 women; aOR 1·20, 95% CI 0·91-1·58; I2=39%), or caesarean delivery for fetal distress (10 trials, 4441 women; aOR 0·86, 95% CI 0·71-1·04; I2=0%). The composite adverse perinatal outcome was lower in women who were allocated to balloon catheters than in those allocated to vaginal prostaglandins (ten trials, 4452 neonates, crude incidence 13·6%; aOR 0·80, 95% CI 0·70-0·92; I2=0%). There was no significant difference in the composite adverse maternal outcome (ten trials, 4326 women, crude incidence 22·7%; aOR 1·02, 95% CI 0·89-1·18; I2=0%). INTERPRETATION In induction of labour, balloon catheters and vaginal prostaglandins have comparable caesarean delivery rates and maternal safety profiles, but balloon catheters lead to fewer adverse perinatal events. FUNDING Australian National Health and Medical Research Council and Monash Health Emerging Researcher Fellowship.
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Affiliation(s)
- Madeleine N Jones
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, VIC, Australia.
| | - Kirsten R Palmer
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, VIC, Australia.
| | - Maleesa M Pathirana
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | | | | | - Lena Marions
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Måns Edlund
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Martina Prager
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Craig Pennell
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Jan E Dickinson
- School of Women's and Infants' Health, University of Western Australia, Perth, WA, Australia
| | - Nelson Sass
- Departamento de Obstetricia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marta Jozwiak
- Gynaecologic Oncology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Mieke Ten Eikelder
- Department of Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Katrien Oude Rengerink
- Department of Biostatistics and Research Support, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, UMC Utrecht, Utrecht, Netherlands
| | - Amanda Henry
- Medicine & Health, University of New South Wales, Kensington, NSW, Australia.
| | - Ellen C L Løkkegaard
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark.
| | | | - Jeff M Szychowski
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rodney K Edwards
- College of Medicine, University of Oklahoma, Oklahoma City, OK, USA
| | - Michael Beckmann
- Mothers, Babies and Women's Health Services, Mater Health, South Brisbane, QLD, Australia
| | - Caroline Diguisto
- Department of Obstetrics, Gynaecology and Fetal Medicine, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Amélie Le Gouge
- Department of Obstetrics, Gynaecology and Fetal Medicine, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Franck Perrotin
- Department of Obstetrics, Gynaecology and Fetal Medicine, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Ian Symonds
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Sean O'Leary
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, VIC, Australia.
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, VIC, Australia; Aberdeen Centre for Women's Health Research, School of Medicine, University of Aberdeen, Aberdeen, UK.
| | - Wentao Li
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, VIC, Australia.
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Diguisto C, Le Gouge A, Marchand MS, Megier P, Ville Y, Haddad G, Winer N, Arthuis C, Doret M, Debarge VH, Flandrin A, Delmas HL, Gallot D, Mares P, Vayssiere C, Sentilhes L, Cheve MT, Paumier A, Durin L, Schaub B, Equy V, Giraudeau B, Perrotin F. Low-dose aspirin to prevent preeclampsia and growth restriction in nulliparous women identified by uterine artery Doppler as at high risk of preeclampsia: A double blinded randomized placebo-controlled trial. PLoS One 2022; 17:e0275129. [PMID: 36260615 PMCID: PMC9581352 DOI: 10.1371/journal.pone.0275129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/08/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION This trial evaluates whether daily low-dose aspirin initiated before 16 weeks of gestation can reduce preeclampsia and fetal growth restriction in nulliparous women identified by first-trimester uterine artery Dopplers as at high risk of preeclampsia. METHODS This randomized, blinded, placebo-controlled, parallel-group trial took place in 17 French obstetric departments providing antenatal care. Pregnant nulliparous women aged ≥ 18 years with a singleton pregnancy at a gestational age < 16 weeks of gestation with a lowest pulsatility index ≥ 1.7 or a bilateral protodiastolic notching for both uterine arteries on an ultrasound performed between 11+0 and 13+6 weeks by a certified sonographer were randomized at a 1:1 ratio to 160 mg of low-dose aspirin or to placebo to be taken daily from inclusion to their 34th week of gestation. The main outcome was preeclampsia or a birthweight ≤ 5th percentile. Other outcomes included preeclampsia, severe preeclampsia, preterm preeclampsia, preterm delivery before 34 weeks, mode of delivery, type of anesthesia, birthweight ≤ 5th percentile and perinatal death. RESULTS The trial was interrupted due to recruiting difficulties. Between June 2012 and June 2016, 1104 women were randomized, two withdrew consent, and two had terminations of pregnancies. Preeclampsia or a birthweight ≤ 5th percentile occurred in 88 (16.0%) women in the low-dose aspirin group and in 79 (14.4%) in the placebo group (proportion difference 1.6 [-2.6; 5.9] p = 0.45). The two groups did not differ significantly for the secondary outcomes. CONCLUSION Low-dose aspirin was not associated with a lower rate of either preeclampsia or birthweight ≤ 5th percentile in women identified by their first-trimester uterine artery Doppler as at high risk of preeclampsia. TRIAL REGISTRATION (NCT0172946).
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Affiliation(s)
- Caroline Diguisto
- Pôle de Gynécologie Obstétrique, Médecine Fœtale, Médecine et Biologie de la Reproduction, Centre Olympe de Gouges, CHRU de Tours, Tours, France
- Université de Tours, Tours, France
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE,F, Paris, France
- * E-mail:
| | | | | | - Pascal Megier
- Department of Gynaecology and Obstetrics, Centre Hospitalier Régional d’Orléans, Orleans, France
| | - Yves Ville
- Centre de Dépistage PRIMA FACIE Université de Paris, Paris, France
- Maternité, AP-HP, Hôpital Necker, Paris, France
| | - Georges Haddad
- Cabinet Mosaïque Santé, La Chaussée Saint Victor, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, University Hospital of Nantes, Nantes, NUN, INRAE, UMR 1280, PhAN, Université de Nantes, Nantes, France
| | - Chloé Arthuis
- Department of Obstetrics and Gynecology, University Hospital of Nantes, Nantes, NUN, INRAE, UMR 1280, PhAN, Université de Nantes, Nantes, France
| | - Muriel Doret
- Service de Gynécologie-Obstétrique, HFME, Hospices Civils de Lyon, Lyon, France
| | - Veronique Houfflin Debarge
- Department of Obstetrics, CHU Lille, Univ. Lille, ULR 2694—METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Anaig Flandrin
- Service de Gynécologie-Obstétrique, Hôpital Arnaud de Villeneuve, CHRU de Montpellier, Montpellier, France
| | - Hélène Laurichesse Delmas
- Service de Gynécologie-Obstétrique, Hôpital d’Estaing, CHU de Clermont-Ferrand, Maternité Clermont Ferrand, Clermont-Ferrand, France
| | - Denis Gallot
- Service de Gynécologie-Obstétrique, Hôpital d’Estaing, CHU de Clermont-Ferrand, Maternité Clermont Ferrand, Clermont-Ferrand, France
| | - Pierre Mares
- Département de Gynécologie Obstétrique, Centre Hospitalo-Universitaire Caremeau, Nîmes, France
- École de Maïeutique, Université de Montpellier, Site de Nîmes, Nîmes, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynaecology, Paule de Viguier Hospital, Toulouse University Hospital Center, Toulouse, France
- Centre for Epidemiology and Population Health Research, Team SPHERE, Toulouse III University, Toulouse, France
| | - Loïc Sentilhes
- Service de Gynécologie-Obstétrique, Groupe Hospitalier Pellegrin, CHRU de Bordeaux, Talence, France
| | | | - Anne Paumier
- Service de Gynécologie-Obstétrique, Polyclinique de l’Atlantique, Saint-Herblain, France
| | - Luc Durin
- Service de Gynécologie-Obstétrique, Polyclinique du Parc, Caen, France
| | - Bruno Schaub
- Service de Gynécologie-Obstétrique, Maison de la Femme, de la Mère et de l’Enfant, CHU Martinique, Fort-de-France, Martinique, France
| | - Veronique Equy
- Service de Gynécologie-Obstétrique, Hôpital Couple Enfant, CHRU de Grenoble, La Tronche, France
| | - Bruno Giraudeau
- Université de Tours, Tours, France
- INSERM CIC1415, CHRU de Tours, Tours, France
| | - Franck Perrotin
- Pôle de Gynécologie Obstétrique, Médecine Fœtale, Médecine et Biologie de la Reproduction, Centre Olympe de Gouges, CHRU de Tours, Tours, France
- Université de Tours, Tours, France
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Sentilhes L, Seco A, Azria E, Beucher G, Bonnet MP, Branger B, Carbillon L, Chiesa C, Crenn-Hebert C, Dreyfus M, Dupont C, Fresson J, Huissoud C, Langer B, Morel O, Patrier S, Perrotin F, Raynal P, Rozenberg P, Rudigoz RC, Vendittelli F, Winer N, Deneux-Tharaux C, Kayem G. Conservative management or cesarean hysterectomy for placenta accreta spectrum: the PACCRETA prospective study. Am J Obstet Gynecol 2022; 226:839.e1-839.e24. [PMID: 34914894 DOI: 10.1016/j.ajog.2021.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/24/2021] [Accepted: 12/09/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Placenta accreta spectrum is a life-threatening condition that has increased dramatically in recent decades along with cesarean rates worldwide. Cesarean hysterectomy is widely practiced in women with placenta accreta spectrum; however, the maternal outcomes after cesarean hysterectomy have not been thoroughly compared with the maternal outcomes after alternative approaches, such as conservative management. OBJECTIVE This study aimed to compare the severe maternal outcomes between women with placenta accreta spectrum treated with cesarean hysterectomy and those treated with conservative management (leaving the placenta in situ). STUDY DESIGN From a source population of 520,114 deliveries in 176 hospitals (PACCRETA study), we designed an observational cohort of women with placenta accreta spectrum who had either a cesarean hysterectomy or a conservative management (the placenta left in situ) during cesarean delivery. Clinicians prospectively identified women meeting the inclusion criteria and included them at delivery. Data collection started only after the women had received information and agreed to participate in the study in the immediate postpartum period. The primary outcome was the transfusion of >4 units of packed red blood cells within 6 months after delivery. Secondary outcomes were other maternal complications within 6 months. We used propensity score weighting to account for potential indication bias. RESULTS Here, 86 women had conservative management and 62 women had cesarean hysterectomy for placenta accreta spectrum during cesarean delivery. The primary outcome occurred in 14 of 86 women in the conservative management group (16.3%) and 36 of 61 (59.0%) in the cesarean hysterectomy group (risk ratio in propensity score weighted model, 0.29; 95% confidence interval, 0.19-0.45). The rates of hysterectomy, total estimated blood loss exceeding 3000 mL, any blood product transfusion, adjacent organ injury, and nonpostpartum hemorrhage-related severe maternal morbidity were lower with conservative management than with cesarean hysterectomy (all adjusted, P≤.02); but, the rates of arterial embolization, endometritis, and readmission within 6 months of discharge were higher with conservative management than with cesarean hysterectomy. CONCLUSION Among women with placenta accreta spectrum who underwent cesarean delivery, conservative management was associated with a lower risk of transfusion of >4 units of packed red blood cells within 6 months than cesarean hysterectomy.
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Affiliation(s)
- Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.
| | - Aurélien Seco
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, National Institute of Health and Medical Research, National Institute of Agronomic Research, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris University, Paris, France; Clinical Research Unit of Paris Descartes Necker Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Elie Azria
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, National Institute of Health and Medical Research, National Institute of Agronomic Research, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris University, Paris, France; Maternité Notre-Dame de Bon Secours, Groupe Hospitalier Paris Saint-Joseph, Paris University, Paris, France
| | - Gaël Beucher
- Department of Obstetrics and Gynecology, Caen University Hospital, Caen, France
| | - Marie-Pierre Bonnet
- Department of Anesthesia and Critical Care, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Bernard Branger
- "Sécurité Naissance-Naître Ensemble" Perinatal Network of the Pays de la Loire, Pays de la Loire, France
| | - Lionel Carbillon
- "Naître dans l'Est Francilien" Perinatal Network, Sorbonne Paris North University, Villetaneuse, France
| | - Coralie Chiesa
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, National Institute of Health and Medical Research, National Institute of Agronomic Research, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris University, Paris, France
| | - Catherine Crenn-Hebert
- Department of Obstetrics and Gynecology, Louis-Mourier University Hospital, Assistance Publique-Hôpitaux de Paris, Colombes, France; "Hauts de Seine" (PERINAT92) Perinatal Network, Issy-les-Moulineaux, Paris, France
| | - Michel Dreyfus
- Department of Obstetrics and Gynecology, Caen University Hospital, Caen, France
| | - Corinne Dupont
- Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France; "Aurore" Perinatal Network, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Jeanne Fresson
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, National Institute of Health and Medical Research, National Institute of Agronomic Research, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris University, Paris, France; Department of Medical Information, Nancy University Hospital, Nancy, France
| | - Cyril Huissoud
- Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France; Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Bruno Langer
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Olivier Morel
- Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy, France
| | - Sophie Patrier
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Franck Perrotin
- Department of Obstetrics and Gynecology, Tours University Hospital, Tours, France
| | - Pierre Raynal
- Department of Obstetrics and Gynecology, Versailles Hospital, Versailles, France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, Poissy University Hospital, Poissy, France
| | - René-Charles Rudigoz
- Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France; Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Francoise Vendittelli
- Auvergne Perinatal Network, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; Department of Obstetrics and Gynecology, University Hospital of Clermont-Ferrand, Scientific Research National Center, SIGMA Clermont, Institute Pascal, Clermont-Ferrand, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, Nantes University Hospital, Nantes, France
| | - Catherine Deneux-Tharaux
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, National Institute of Health and Medical Research, National Institute of Agronomic Research, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris University, Paris, France
| | - Gilles Kayem
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, National Institute of Health and Medical Research, National Institute of Agronomic Research, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris University, Paris, France; Department of Obstetrics and Gynecology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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12
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Groussolles M, Winer N, Sentilhes L, Biquart F, Massoud M, Vivanti AJ, Bouchghoul H, Rozenberg P, Olivier P, Desbriere R, Chauleur C, Perrotin F, Coatleven F, Fuchs F, Bretelle F, Tsatsaris V, Salomon LJ, Sananes N, Kayem G, Houflin-Debarge V, Schmitz T, Benoist G, Arnaud C, Ehlinger V, Vayssière C. Arabin pessary to prevent adverse perinatal outcomes in twin pregnancies with a short cervix: a multicenter randomized controlled trial (PESSARONE). Am J Obstet Gynecol 2022; 227:271.e1-271.e13. [PMID: 35123930 DOI: 10.1016/j.ajog.2022.01.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/17/2022] [Accepted: 01/28/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The number of twin pregnancies continues to increase worldwide as both the number of pregnancies obtained by medically assisted reproduction and age at first pregnancy keep rising. Preterm delivery is the major complication associated with twin pregnancies. The effectiveness of preventive treatments such as progesterone or cervical cerclage for women with a short cervix is doubtful in twin pregnancies. The effectivity of cervical pessaries in preventing preterm birth and its associated morbidity and mortality is also controversial. OBJECTIVE We sought to investigate if the Arabin pessary reduces adverse neonatal outcomes in twin pregnancies with a short cervix. STUDY DESIGN This open-label, multicenter, randomized controlled trial on twin pregnancies with a cervical length of <35 mm compared pessary placement at 16+0 to 24+0 weeks' gestation with standard care alone. The primary endpoint was a composite of adverse neonatal outcomes, namely peripartum or neonatal death or significant neonatal morbidity before hospital discharge, defined as at least 1 of the following complications: bronchopulmonary dysplasia, intraventricular hemorrhage grade III to IV, periventricular leukomalacia, necrotizing enterocolitis grade II or higher, culture-proven sepsis, and retinopathy requiring treatment. A sample size of 308 pregnancies was planned to ensure 80% power to compare the proportions of women with at least 1 infant with an adverse neonatal outcome. The intention-to-treat analysis after multiple imputation of missing data, was supplemented with a secondary analysis that controlled for gestational age and cervical length, both at inclusion. The primary endpoint was also compared between randomization groups in the per-protocol population, which excluded patients with prespecified major protocol violations (mostly cervical cerclage and/or progesterone after inclusion). Secondary endpoints included preterm birth, spontaneous preterm birth, and pessary side effects. RESULTS In total, 315 women were randomized to either receive a pessary (n=157) or standard management (n=158). Overall, 10.8% (34 women) of participants had a missing value for the primary endpoint, mostly (79%) because of the lack of paternal consent for neonatal data collection. In the intention-to-treat analysis, the adverse neonatal outcome occurred in 16.8% of the pessary group vs in 22.5% of the control group (risk ratio, 0.69; 95% confidence interval, 0.39-1.23; P=.210). The per-protocol analysis did not show any significant difference between groups (risk ratio, 0.78; 95% confidence interval, 0.47-1.28; P=.320). The occurrence of preterm birth or spontaneous preterm birth did not differ significantly between groups. No serious side effects were associated with pessary use. CONCLUSION Pessary use in our study did not significantly reduce adverse neonatal outcomes in twin pregnancies with a short cervix.
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Halimi JM, Thoreau B, von Tokarski F, Bauvois A, Gueguen J, Goin N, Barbet C, Cloarec S, Mérieau E, Lachot S, Garot D, Lemaignen A, Gyan E, Perrotin F, Pouplard C, Maillot F, Gatault P, Sautenet B, Rusch E, Frémeaux-Bacchi V, Vigneau C, Bayer G, Fakhouri F. What is the impact of blood pressure on neurological symptoms and the risk of ESKD in primary and secondary thrombotic microangiopathies based on clinical presentation: a retrospective study. BMC Nephrol 2022; 23:39. [PMID: 35057750 PMCID: PMC8781095 DOI: 10.1186/s12882-022-02672-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 01/05/2022] [Indexed: 12/26/2022] Open
Abstract
Abstract
Background
The impact of blood pressure on neurological symptoms and risk of end-stage kidney disease (ESKD) is unknown in primary and secondary thrombotic microangiopathies (TMAs).
Methods
We measured baseline systolic (SBP) and diastolic (DBP) BP in consecutive 563 patients with adjudicated primary and secondary TMAs, and assessed its association with the risk of ESKD.
Results
Normal BP, grade 1, 2 and 3 hypertension were present in 243 (43.1%), 132 (23.4%), 101 (17.9%) and 88 (15.6%), respectively.
Significant BP differences were noted in relation to the cause of TMA: highest BP values were found in patients with atypical hemolytic-uremic syndrome (aHUS), pregnancy, transplantation and auto-immune-related TMAs. Normal BP or grade 1 hypertension was found in 17/18 (94.4%) patients with thrombotic thrombocytopenic patients (only 1/18 (5.6%) had a SBP value>150 mmHg). In contrast, BP values could not differentiate isolated “essential” malignant hypertension (MH) from MH associated with aHUS (isolated MH (n=15): BP (median (IQR)): 220 (182-249)/132 (101-150) mmHg; MH with aHUS (n=5): BP: 223 (196-245)/131 (111-144) mmHg).
The risk of vigilance disturbances (6.9%, 15.0%, 25.0%, respectively), epileptic seizures (1.5%, 4.0%, 12.5%, respectively) and posterior reversible encephalopathy syndrome (0.76%, 2.97%, 6.82%, respectively) increased with increasing baseline BP values from grade 1 to grade 3 hypertension.
ESKD occurred in 35/563 (6.2%) patients (1.23%, 2.27%, 11.9% and 19.3% of patients with normal BP, grade 1, 2 and 3 hypertension, respectively). As compared to patients with normal BP (<120/139 mmHg), grade 1, grade 2 and grade 3 hypertension were associated with a greater risk of ESKD in univariate (OR: 1.91 [0.83-4.40], 13.2 [3.56-48.9] and 34.8 [9.31-130], respectively) and multivariate (OR: 0.89 [0.30-2.69], 7.00 [1.57-31.3] and 19.7 [4.53-85.2], respectively) analyses. The association between BP and the risk of ESRD was unchanged after adjustment on eculizumab use (OR: 3.46 [1.41-8.49], 17.7 [4.44-70.0] and 70.6 [8.61-579], respectively). Patients with MH, regardless of its cause, had a greater risk of ESKD (OR: 26.4 [10.0-69.8] vs other patients).
Conclusions
Baseline BP differs in primary and secondary TMAs. High BP reduces the neurological tolerance of TMAs and is a powerful independent risk factor of ESKD, even after adjustment on TMA’s cause.
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14
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Poinas AC, Padgett K, Heus RD, Perrotin F, Devlieger R. Oral misoprostol tablets (25 µg) for induction of labor: a targeted literature review and cost analysis. J Med Econ 2022; 25:428-436. [PMID: 35297743 DOI: 10.1080/13696998.2022.2053432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Various methods exist for the induction of labor (IOL), and there is limited consensus as to optimal methods. Off-label misoprostol is recommended by the World Health Organization (WHO) for IOL but preparing it into doses suitable for IOL lacks precision, with potential adverse outcomes if dosing is inaccurate. This study explores potential outcomes and costs associated with increased uptake of a low-dose (25 µg) oral misoprostol formulation (Angusta; Norgine BV, Amsterdam) approved for IOL, in France, Belgium, and the Netherlands. METHODS A literature review was undertaken to derive probabilities of delivery outcomes (vaginal, instrumental, and cesarean sections) for IOL methods, from published meta-analyses. Outcomes for oral misoprostol tablets (25 µg) were unavailable in the meta-analyses, so were estimated using data from two published retrospective cohort studies. A model was developed to predict the frequency of IOL outcomes and associated costs at the national level, across multiple scenarios. Scenarios were tested using a moderate, medium, and high increase in oral misoprostol tablet (25 µg) uptake. Market shares, costs, and induction rates were defined for each country using multiple data sources. RESULTS Increased uptake of oral misoprostol tablets (25 µg) was estimated to be associated with a slightly increased rate of routine vaginal deliveries, and concurrent decreases in instrumental vaginal deliveries and cesarean sections. Since routine vaginal deliveries are less costly than other delivery outcomes, increased uptake of oral misoprostol tablets (25 µg) within the IOL market has the potential to be cost-saving. These trends were predicted using 25 µg oral misoprostol tablet outcomes informed by both retrospective studies. CONCLUSION Preliminary outcomes suggest that oral misoprostol tablets at 25 µg per dose may improve outcomes in IOL and be cost-saving. Further study is required to validate these findings and assess the comparative efficacy of IOL methods, including oral misoprostol tablets (25 µg).
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Affiliation(s)
| | | | - Roel de Heus
- Department of Obstetrics and Gynaecology, St. Antonius Hospital, Utrecht, Netherlands
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15
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Jones M, Palmer K, Pathirana MM, Cecatti JG, Moraes Filho OB, Marions L, Prager M, Edlund M, Jozwiak M, Eikelder MT, Rengerink KO, Bloemenkamp KW, Henry A, Beckmann M, Kumar S, Diguisto C, Le Gouge A, Perrotin F, Symonds I, O'Leary S, Rolnik DL, Mol BW, Li W. A comparison of balloon catheters and vaginal prostaglandins for cervical ripening prior to labour induction. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Mégier C, Bourbao-Tournois C, Perrotin F, Merle P, Ouaissi M, Diguisto C. Long-term evaluation of the impact of delivery modalities on anal continence in women with Crohn's disease. J Visc Surg 2021; 159:353-361. [PMID: 34799288 DOI: 10.1016/j.jviscsurg.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Crohn's disease (CD) and sphincter injury during childbirth are two risk factors for anal incontinence (AI). The long-term risk of developing AI in women with CD after childbirth has never been studied. GOAL The main objective of the study is to assess the risk of developing severe AI after childbirth in women with CD. METHODS A retrospective study was performed in women with CD who gave birth in a French "Level 3" maternity hospital between 2000 and 2015. The primary endpoint was severe AI as defined by a Wexner score≥9 or a St. Mark's score≥9, at least five years after childbirth. The association between delivery route and occurrence of severe AI was assessed by univariate and multivariate analyses. RESULTS Forty-six women were included, 32 of whom were delivered vaginally and 14 by Caesarean section. Thirty-one percent of the women had severe AI according to the Wexner score, and 41% according to the St. Mark's score. Two factors were associated with severe AI: vaginal delivery and the occurrence of an obstetric perineal injury: (crude OR=8.89, 95% (CI: 1.03-76.57) and crude OR=4.16, 95% (CI: 1.06-16.27) respectively for AI defined by the Wexner score, and crude OR=6.8, 95% (CI: 1.30-35.41) and crude OR=4.3, 95% (CI: 1.23-15.2) for AI defined by the St. Mark's score). After adjusting for confounding factors, only vaginal delivery was associated with severe AI (adjusted OR=22.86, 95% CI: 1.52-931.28 for a Wexner score≥9 and adjusted OR=16. 11 (95% CI: 1.43-533.26) for a St Mark score≥9). CONCLUSION Vaginal birth was associated with the development of severe long-term AI in women with CD.
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Affiliation(s)
- C Mégier
- Maternity Olympe de Gouges, Regional University Hospital of Tours, 2, Boulevard Tonnellé, 37044 Tours cedex 1, France; François Rabelais University, Tours, France.
| | - C Bourbao-Tournois
- François Rabelais University, Tours, France; Department of Digestive, Oncological, Endocrine, Hepatobiliary and Hepatic Transplantation Surgery. Trousseau Hospital, Regional University Hospital of Tours, Tours, France
| | - F Perrotin
- Maternity Olympe de Gouges, Regional University Hospital of Tours, 2, Boulevard Tonnellé, 37044 Tours cedex 1, France; François Rabelais University, Tours, France
| | - P Merle
- François Rabelais University, Tours, France; Department of Gastroenterology, Trousseau Hospital, Regional University Hospital of Tours, Tours, France
| | - M Ouaissi
- François Rabelais University, Tours, France; Department of Digestive, Oncological, Endocrine, Hepatobiliary and Hepatic Transplantation Surgery. Trousseau Hospital, Regional University Hospital of Tours, Tours, France
| | - C Diguisto
- Maternity Olympe de Gouges, Regional University Hospital of Tours, 2, Boulevard Tonnellé, 37044 Tours cedex 1, France; François Rabelais University, Tours, France
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17
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Thoreau B, von Tokarski F, Bauvois A, Bayer G, Barbet C, Cloarec S, Mérieau E, Lachot S, Garot D, Bernard L, Gyan E, Perrotin F, Pouplard C, Maillot F, Gatault P, Sautenet B, Rusch E, Frémeaux-Bacchi V, Vigneau C, Fakhouri F, Halimi JM. Infection in Patients with Suspected Thrombotic Microangiopathy Based on Clinical Presentation. Clin J Am Soc Nephrol 2021; 16:1355-1364. [PMID: 34497111 PMCID: PMC8729578 DOI: 10.2215/cjn.17511120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 06/08/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES In contrast to shigatoxin-associated Escherichia coli (STEC) causing hemolytic uremic syndrome, STEC-unrelated infections associated with thrombotic microangiopathy are less characterized. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Our retrospective study in a four-hospital institution of 530 consecutive patients with adjudicated thrombotic microangiopathies during the 2009-2016 period studied STEC-unrelated infections' epidemiology and major outcomes (death, acute dialysis, and major cardiovascular events). RESULTS STEC-unrelated infection was present in 145 of 530 (27%) patients, thrombotic microangiopathies without infection were present in 350 of 530 (66%) patients, and STEC causing hemolytic and uremic syndrome was present in 35 of 530 (7%) patients. They (versus thrombotic microangiopathy without infection) were associated with age >60 years (36% versus 18%), men (53% versus 27%), altered consciousness (32% versus 11%), mean BP <65 mm Hg (21% versus 4%), lower hemoglobin and platelet count, and AKI (72% versus 49%). They were associated with more than one pathogen in 36 of 145 (25%) patients (either isolated [14%] or combined [86%] to other causes of thrombotic microangiopathy); however, no significant clinical or biologic differences were noted between the two groups. They were more frequently due to bacteria (enterobacteria [41%], Staphylococcus aureus [11%], and Streptococcus pneumonia [3%]) than viruses (Epstein-Barr [20%], cytomegalovirus [18%], influenza [3%], hepatitis C [1%], HIV [1%], and rotavirus [1%]). STEC-unrelated infections were independent risk factors for in-hospital death (odds ratio, 2.22; 95% confidence interval, 1.18 to 4.29), major cardiovascular event (odds ratio, 3.43; 95% confidence interval, 1.82 to 6.69), and acute dialysis (odds ratio, 3.48; 95% confidence interval, 1.78 to 7.03). Bacteria (versus other pathogens), and among bacteria, enterobacteria, presence of more than one bacteria, and E. coli without shigatoxin were risk factors for acute dialysis. CONCLUSIONS Infections are frequent thrombotic microangiopathy triggers or causes, and they are mostly unrelated to STEC. Infections convey a higher risk of death and major complications. The most frequent pathogens were enterobacteria, S. aureus, Epstein-Barr virus, and cytomegalovirus. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_09_07_CJN17511120.mp3.
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Affiliation(s)
- Benjamin Thoreau
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Néphrologie Pédiatrique, Hôpital Bretonneau et Hôpital Clocheville, Centre Hospitalier Universitaire (CHU) Tours, Tours, France et French Clinical Research Network Infrastructure-Cardiovascular and Renal Clinical Trialists, Tours, France
| | - Florent von Tokarski
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Néphrologie Pédiatrique, Hôpital Bretonneau et Hôpital Clocheville, Centre Hospitalier Universitaire (CHU) Tours, Tours, France et French Clinical Research Network Infrastructure-Cardiovascular and Renal Clinical Trialists, Tours, France
| | - Adeline Bauvois
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Néphrologie Pédiatrique, Hôpital Bretonneau et Hôpital Clocheville, Centre Hospitalier Universitaire (CHU) Tours, Tours, France et French Clinical Research Network Infrastructure-Cardiovascular and Renal Clinical Trialists, Tours, France
| | - Guillaume Bayer
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Néphrologie Pédiatrique, Hôpital Bretonneau et Hôpital Clocheville, Centre Hospitalier Universitaire (CHU) Tours, Tours, France et French Clinical Research Network Infrastructure-Cardiovascular and Renal Clinical Trialists, Tours, France
| | - Christelle Barbet
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Néphrologie Pédiatrique, Hôpital Bretonneau et Hôpital Clocheville, Centre Hospitalier Universitaire (CHU) Tours, Tours, France et French Clinical Research Network Infrastructure-Cardiovascular and Renal Clinical Trialists, Tours, France
| | - Sylvie Cloarec
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Néphrologie Pédiatrique, Hôpital Bretonneau et Hôpital Clocheville, Centre Hospitalier Universitaire (CHU) Tours, Tours, France et French Clinical Research Network Infrastructure-Cardiovascular and Renal Clinical Trialists, Tours, France
| | - Elodie Mérieau
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Néphrologie Pédiatrique, Hôpital Bretonneau et Hôpital Clocheville, Centre Hospitalier Universitaire (CHU) Tours, Tours, France et French Clinical Research Network Infrastructure-Cardiovascular and Renal Clinical Trialists, Tours, France
| | - Sébastien Lachot
- Service d'Hématologie Biologique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Denis Garot
- Service de Médecine Intensive Réanimation, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Louis Bernard
- Service de Maladies Infectieuses, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Emmanuel Gyan
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Bretonneau, CHU Tours, Equipe de recherche Labellisée, Centre National pour le Recherche Scientifique 7001, Université de Tours, Tours, France
| | - Franck Perrotin
- Service de Gynécologie Obstétrique B. Maternité Olympe de Gouges, Hôpital Bretonneau, CHU Tours, Tours, France.,Institut National de la Santé et de la Recherche Médicale U1253 Imaging and Brain (iBrain), Université de Tours, Tours, France
| | - Claire Pouplard
- Service d'Hématologie-Hémostase, Hôpital Trousseau, CHU Tours, Tours, France.,EA7501, François-Rabelais University, Tours, France
| | - François Maillot
- Service de Médecine interne, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Philippe Gatault
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Néphrologie Pédiatrique, Hôpital Bretonneau et Hôpital Clocheville, Centre Hospitalier Universitaire (CHU) Tours, Tours, France et French Clinical Research Network Infrastructure-Cardiovascular and Renal Clinical Trialists, Tours, France.,EA4245, François-Rabelais University, Tours, France
| | - Bénédicte Sautenet
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Néphrologie Pédiatrique, Hôpital Bretonneau et Hôpital Clocheville, Centre Hospitalier Universitaire (CHU) Tours, Tours, France et French Clinical Research Network Infrastructure-Cardiovascular and Renal Clinical Trialists, Tours, France.,Institut National de la Santé et de la Recherche Médicale U1246 the methodS in Patient-centered outcomes and HEalth ResEarch, Université de Tours, Université de Nantes, Tours, France
| | - Emmanuel Rusch
- Laboratoire de Santé Publique, Hôpital Bretonneau, CHU Tours, Tours, France
| | | | - Cécile Vigneau
- CHU Pontchaillou, Service de Néphrologie, Rennes, France.,Université Rennes 1, Institut National de la Santé et de la Recherche Médicale Institut de Recherche en Santé, environnement et Travail, Unité Mixte de Recherche 1085, Rennes, France
| | - Fadi Fakhouri
- Service of Nephrology, Department of Medicine, Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland
| | - Jean-Michel Halimi
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Néphrologie Pédiatrique, Hôpital Bretonneau et Hôpital Clocheville, Centre Hospitalier Universitaire (CHU) Tours, Tours, France et French Clinical Research Network Infrastructure-Cardiovascular and Renal Clinical Trialists, Tours, France .,EA4245, François-Rabelais University, Tours, France
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18
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Arthuis C, Potin J, Winer N, Tavernier E, Paternotte J, Ramos A, Perrotin F, Diguisto C. Contribution of ultrasonography to the prediction of the induction-delivery interval: The ECOLDIA prospective multicenter cohort study. J Gynecol Obstet Hum Reprod 2021; 50:102196. [PMID: 34256166 DOI: 10.1016/j.jogoh.2021.102196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION To evaluate the ability of preinduction ultrasonographic cervical length to predict the interval between induction and delivery in women at term with a Bishop score of 4 to 6 at induction. STUDY DESIGN This multicenter prospective observational cohort recruited 334 women from April 2010 to March 2014. Inclusion criteria were women with singleton pregnancies at a gestational age ≥37 weeks, with no previous caesarean, a medical indication for induction of labor, and a Bishop score of 4, 5, or 6. All women underwent cervical assessment by both transvaginal ultrasound and digital examination (Bishop score). The induction protocol was standardized. The primary outcome measure was the induction-delivery interval. Hazard ratios (HR) and their 95% confidence intervals (95% CI) were used to assess potential predictors. RESULTS Mean gestational age at induction was 40.1 weeks, 60.8% of the women were nulliparous, and the cesarean rate was 13.4%. The mean induction-delivery interval was 20.8 h (± 10.6). Delivery occurred within 24 h for 56.9% (n=190) of the women. An ultrasonographic cervical length measurement less than 25 mm (HR=1.50, 95% CI 1.18-1.91, P<0.01) and parity (HR=1.41, 95% CI 1.21-1.65, P<0.01) appeared to predict induction-delivery interval. The cervical length cutoff to reduce the induction-delivery interval was 25 mm. CONCLUSION A cervical length cutoff of 25 mm was associated with shorter induction-delivery interval in women at term with a Bishop score of 4 to 6.
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Affiliation(s)
- Chloé Arthuis
- Department of Gynecology and Obstetrics, Centre Hospitalier Universitaire Nantes, Nantes, France.
| | - Jérôme Potin
- Department of Gynecology and Obstetrics, Centre Hospitalier Régional Universitaire Tours, Tours, France
| | - Norbert Winer
- Department of Gynecology and Obstetrics, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Elsa Tavernier
- Inserm CIC 1415, Centre Hospitalier Régional Universitaire Tours, Tours, France
| | - Julie Paternotte
- Department of Gynecology and Obstetrics, Centre Hospitalier Régional Universitaire Tours, Tours, France
| | - Anna Ramos
- Department of Gynaecology and Obstetrics, Centre Hospitalier Régional d'Orléans, Orleans, France
| | - Franck Perrotin
- Department of Gynecology and Obstetrics, Centre Hospitalier Régional Universitaire Tours, Tours, France
| | - Caroline Diguisto
- Department of Gynecology and Obstetrics, Centre Hospitalier Régional Universitaire Tours, Tours, France
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19
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Cordier AG, Laup L, Letourneau A, Le Sache N, Fouquet V, Senat MV, Perrotin F, Rosenblatt J, Sananes N, Jouannic JM, Benoist G, Jani JC, Benachi A. Prenatal stomach position predicts gastrointestinal morbidity at 2 years in fetuses with left-sided congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2021; 57:959-967. [PMID: 32462707 DOI: 10.1002/uog.22086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/02/2020] [Accepted: 05/10/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The long-term morbidity associated with isolated left-sided congenital diaphragmatic hernia (CDH) has been described previously. However, antenatal criteria impacting gastrointestinal morbidity (GIM) are not yet defined. The objective of this study was to evaluate the effect of fetal stomach position on the risk of GIM at 2 years of age in children with left-sided CDH. METHODS This was a retrospective, observational multicenter cohort study of data obtained from January 2010 to January 2014, that included patients whose fetus had isolated left-sided CDH, with or without fetal endoscopic tracheal occlusion (FETO). Prenatal maternal, fetal and pediatric data were collected. Fetal stomach position was evaluated a posteriori by two observers, using ultrasound images at the level of the four-chamber view of the heart that had been obtained to calculate the observed-to-expected lung-area-to-head-circumference ratio (O/E-LHR). Fetal stomach position was graded as follows: Grade 1, stomach not visualized; Grade 2, stomach visualized anteriorly, next to the apex of the heart, with no structure in between the stomach and the sternum; Grade 3, stomach visualized alongside the left ventricle of the heart, and abdominal structures anteriorly; or Grade 4, as Grade 3 but with stomach posterior to the level of the atrioventricular heart valves. The primary outcome was GIM at 2 years of age, assessed in a composite manner, including the occurrence of gastroesophageal reflux disease, need for gastrostomy, duration of parenteral and enteral nutrition and persistence of oral aversion. Regression analysis was performed in order to investigate the effect of O/E-LHR, stomach position and FETO on various GIM outcome variables. RESULTS Forty-seven patients with fetal left-sided CDH were included in the analysis. Thirteen (27.7%) infants did not meet the criterion of exclusive oral feeding at 2 years of age. Fetal stomach position grade was associated significantly and independently with the duration of parenteral nutrition (odds ratio (OR), 19.86; P = 0.031) and persistence of oral aversion at 2 years (OR, 3.40; P = 0.006). On multivariate analysis, O/E-LHR was predictive of the need for prosthetic patch repair, but not for GIM. FETO did not seem to affect the risk of GIM at 2 years. CONCLUSION In isolated left-sided CDH, fetal stomach position is the only factor that is predictive of GIM at 2 years of age. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A G Cordier
- Department of Gynecology and Obstetrics, Antoine Béclère Hospital, Paris-Sud University, Clamart, France
- Reference Center for Rare Diseases: Congenital Diaphragmatic Hernia, Clamart, France
| | - L Laup
- Department of Gynecology and Obstetrics, Antoine Béclère Hospital, Paris-Sud University, Clamart, France
| | - A Letourneau
- Department of Gynecology and Obstetrics, Antoine Béclère Hospital, Paris-Sud University, Clamart, France
- Reference Center for Rare Diseases: Congenital Diaphragmatic Hernia, Clamart, France
| | - N Le Sache
- Reference Center for Rare Diseases: Congenital Diaphragmatic Hernia, Clamart, France
- Department of Neonatal Pediatrics, Bicêtre Hospital, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - V Fouquet
- Reference Center for Rare Diseases: Congenital Diaphragmatic Hernia, Clamart, France
- Department of Pediatric Surgery, Bicêtre Hospital, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - M V Senat
- Reference Center for Rare Diseases: Congenital Diaphragmatic Hernia, Clamart, France
- Department of Gynecology and Obstetrics, Bicêtre Hospital, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - F Perrotin
- Department of Obstetrics, Gynecology and Fetal Medicine, Regional University Hospital, Francois Rabelais University, Tours, France
| | - J Rosenblatt
- Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, Paris, France
| | - N Sananes
- Department of Maternal-Fetal Medicine, Strasbourg University Hospital, Strasbourg, France
| | - J M Jouannic
- Department of Fetal Medicine, Trousseau Hospital, APHP Sorbonne, Sorbonne University, Paris, France
| | - G Benoist
- Department of Obstetrics and Gynecology, Caen University Hospital, Caen, France
| | - J C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - A Benachi
- Department of Gynecology and Obstetrics, Antoine Béclère Hospital, Paris-Sud University, Clamart, France
- Reference Center for Rare Diseases: Congenital Diaphragmatic Hernia, Clamart, France
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20
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Sentilhes L, Sénat MV, Le Lous M, Winer N, Rozenberg P, Kayem G, Verspyck E, Fuchs F, Azria E, Gallot D, Korb D, Desbrière R, Le Ray C, Chauleur C, de Marcillac F, Perrotin F, Parant O, Salomon LJ, Gauchotte E, Bretelle F, Sananès N, Bohec C, Mottet N, Legendre G, Letouzey V, Haddad B, Vardon D, Madar H, Mattuizzi A, Daniel V, Regueme S, Roussillon C, Benard A, Georget A, Darsonval A, Deneux-Tharaux C. Tranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery. N Engl J Med 2021; 384:1623-1634. [PMID: 33913639 DOI: 10.1056/nejmoa2028788] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prophylactic administration of tranexamic acid has been associated with reduced postpartum blood loss after cesarean delivery in several small trials, but evidence of its benefit in this clinical context remains inconclusive. METHODS In a multicenter, double-blind, randomized, controlled trial, we assigned women undergoing cesarean delivery before or during labor at 34 or more gestational weeks to receive an intravenously administered prophylactic uterotonic agent and either tranexamic acid (1 g) or placebo. The primary outcome was postpartum hemorrhage, defined as a calculated estimated blood loss greater than 1000 ml or receipt of a red-cell transfusion within 2 days after delivery. Secondary outcomes included gravimetrically estimated blood loss, provider-assessed clinically significant postpartum hemorrhage, use of additional uterotonic agents, and postpartum blood transfusion. RESULTS Of the 4551 women who underwent randomization, 4431 underwent cesarean delivery, 4153 (93.7%) of whom had primary outcome data available. The primary outcome occurred in 556 of 2086 women (26.7%) in the tranexamic acid group and in 653 of 2067 (31.6%) in the placebo group (adjusted risk ratio, 0.84; 95% confidence interval [CI], 0.75 to 0.94; P = 0.003). There were no significant between-group differences in mean gravimetrically estimated blood loss or in the percentage of women with provider-assessed clinically significant postpartum hemorrhage, use of additional uterotonic agents, or postpartum blood transfusion. Thromboembolic events in the 3 months after delivery occurred in 0.4% of women (8 of 2049) who received tranexamic acid and in 0.1% of women (2 of 2056) who received placebo (adjusted risk ratio, 4.01; 95% CI, 0.85 to 18.92; P = 0.08). CONCLUSIONS Among women who underwent cesarean delivery and received prophylactic uterotonic agents, tranexamic acid treatment resulted in a significantly lower incidence of calculated estimated blood loss greater than 1000 ml or red-cell transfusion by day 2 than placebo, but it did not result in a lower incidence of hemorrhage-related secondary clinical outcomes. (Funded by the French Ministry of Health; TRAAP2 ClinicalTrials.gov number, NCT03431805.).
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Affiliation(s)
- Loïc Sentilhes
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Marie V Sénat
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Maëla Le Lous
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Norbert Winer
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Patrick Rozenberg
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Gilles Kayem
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Eric Verspyck
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Florent Fuchs
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Elie Azria
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Denis Gallot
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Diane Korb
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Raoul Desbrière
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Camille Le Ray
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Céline Chauleur
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Fanny de Marcillac
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Franck Perrotin
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Olivier Parant
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Laurent J Salomon
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Emilie Gauchotte
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Florence Bretelle
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Nicolas Sananès
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Caroline Bohec
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Nicolas Mottet
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Guillaume Legendre
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Vincent Letouzey
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Bassam Haddad
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Delphine Vardon
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Hugo Madar
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Aurélien Mattuizzi
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Valérie Daniel
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Sophie Regueme
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Caroline Roussillon
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Antoine Benard
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Aurore Georget
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Astrid Darsonval
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
| | - Catherine Deneux-Tharaux
- From the Department of Obstetrics and Gynecology (L.S., H.M., A.M.), the Department of Clinical Research and Innovation (S.R.), and the Euclid-French Clinical Research Infrastructure Network (F-CRIN) Clinical Trials Platform, Department of Clinical Research and Innovation (C.R.), Bordeaux University Hospital, and the Public Health Department, Clinical Epidemiology Unit, Centre Hospitalier Universitaire (CHU) Bordeaux (A.B., A.G.), Bordeaux, the Department of Obstetrics and Gynecology, Bicêtre University Hospital (M.V.S.), the Department of Obstetrics and Gynecology, Trousseau Hospital (G.K.), the Department of Obstetrics and Gynecology, Robert Debré Hospital (D.K.), Port Royal Maternity Unit, Cochin Hospital (C.L.R.), and the Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital (L.J.S.), Assistance Publique-Hôpitaux de Paris, Université de Paris, Center of Research in Epidemiology and Statistics Sorbonne, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), INSERM, Institut National de la Recherche Agronomique (INRA), University Hospital Department-Risks in Pregnancy (G.K., E.A., C.L.R., C.D.-T.), and the Maternity Unit, Paris Saint Joseph Hospital, Paris Descartes University (E.A.), Paris, the Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes (M.L.L.), the Department of Obstetrics and Gynecology, University Medical Center of Nantes, Centre d'Investigation Clinique Mère Enfant, University Hospital, and INRA, Unité Mixte de Recherche (UMR) 1280, Physiology of Nutritional Adaptations, University of Nantes, Institut des Maladie de l'Appareil Digestif, and Centre de Recherche en Nutrition Humaine-Ouest, Nantes (N.W.), the Department of Obstetrics and Gynecology, Poissy/Saint-Germain Hospital, Poissy (P.R.), the Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen (E.V.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), INSERM, Center for Research in Epidemiology and Population Health, Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand (D.G.), the Department of Obstetrics and Gynecology, Saint-Joseph Hospital (R.D.), and the Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université (F.B.), Marseille, the Department of Obstetrics and Gynecology, Saint-Etienne University Hospital, Saint Etienne (C.C.), the Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg (F.M.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse (O.P.), the Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy (E.G.), the Department of Obstetrics and Gynecology, Centre Médico-chirurgical et Obstétrical, Schiltigheim (N.S.), the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon (N.M.), the Departments of Obstetrics and Gynecology (G.L.) and Pharmacy (V.D., A.D.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes (V.L.), the Department of Obstetrics and Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil (B.H.), the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), and PPRIGO (Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest), Brest University Hospital, Brest (V.D., A.D.) - all in France
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21
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Kayem G, Seco A, Beucher G, Dupont C, Branger B, Crenn Hebert C, Huissoud C, Fresson J, Winer N, Langer B, Rozenberg P, Morel O, Bonnet MP, Perrotin F, Azria E, Carbillon L, Chiesa C, Raynal P, Rudigoz RC, Dreyfus M, Vendittelli F, Patrier S, Deneux-Tharaux C, Sentilhes L. Clinical profiles of placenta accreta spectrum: the PACCRETA population-based study. BJOG 2021; 128:1646-1655. [PMID: 33393174 DOI: 10.1111/1471-0528.16647] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe and compare the characteristics of women with placenta accreta spectrum (PAS) and their pregnancy outcomes according to the presence of placenta praevia and a prior caesarean section. DESIGN Prospective population-based study. SETTING All 176 maternity hospitals of eight French regions. POPULATION Two hundred and forty-nine women with PAS, from a source population of 520 114 deliveries. METHODS Women with PAS were classified into two risk-profile groups, with or without the high-risk combination of placenta praevia (or an anterior low-lying placenta) and at least one prior caesarean. These two groups were described and compared. MAIN OUTCOME MEASURES Population-based incidence of PAS, characteristics of women, pregnancies, deliveries and pregnancy outcomes. RESULTS The PAS population-based incidence was 4.8/10 000 (95% CI 4.2-5.4/10 000). After exclusion of women lost to follow up from the analysis, the group with placenta praevia and a prior caesarean included 115 (48%) women and the group without this combination included 127 (52%). In the group with both factors, PAS was more often suspected antenatally (77% versus 17%; P < 0.001) and more often percreta (38% versus 5%; P < 0.001). This group also had more hysterectomies (53% versus 21%, P < 0.001) and higher rates of blood product transfusions, maternal complications, preterm births and neonatal intensive care unit admissions. Sensitivity analysis showed similar results after exclusion of women who delivered vaginally. CONCLUSION More than half the cases of PAS occurred in women without the combination of placenta praevia and a prior caesarean delivery, and these women had better maternal and neonatal outcomes. We cannot completely rule out that some of the women who delivered vaginally had placental retention rather than PAS; however, we found similar results among women who delivered by caesarean. TWEETABLE ABSTRACT Half the women with PAS do not have both placenta praevia and a prior caesarean delivery, and they have better maternal outcomes.
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Affiliation(s)
- G Kayem
- Trousseau Hospital, APHP, Sorbonne University, Paris, France.,CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France
| | - A Seco
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.,Clinical Research Unit Necker Cochin, APHP, Paris, France
| | - G Beucher
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Caen, Caen Cedex, France
| | - C Dupont
- Réseau Périnatal Aurore, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France.,Health Services and Performance Research HESPER EA 7425, Université de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - B Branger
- Réseau « Sécurité Naissance - Naître ensemble » des Pays-de-la-Loire, France
| | - C Crenn Hebert
- Louis Mourier University Hospital, APHP, Colombes, France.,Réseau Périnatal des Hauts de Seine, PERINAT92, Issy-les-Moulineaux, France
| | - C Huissoud
- Health Services and Performance Research HESPER EA 7425, Université de Lyon, University Claude Bernard Lyon 1, Lyon, France.,Maternité de la Croix Rousse, Lyon, France
| | - J Fresson
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.,CHRU Nancy, Réseau Périnatal Lorrain, France
| | - N Winer
- Service de Gynécologie Obstétrique HME Université de Nantes, NUN, INRA, UMR 1280, Phan, Université de Nantes, Nantes, France
| | - B Langer
- CHU de Strasbourg, Strasbourg, France
| | | | - O Morel
- CHRU de Nancy, Nancy, France
| | - M P Bonnet
- Anaesthesia and Critical Care department, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | | | - E Azria
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.,Maternity Unit, Paris Saint Joseph Hospital, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - L Carbillon
- Réseau Périnatal NEF Naître dans l'Est Francilien, Paris 13 University, France
| | - C Chiesa
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France
| | - P Raynal
- CH de Versailles, Site Andre Mignot, Versailles, France
| | - R C Rudigoz
- Health Services and Performance Research HESPER EA 7425, Université de Lyon, University Claude Bernard Lyon 1, Lyon, France.,Maternité de la Croix Rousse, Lyon, France
| | - M Dreyfus
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Caen, Caen Cedex, France
| | - F Vendittelli
- Réseau de Santé en Périnatalité d'Auvergne, CHU de Clermont-Ferrand, France.,CNRS, SIGMA Clermont, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | | | - C Deneux-Tharaux
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France
| | - L Sentilhes
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France
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22
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Rozenberg P, Sentilhes L, Winer N, goffinet F, Vayssiere C, senat MV, Morel O, Haddad B, Garabédian C, Vivanti A, Perrotin F, Kayem G, Raynal P, Blanc J, Verspyck E, Gallot D, Sananes N, séco A, Desbrière R, Deneux-Tharaux C. 485 Efficacy of early versus late intrauterine balloon tamponade in the management of severe postpartum hemorrhage. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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Diguisto C, Le Gouge A, Arthuis C, Winer N, Parant O, Poncelet C, Chauleur C, Hannigsberg J, Ducarme G, Gallot D, Gabriel R, Desbriere R, Beucher G, Faraguet C, Isly H, Rozenberg P, Giraudeau B, Perrotin F. Cervical ripening in prolonged pregnancies by silicone double balloon catheter versus vaginal dinoprostone slow release system: The MAGPOP randomised controlled trial. PLoS Med 2021; 18:e1003448. [PMID: 33571294 PMCID: PMC7877637 DOI: 10.1371/journal.pmed.1003448] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Prolonged pregnancies are a frequent indication for induction of labour. When the cervix is unfavourable, cervical ripening before oxytocin administration is recommended to increase the likelihood of vaginal delivery, but no particular method is currently recommended for cervical ripening of prolonged pregnancies. This trial evaluates whether the use of mechanical cervical ripening with a silicone double balloon catheter for induction of labour in prolonged pregnancies reduces the cesarean section rate for nonreassuring fetal status compared with pharmacological cervical ripening by a vaginal pessary for the slow release of dinoprostone (prostaglandin E2). METHODS AND FINDINGS This is a multicentre, superiority, open-label, parallel-group, randomised controlled trial conducted in 15 French maternity units. Women with singleton pregnancies, a vertex presentation, ≥41+0 and ≤42+0 weeks' gestation, a Bishop score <6, intact membranes, and no history of cesarean delivery for whom induction of labour was decided were randomised to either mechanical cervical ripening with a Cook Cervical Ripening Balloon or pharmacological cervical ripening by a Propess vaginal pessary serving as a prostaglandin E2 slow-release system. The primary outcome was the rate of cesarean for nonreassuring fetal status, with an independent endpoint adjudication committee determining whether the fetal heart rate was nonreassuring. Secondary outcomes included delivery (time from cervical ripening to delivery, number of patients requiring analgesics), maternal and neonatal outcomes. Between January 2017 and December 2018, 1,220 women were randomised in a 1:1 ratio, 610 allocated to a silicone double balloon catheter, and 610 to the Propess vaginal pessary for the slow release of dinoprostone. The mean age of women was 31 years old, and 80% of them were of white ethnicity. The cesarean rates for nonreassuring fetal status were 5.8% (35/607) in the mechanical ripening group and 5.3% (32/609) in the pharmacological ripening group (proportion difference: 0.5%; 95% confidence interval (CI) -2.1% to 3.1%, p = 0.70). Time from cervical ripening to delivery was shorter in the pharmacological ripening group (23 hours versus 32 hours, median difference 6.5 95% CI 5.0 to 7.9, p < 0.001), and fewer women required analgesics in the mechanical ripening group (27.5% versus 35.4%, difference in proportion -7.9%, 95% CI -13.2% to -2.7%, p = 0.003). There were no statistically significant differences between the 2 groups for other delivery, maternal, and neonatal outcomes. A limitation was a low observed rate of cesarean section. CONCLUSIONS In this study, we observed no difference in the rates of cesarean deliveries for nonreassuring fetal status between mechanical ripening with a silicone double balloon catheter and pharmacological cervical ripening with a pessary for the slow release of dinoprostone. TRIAL REGISTRATION ClinicalTrials.gov NCT02907060.
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Affiliation(s)
- Caroline Diguisto
- Pôle de gynécologie obstétrique, médecine fœtale, médecine et biologie de la reproduction, centre Olympe de Gouges, CHRU de Tours, Tours, France
- Université de Tours, France
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- * E-mail:
| | | | - Chloé Arthuis
- Department of Obstetrics and Gynecology, University Hospital of Nantes, NUN, INRAE, UMR 1280, PhAN, Université de Nantes, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, University Hospital of Nantes, NUN, INRAE, UMR 1280, PhAN, Université de Nantes, France
| | - Olivier Parant
- Pôle de gynécologie obstétrique, hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France
| | - Christophe Poncelet
- Department of Obstetrics and Gynecology, Rene DUBOS Hospital, Cergy-Pontoise, France
- Université Paris 13, Sorbonne Paris Cité, UFR SMBH, Bobigny, France
| | - Celine Chauleur
- Department of Gynecology and Obstetrics, University Hospital of Saint-Etienne, Saint-Etienne, France
- INSERM, SAINBIOSE, U1059, Dysfonction Vasculaire et Hémostase, Université Jean-Monnet; CIC1408, Saint-Etienne, France
| | - Jacob Hannigsberg
- CHU Brest, Hôpital Morvan, service de gynécologie-obstétrique, Brest, France
| | - Guillaume Ducarme
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche sur Yon, France
| | - Denis Gallot
- Pôle femme et enfant, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, Clermont-Ferrand, France, Team Translational approach to epithelial injury and repair, UMR6293 CNRS-Université Clermont Auvergne, U1103 Inserm, GReD, Clermont-Ferrand, France
| | - Rene Gabriel
- Service de Gynécologie-Obstétrique, Hôpital Maison Blanche, Reims Cedex, Université de Reims Champagne Ardennes, France
| | - Raoul Desbriere
- Hôpital Saint Joseph, Department of Obstetrics and Gynecology, Marseille, France
| | - Gael Beucher
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, Caen, France
| | - Cyrille Faraguet
- Service de Gynécologie Obstétrique, Centre Hospitalier de Chartre, France
| | - Helene Isly
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Rennes, France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
- Versailles St-Quentin University, research unit EA 7285. Montigny-le-Bretonneux, France
| | - Bruno Giraudeau
- Université de Tours, France
- INSERM CIC1415, CHRU de Tours, Tours, France
| | - Franck Perrotin
- Pôle de gynécologie obstétrique, médecine fœtale, médecine et biologie de la reproduction, centre Olympe de Gouges, CHRU de Tours, Tours, France
- Université de Tours, France
- INSERM U1253 Imaging and Brain (iBrain), Tours, France
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24
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Pintault C, Bleuzen A, Perrotin F, Diguisto C. Second trimester uterine rupture and repair followed by morbidly adherent placenta: a case report. J OBSTET GYNAECOL 2020; 41:984-985. [PMID: 33249972 DOI: 10.1080/01443615.2020.1824213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Claire Pintault
- Pôle de Gynécologie Obstétrique, Médecine Foetale, Médecine et Biologie de la Reproduction, Centre Olympe de Gouges, CHRU de Tours, Tours Cedex 9, France.,Université François Rabelais, Tours Cedex, France
| | - Aurore Bleuzen
- Pôle de Radiologie, CHRU de Tours, Tours Cedex 9, France
| | - Franck Perrotin
- Pôle de Gynécologie Obstétrique, Médecine Foetale, Médecine et Biologie de la Reproduction, Centre Olympe de Gouges, CHRU de Tours, Tours Cedex 9, France.,Université François Rabelais, Tours Cedex, France.,UMR Inserm U930, University of Tours, Tours Cedex 1, France
| | - Caroline Diguisto
- Pôle de Gynécologie Obstétrique, Médecine Foetale, Médecine et Biologie de la Reproduction, Centre Olympe de Gouges, CHRU de Tours, Tours Cedex 9, France.,Université François Rabelais, Tours Cedex, France
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25
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Deruelle P, Lelorain S, Deghilage S, Couturier E, Guilbert E, Berveiller P, Sénat MV, Vayssière C, Sentilhes L, Perrotin F, Gallot D, Chauleur C, Sananes N, Roth E, Luton D, Caputo M, Lorio E, Chatelet C, Couster J, Timbely O, Doret-Dion M, Duhamel A, Pigeyre M. Rationale and design of ePPOP-ID: a multicenter randomized controlled trial using an electronic-personalized program for obesity in pregnancy to improve delivery. BMC Pregnancy Childbirth 2020; 20:602. [PMID: 33028261 PMCID: PMC7542973 DOI: 10.1186/s12884-020-03288-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/27/2020] [Indexed: 11/29/2022] Open
Abstract
Background Pre-pregnancy obesity and excessive gestational weight gain (GWG) are established risk factors for adverse pregnancy, delivery and birth outcomes. Pregnancy is an ideal moment for nutritional interventions in order to establish healthier lifestyle behaviors in women at high risk of obstetric and neonatal complications. Methods Electronic-Personalized Program for Obesity during Pregnancy to Improve Delivery (ePPOP-ID) is an open multicenter randomized controlled trial which will assess the efficacy of an e-health web-based platform offering a personalized lifestyle program to obese pregnant women in order to reduce the rate of labor procedures and delivery interventions in comparison to standard care. A total of 860 eligible pregnant women will be recruited in 18 centers in France between 12 and 22 weeks of gestation, randomized into the intervention or the control arm and followed until 10 weeks of postpartum. The intervention is based on nutrition, eating behavior, physical activity, motivation and well-being advices in which personalization is central, as well as the use of a mobile/tablet application. Inputs includes data from the medical record of participants (medical history, anthropometric data), from the web platform (questionnaires on dietary habits, eating behavior, physical activity and motivation in both groups), and adherence to the program (time of connection for the intervention group only). Data are collected at inclusion, 32 weeks, delivery and 10 weeks postpartum. As primary outcome, we will use a composite endpoint score of obstetrical interventions during labor and delivery, defined as caesarean section and instrumental delivery (forceps and vacuum extractor). Secondary outcomes will consist of data routinely collected as part of usual antenatal and perinatal care, such as GWG, hypertension, preeclampsia, as well as fetal and neonatal outcomes including premature birth, gestational age at birth, birth weight, macrosomia, Apgar score, arterial umbilical cord pH, neonatal traumatism, hyperbilirubinemia, respiratory distress syndrome, transfer in neonatal intensive care unit, and neonatal adiposity. Post-natal outcomes will be duration of breastfeeding, maternal weight retention and child weight at postnatal visit. Discussion The findings of the ePPOP-ID trial will help design e-health intervention program for obese women in pregnancy. Trial registration ClinicalTrials.gov Identifier: NCT02924636 / October 5th 2016.
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Affiliation(s)
- Philippe Deruelle
- Univ. Lille, CHU Lille, EA 4489 - Environnement Périnatal et Santé, F-59000, Lille, France. .,Pôle Gynécologie, Obstétrique et Fertilité, Hôpitaux Universitaires de Strasbourg, 67200, Strasbourg cedex, France.
| | - Sophie Lelorain
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Cognitive and Affective Sciences, Lille, France
| | - Sylvie Deghilage
- Univ. Lille, CHU Lille, EA 4489 - Environnement Périnatal et Santé, F-59000, Lille, France
| | - Emmanuelle Couturier
- Univ. Lille, CHU Lille, EA 4489 - Environnement Périnatal et Santé, F-59000, Lille, France
| | - Elodie Guilbert
- Univ. Lille, CHU Lille, EA 4489 - Environnement Périnatal et Santé, F-59000, Lille, France
| | - Paul Berveiller
- Department of Obstetrics and Gynecology, Poissy Saint Germain hospital, Poissy, France
| | - Marie Victoire Sénat
- Assistance Publique-Hôpitaux de Paris, Department of Gynecology-Obstetrics, Bicêtre Hospital, University of Paris-Sud, University of Medicine Paris- Saclay Le Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
| | - Christophe Vayssière
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Franck Perrotin
- Department of Gynecology and Obstetrics, Inserm U1253 « Imaging and Brain » (iBrain). CHU Bretonneau, Tours, France
| | - Denis Gallot
- Pôle Femme Et Enfant, CHU Estaing, Clermont-Ferrand cedex 1, France.,R2D2-EA7281, Université d'Auvergne, Faculté de Médecine, Place Henri Dunant, Clermont-Ferrand, France
| | - Céline Chauleur
- INSERM, SAINBIOSE, U1059, Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, CIC1408, F- 42055, Saint-Etienne, France
| | - Nicolas Sananes
- Pôle Gynécologie, Obstétrique et Fertilité, Hôpitaux Universitaires de Strasbourg, 67200, Strasbourg cedex, France.,Maternal Fetal Medicine Department, INSERM 1121 "Biomaterials and Bioengineering", Strasbourg University Hospital, Strasbourg, France
| | - Emmanuel Roth
- Pôle Gynécologie, Obstétrique et Fertilité, Hôpitaux Universitaires de Strasbourg, 67200, Strasbourg cedex, France
| | - Dominique Luton
- Department of Obstetrics and Gynecology, AP-HP, Bichat hospital, Paris, France
| | - Marie Caputo
- Department of Obstetrics and Gynecology, Lens general hospital, Lens, France
| | - Elodie Lorio
- Department of Obstetrics and Gynecology, Valenciennes general hospital, Valenciennes, France
| | - Carla Chatelet
- Department of Obstetrics and Gynecology, Béthune general hospital, Béthune, France
| | - Julien Couster
- Department of Obstetrics and Gynecology, Boulogne general hospital, Boulogne, France
| | - Oumar Timbely
- Department of Obstetrics and Gynecology, Meaux general hospital, Meaux, France
| | - Muriel Doret-Dion
- Department of obstetrics and gynecology surgery, Femme mere enfant university hospital, hospices civils de Lyon, Bron, France
| | - Alain Duhamel
- Univ. Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, F-59000, Lille, France
| | - Marie Pigeyre
- Department of medicine, endocrinology division, Mc Master university, Hamilton, Canada
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26
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Kayem G, Lecarpentier E, Deruelle P, Bretelle F, Azria E, Blanc J, Bohec C, Bornes M, Ceccaldi PF, Chalet Y, Chauleur C, Cordier AG, Desbrière R, Doret M, Dreyfus M, Driessen M, Fermaut M, Gallot D, Garabédian C, Huissoud C, Luton D, Morel O, Perrotin F, Picone O, Rozenberg P, Sentilhes L, Sroussi J, Vayssière C, Verspyck E, Vivanti AJ, Winer N, Alessandrini V, Schmitz T. A snapshot of the Covid-19 pandemic among pregnant women in France. J Gynecol Obstet Hum Reprod 2020; 49:101826. [PMID: 32505805 PMCID: PMC7270811 DOI: 10.1016/j.jogoh.2020.101826] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 05/31/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe the course over time of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in French women from the beginning of the pandemic until mid-April, the risk profile of women with respiratory complications, and short-term pregnancy outcomes. METHODS We collected a case series of pregnant women with COVID-19 in a research network of 33 French maternity units between March 1 and April 14, 2020. All cases of SARS-CoV-2 infection confirmed by a positive result on real-time reverse transcriptase polymerase chain reaction tests of a nasal sample and/or diagnosed by a computed tomography chest scan were included and analyzed. The primary outcome measures were COVID-19 requiring oxygen (oxygen therapy or noninvasive ventilation) and critical COVID-19 (requiring invasive mechanical ventilation or extracorporeal membrane oxygenation, ECMO). Demographic data, baseline comorbidities, and pregnancy outcomes were also collected. RESULTS Active cases of COVID-19 increased exponentially during March 1-31, 2020; the numbers fell during April 1-14, after lockdown was imposed on March 17. The shape of the curve of active critical COVID-19 mirrored that of all active cases. By April 14, among the 617 pregnant women with COVID-19, 93 women (15.1 %; 95 %CI 12.3-18.1) had required oxygen therapy and 35 others (5.7 %; 95 %CI 4.0-7.8) had had a critical form of COVID-19. The severity of the disease was associated with age older than 35 years and obesity, as well as preexisting diabetes, previous preeclampsia, and gestational hypertension or preeclampsia. One woman with critical COVID-19 died (0.2 %; 95 %CI 0-0.9). Among the women who gave birth, rates of preterm birth in women with non-severe, oxygen-requiring, and critical COVID-19 were 13/123 (10.6 %), 14/29 (48.3 %), and 23/29 (79.3 %) before 37 weeks and 3/123 (2.4 %), 4/29 (13.8 %), and 14/29 (48.3 %) before 32 weeks, respectively. One neonate (0.5 %; 95 %CI 0.01-2.9) in the critical group died from prematurity. CONCLUSION COVID-19 can be responsible for significant rates of severe acute, potentially deadly, respiratory distress syndromes. The most vulnerable pregnant women, those with comorbidities, may benefit particularly from prevention measures such as a lockdown.
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Affiliation(s)
- Gilles Kayem
- Assistance Publique-Hôpitaux de Paris, 75004, Paris, France.
| | | | - Philippe Deruelle
- Centre Hospitalo-Universitaire de Strasbourg, 67000, Strasbourg, France
| | | | - Elie Azria
- Groupe Hospitalier Saint-Joseph, 75014, Paris, France
| | - Julie Blanc
- Assistance Publique-Hôpitaux de Marseille, 13000, Marseille, France
| | | | - Marie Bornes
- Assistance Publique-Hôpitaux de Paris, 75004, Paris, France
| | | | - Yasmine Chalet
- Assistance Publique-Hôpitaux de Paris, 75004, Paris, France
| | - Céline Chauleur
- Centre Hospitalo-Universitaire de Saint-Etienne, 42000, Saint-Etienne, France
| | | | | | | | - Michel Dreyfus
- Centre Hospitalo-Universitaire de Caen, 14000, Caen, France
| | | | - Marion Fermaut
- Assistance Publique-Hôpitaux de Paris, 75004, Paris, France
| | - Denis Gallot
- Centre Hospitalo-Universitaire Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Charles Garabédian
- Centre Hospitalier Régional Universitaire de Lille, 59000, Lille, France
| | | | | | | | - Franck Perrotin
- Centre Hospitalier Régional Universitaire de Tours, 37000, Tours, France
| | - Olivier Picone
- Assistance Publique-Hôpitaux de Paris, 75004, Paris, France
| | | | - Loïc Sentilhes
- Centre Hospitalo-Universitaire de Bordeaux, 33000, Bordeaux, France
| | - Jeremy Sroussi
- Assistance Publique-Hôpitaux de Paris, 75004, Paris, France
| | | | - Eric Verspyck
- Centre Hospitalo-Universitaire de Rouen, 76000, Rouen, France
| | | | - Norbert Winer
- Centre Hospitalo-Universitaire de Nantes, 44000, Nantes, France
| | | | - Thomas Schmitz
- Assistance Publique-Hôpitaux de Paris, 75004, Paris, France
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27
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Klein J, Buffin-Meyer B, Boizard F, Moussaoui N, Lescat O, Breuil B, Fedou C, Feuillet G, Casemayou A, Neau E, Hindryckx A, Decatte L, Levtchenko E, Raaijmakers A, Vayssière C, Goua V, Lucas C, Perrotin F, Cloarec S, Benachi A, Manca-Pellissier MC, Delmas HL, Bessenay L, Le Vaillant C, Allain-Launay E, Gondry J, Boudailliez B, Simon E, Prieur F, Lavocat MP, Saliou AH, De Parscau L, Bidat L, Noel C, Floch C, Bourdat-Michel G, Favre R, Weingertner AS, Oury JF, Baudouin V, Bory JP, Pietrement C, Fiorenza M, Massardier J, Kessler S, Lounis N, Auriol FC, Marcorelles P, Collardeau-Frachon S, Zürbig P, Mischak H, Magalhães P, Batut J, Blader P, Saulnier Blache JS, Bascands JL, Schaefer F, Decramer S, Schanstra JP. Amniotic fluid peptides predict postnatal kidney survival in developmental kidney disease. Kidney Int 2020; 99:737-749. [PMID: 32750455 DOI: 10.1016/j.kint.2020.06.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 12/16/2022]
Abstract
Although a rare disease, bilateral congenital anomalies of the kidney and urinary tract (CAKUT) are the leading cause of end stage kidney disease in children. Ultrasound-based prenatal prediction of postnatal kidney survival in CAKUT pregnancies is far from accurate. To improve prediction, we conducted a prospective multicenter peptidome analysis of amniotic fluid spanning 140 evaluable fetuses with CAKUT. We identified a signature of 98 endogenous amniotic fluid peptides, mainly composed of fragments from extracellular matrix proteins and from the actin binding protein thymosin-β4. The peptide signature predicted postnatal kidney outcome with an area under the curve of 0.96 in the holdout validation set of patients with CAKUT with definite endpoint data. Additionally, this peptide signature was validated in a geographically independent sub-cohort of 12 patients (area under the curve 1.00) and displayed high specificity in non-CAKUT pregnancies (82 and 94% in 22 healthy fetuses and in 47 fetuses with congenital cytomegalovirus infection respectively). Change in amniotic fluid thymosin-β4 abundance was confirmed with ELISA. Knockout of thymosin-β4 in zebrafish altered proximal and distal tubule pronephros growth suggesting a possible role of thymosin β4 in fetal kidney development. Thus, recognition of the 98-peptide signature in amniotic fluid during diagnostic workup of prenatally detected fetuses with CAKUT can provide a long-sought evidence base for accurate management of the CAKUT disorder that is currently unavailable.
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Affiliation(s)
- Julie Klein
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Bénédicte Buffin-Meyer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Franck Boizard
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Nabila Moussaoui
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Ophélie Lescat
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Benjamin Breuil
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Camille Fedou
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Guylène Feuillet
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Audrey Casemayou
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Eric Neau
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - An Hindryckx
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Luc Decatte
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Elena Levtchenko
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Anke Raaijmakers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Christophe Vayssière
- Université Toulouse III Paul-Sabatier, Toulouse, France; Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France; INSERM, UMR1027, Toulouse, France
| | - Valérie Goua
- Prenatal Diagnosis Unit, Poitiers University Hospital, Poitiers, France
| | | | - Franck Perrotin
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, Tours, France; INSERM, U1253, "Imaging and Brain," François-Rabelais University of Tours, Tours, France
| | - Sylvie Cloarec
- Reference Center for Rare Kidney Diseases, Pediatric Nephrology Service, CHRU Clocheville, Tours, France
| | - Alexandra Benachi
- Gynecology-Obstetric Service, AP-HP, Hôpital Antoine Béclère, Université Paris-Sud, Clamart, France
| | - Marie-Christine Manca-Pellissier
- Center for Prenatal Diagnosis, Timone Children's Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, Marseille, France
| | | | - Lucie Bessenay
- Pediatric Service, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Emma Allain-Launay
- Pediatric Nephrology Service, Hôpital Mère-Enfants, CHU Nantes, Nantes, France
| | - Jean Gondry
- Department of Obstetrics and Gynecology, University Hospital of Amiens, Amiens, France; INSERM, U1105, Picardie Jules Verne University, CHU Amiens, Amiens, France
| | | | - Elisabeth Simon
- Prenatal Diagnosis, Fondation Lenval, CHU de Nice, Nice, France
| | - Fabienne Prieur
- Clinical Genetics Service, CHU de Saint-Etienne, Saint-Etienne, France
| | - Marie-Pierre Lavocat
- Department of Pediatrics, Hôpital Nord, CHU de Saint Etienne, Saint Etienne, France
| | - Anne-Hélène Saliou
- Multidisciplinary Center for Prenatal Diagnosis, CHRU de Brest, Brest, France
| | - Loic De Parscau
- Department of Pediatrics and Medical Genetics, CHRU Morvan, Brest, France
| | - Laurent Bidat
- Gynecology-Obstetrics Service, Centre Hospitalier René Dubos, Pontoise, France
| | - Catherine Noel
- Gynecology-Obstetrics Service, Centre Hospitalier René Dubos, Pontoise, France
| | - Corinne Floch
- Pediatric Service, Hôpital Louis Mourier, Colombes, France
| | | | - Romain Favre
- Ultrasound and Foetal Medicine Service of the Department of Gynecology and Obstetrics, Hôpitaux Universitaires de Strasbourg, CMCO, Schiltigheim, France
| | - Anne-Sophie Weingertner
- Ultrasound and Foetal Medicine Service of the Department of Gynecology and Obstetrics, Hôpitaux Universitaires de Strasbourg, CMCO, Schiltigheim, France
| | - Jean-François Oury
- Gynecology-Obstetrics Service, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | - Véronique Baudouin
- Pediatric Nephrology Service, Hôpital Universitaire Robert-Debré, APHP, Paris, France
| | - Jean-Paul Bory
- Service de Gynécologie-Obstétrique, Maternité Alix-de-Champagne, CHU de Reims, Reims, France
| | | | - Maryse Fiorenza
- Gynecology-Obstetrics Service, l'Hôpital Mère Enfant de Limoges, Limoges, France
| | - Jérôme Massardier
- Gynecology-Obstetrics Service, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | | | - Nadia Lounis
- Pediatric Clinical Research Unit, Clinical Research Center Toulouse, Hôpital des Enfants, Toulouse, France
| | - Françoise Conte Auriol
- Pediatric Clinical Research Unit, Clinical Research Center Toulouse, Hôpital des Enfants, Toulouse, France
| | - Pascale Marcorelles
- Department of Pathology, EA 4685, Neuronal Epithelium Interaction Laboratory, Université de Bretagne Occidentale Brest, France
| | - Sophie Collardeau-Frachon
- Department of Pathology, Children and Mother's Hospital, Groupement Hospitalier Est, CHU de Lyon-Bron, France
| | - Petra Zürbig
- Mosaiques Diagnostics and Therapeutics, Hannover, Germany
| | - Harald Mischak
- Mosaiques Diagnostics and Therapeutics, Hannover, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Pedro Magalhães
- Mosaiques Diagnostics and Therapeutics, Hannover, Germany; Department of Pediatric Nephrology, Hannover Medical School, Hannover, Germany
| | - Julie Batut
- Center for Developmental Biology (UMR5547) and Center for Integrative Biology (FR 3743), Université de Toulouse, CNRS, UPS, 31062, Toulouse, France
| | - Patrick Blader
- Center for Developmental Biology (UMR5547) and Center for Integrative Biology (FR 3743), Université de Toulouse, CNRS, UPS, 31062, Toulouse, France
| | - Jean-Sebastien Saulnier Blache
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | | | - Franz Schaefer
- Division of Pediatric Nephrology, Heidelberg University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Stéphane Decramer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France; Pediatric Nephrology Service, Hôpital des Enfants, CHU Toulouse, Toulouse, France; Reference Center for Rare Renal Diseases of the Southwest (SORARE), Toulouse, France.
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France.
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28
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Pinton A, Boubnova J, Becmeur F, Kuhn P, Senat MV, Stirnemann J, Capelle M, Rosenblatt J, Massardier J, Vaast P, Le Bouar G, Desrumaux A, Connant L, Begue L, Parmentier B, Perrotin F, Diguet A, Benoist G, Muszynski C, Scalabre A, Winer N, Michel JL, Casagrandre-Magne F, Jouannic JM, Gallot D, Coste Mazeau P, Sapin E, Maatouk A, Saliou AH, Sentilhes L, Biquard F, Mottet N, Favre R, Benachi A, Sananès N. Is laterality of congenital diaphragmatic hernia a reliable prognostic factor? French national cohort study. Prenat Diagn 2020; 40:949-957. [PMID: 32279384 DOI: 10.1002/pd.5706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/07/2019] [Accepted: 03/21/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The objective of this study was to assess whether the laterality of congenital diaphragmatic hernia (CDH) was a prognostic factor for neonatal survival. METHODS This was a cohort study using the French national database of the Reference Center for Diaphragmatic Hernias. The principal endpoint was survival after hospitalization in intensive care. We made a comparative study between right CDH and left CDH by univariate and multivariate analysis. Terminations and stillbirths were excluded from analyses of neonatal outcomes. RESULTS A total of 506 CDH were included with 67 (13%) right CDH and 439 left CDH (87%). Rate of survival was 49% for right CDH and 74% for left CDH (P < .01). Multivariate analysis showed two factors significantly associated with mortality: thoracic herniation of liver (OR 2.27; IC 95% [1.07-4.76]; P = .03) and lung-to-head-ratio over under expected (OR 2.99; IC 95% [1.41-6.36]; P < .01). Side of CDH was not significantly associated with mortality (OR 1.87; IC 95% [0.61-5.51], P = .26). CONCLUSION Rate of right CDH mortality is more important than left CDH. Nevertheless after adjusting for lung-to-head-ratio and thoracic herniation of liver, right CDH does not have a higher risk of mortality than left CDH.
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Affiliation(s)
- Anne Pinton
- Department of Obstetrics and Gynecology, Hôpital Trousseau, AP-HP, Paris, France.,Sorbonne Université, boulevard de l'Hôpital, Paris, France
| | - Julia Boubnova
- Department of Obstetrics and Gynecology, Maternité de la Conception, Gynepole, Marseille, France
| | - François Becmeur
- Department of Pediatric Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierre Kuhn
- Department of Neonatal Intensive Care Unit, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut des Neurosciences Cellulaires et Intégratives, UPR 3212, CNRS et Université de Strasbourg, Strasbourg, France
| | - Marie-Victoire Senat
- Department of Obstetrics and Gynecology, Maternal-fetal medicine, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Julien Stirnemann
- Department of Obstetrics and Gynecology, Maternal-fetal medicine, Hôpital Necker-Enfants malades, AP-HP, Paris, France.,EHU7328, Université de Paris and Institut IMAGINE, Paris, France
| | - Marianne Capelle
- Department of Obstetrics and Gynecology, Maternité de la Conception, Gynepole, Marseille, France
| | - Jonathan Rosenblatt
- Department of Obstetrics and Gynecology, Maternal-fetal medicine, Hôpital Universitaire Robert-Debré, AP-HP, Paris, France
| | - Jérôme Massardier
- Department of Obstetrics and Gynecology, Maternal-fetal medicine, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, University Claude Bernard, Lyon, France
| | - Pascal Vaast
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Lille, Lille, France
| | - Gwenaelle Le Bouar
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Rennes, University of Rennes 1, Rennes, France
| | - Amélie Desrumaux
- Department of Pediatrics, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France
| | - Laure Connant
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Laetitia Begue
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
| | - Benoit Parmentier
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Poitiers, Poitiers, France
| | - Franck Perrotin
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Tours, François Rabelais University, Tours, France
| | - Alain Diguet
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Rouen, Rouen, France
| | - Guillaume Benoist
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Caen, Normandie University, Caen, France
| | - Charles Muszynski
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire d'Amiens, Amiens, France
| | - Aurélien Scalabre
- Department of Pediatric Surgery, Centre Hospitalo-Universitaire de Saint Etienne, Saint-Etienne, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Nantes, Nantes, France.,NUN, INRAE, UMR 1280, PhAN, Université de Nantes, CIC Femme enfant adolescent, Nantes, France
| | - Jean-Luc Michel
- Department of Pediatric Surgery, Centre Hospitalo-Universitaire de Félix Guyon, Bellepierre Saint-Denis, Saint-Denis, France
| | | | - Jean-Marie Jouannic
- Department of Obstetrics and Gynecology, Fetal Medicine Department, Hôpital Trousseau AP-HP, Paris, France.,Sorbonne université, boulevard de l'Hôpital, Paris, France
| | - Denis Gallot
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire Estaing, Pole FEE, Clermont-Ferrand, France
| | - Perrine Coste Mazeau
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Limoges, Limoges, France
| | - Emmanuel Sapin
- Department of Pediatric Surgery, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, Dijon, France
| | - Alexis Maatouk
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Nancy, Nancy, France
| | - Anne-Hélène Saliou
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Brest, Hôpital Morvan, Brest, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Florence Biquard
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire d'Angers, Angers, France
| | - Nicolas Mottet
- Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Besançon, Université de Franche-Comté, Besançon, France
| | - Romain Favre
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology and Reproductive Medicine, AP-HP, Antoine Béclère Hospital, University Paris Saclay, Clamart, France
| | - Nicolas Sananès
- Department of Obstetrics and Gynecology, Hôpitaux universitaires de Strasbourg, Strasbourg, France.,INSERM UMR-S 1121 "Biomatériaux et bioingénierie", Université de Strasbourg, Strasbourg, France
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Diguisto C, Arthuis C, Couderchet J, Morgan AS, Perrotin F, Rivière O, Vendittelli F. Impact of antenatal corticosteroids on head circumference of full-term newborns: A French multicenter cohort study. Acta Obstet Gynecol Scand 2020; 99:1147-1154. [PMID: 32162298 DOI: 10.1111/aogs.13839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/27/2020] [Accepted: 03/05/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Our main objective was to evaluate whether antenatal corticosteroids increase the risk of small head circumference in children born at term. Secondary objectives were to evaluate whether they increase the risk of small birthweight and birth length among those children. MATERIAL AND METHODS A historical cohort included 275 270 live term born children between 2000 and 2013 in 175 French maternity units. The rate of head circumference below the 5th percentile among children born at term and exposed to antenatal corticosteroids was compared with that of two unexposed groups: those children born at term whose mothers had an episode of threatened preterm labor without corticosteroids and those whose mothers had neither threatened preterm labor nor corticosteroids. The association between this treatment and head circumference was evaluated by calculating adjusted risk ratios (aRRs) and their 95% confidence intervals (CIs). The main outcome measure was a head circumference below the 5th percentile at birth, adjusted for sex, and gestational age according to the Pediatric, Obstetrics, and Gynecology Electronic Records Users Association (AUDIPOG) curves. Secondary outcomes were birthweight and birth length below the 5th percentile. RESULTS The rate of head circumference below the 5th percentile was 5.8% (n = 3388) among children exposed to antenatal corticosteroids and 4.3% (n = 7077) and 4.6% (n = 198 462), respectively, for the two unexposed groups. After adjustment, the risk of having a head circumference below the 5th percentile did not differ between the exposed group and the two control groups (aRR 1.28, 95% confidence interval [CI] 0.97-1.69] and aRR 0.91, 95% CI 0.74-1.13). We did not find an association between antenatal corticosteroids and the rate of birthweight below the 5th percentile. Children exposed to antenatal corticosteroids had a higher risk of a birth length below the 5th percentile when compared with those not exposed to threatened preterm labor or corticosteroids. CONCLUSIONS We found no association between antenatal corticosteroids and increased risk of head circumference below the 5th percentile in children born at term.
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Affiliation(s)
- Caroline Diguisto
- Department of Obstetrics and Gynecology, Regional University Hospital of Tours, Tours, France.,François Rabelais University, Tours, France.,Université de Paris, CRESS, INSERM, INRA, Paris, France
| | - Chloé Arthuis
- Department of Obstetrics and Gynecology, University Hospital of Nantes, Nantes, France
| | - Judith Couderchet
- Department of Obstetrics and Gynecology, Regional University Hospital of Tours, Tours, France.,François Rabelais University, Tours, France
| | - Andrei S Morgan
- Université de Paris, CRESS, INSERM, INRA, Paris, France.,Elizabeth Garret Anderson Institute for Womens' Health, University College London, London, UK.,SAMU 93 - SMUR Pédiatrique, CHI André Gregoire Hospital, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, Assistance Publique des Hôpitaux de Paris, Montreuil, France
| | - Franck Perrotin
- Department of Obstetrics and Gynecology, Regional University Hospital of Tours, Tours, France.,François Rabelais University, Tours, France
| | - Olivier Rivière
- Claude Bernard Lyon 1 University-Laennec, Audipog, Lyon, France
| | - Françoise Vendittelli
- Claude Bernard Lyon 1 University-Laennec, Audipog, Lyon, France.,Clermont Auvergne University, CHU Clermont-Ferrand Hospital, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
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30
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Arthuis C, Diguisto C, Lorphelin H, Dochez V, Simon E, Perrotin F, Winer N. Perinatal outcomes of intrahepatic cholestasis during pregnancy: An 8-year case-control study. PLoS One 2020; 15:e0228213. [PMID: 32074108 PMCID: PMC7029845 DOI: 10.1371/journal.pone.0228213] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/10/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Previous studies of fetal effects have suggested that intrahepatic cholestasis of pregnancy is associated with a higher rate of adverse neonatal outcomes including preterm birth, neonatal respiratory distress syndrome, meconium-stained amniotic fluid, neonatal intensive care unit admission, and stillbirth. The objective was to compare the neonatal and maternal consequences in pregnancies affected by intrahepatic cholestasis and normal pregnancies. MATERIAL AND METHODS This case-control study compares pregnancies affected by intrahepatic cholestasis (pruritus and bile acid ≥ 10 μmol/L) with low-risk pregnancies managed between December 2006 and December 2014 at a French university hospital center. RESULTS There were 83 (59.3%) cases of mild cholestasis (10≤ BA ≤39 μmol/L), 46 (32.8%) of moderate cholestasis (40≤ BA ≤99 μmol/L), and 11 (7.9%) of severe cholestasis (BA ≥100 μmol/L). No in utero fetal deaths occurred in the 140 women with cholestasis or the 560 controls analyzed. The rate of respiratory distress syndrome was higher in neonates of women with intrahepatic cholestasis (17.1% vs. 4.6%, P<0.001; crude OR 4.46 (CI95% 2.49-8.03)). This risk was also significant after adjustment for gestational age at birth and mode of delivery, adjusted OR 2.56 (CI95%1.26-5.18). The postpartum hemorrhage rate was twice as high among the case mothers (25% versus 14.1% for controls, P = 0.002). CONCLUSION After adjustment on the confounding factors we found a higher rate of respiratory distress syndrome and neonatal morbidity among neonates of the cholestasis group.
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Affiliation(s)
- Chloé Arthuis
- Department of Gynecology and Obstetrics, University Hospital Regional Center Tours, Tours, France
- Department of Gynecology and Obstetrics, University Hospital Center Nantes, Nantes, France
- * E-mail:
| | - Caroline Diguisto
- Department of Gynecology and Obstetrics, University Hospital Regional Center Tours, Tours, France
| | - Henri Lorphelin
- Department of Gynecology and Obstetrics, University Hospital Regional Center Tours, Tours, France
| | - Vincent Dochez
- Department of Gynecology and Obstetrics, University Hospital Center Nantes, Nantes, France
| | - Emmanuel Simon
- Department of Gynecology and Obstetrics, University Hospital Regional Center Tours, Tours, France
| | - Franck Perrotin
- Department of Gynecology and Obstetrics, University Hospital Regional Center Tours, Tours, France
| | - Norbert Winer
- Department of Gynecology and Obstetrics, University Hospital Center Nantes, Nantes, France
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31
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Thoreau B, Bayer G, Barbet C, Cloarec S, Meriau E, Lachot S, Garot D, Bernard L, Gyan E, Perrotin F, Pouplard C, Maillot F, Gatault P, Sautenet B, Rusch E, Buchler M, Fremeaux-Bacchi V, Vigneau C, Fakhouri F, Halimi J. Microangiopathies thrombotiques (MAT) associées aux infections : particularités et pronostic. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Luton D, Mitanchez D, Winer N, Muller F, Gallot D, Perrotin F, Jouannic JM, Bretelle F, de Lagausie P, Ville Y, Guibourdenche J, Oury JF, Alberti C, Benachi A. A randomised controlled trial of amnioexchange for fetal gastroschisis. BJOG 2019; 126:1233-1241. [PMID: 31033140 DOI: 10.1111/1471-0528.15804] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Morbidity in fetuses affected by gastroschisis is mainly the result of bowel ischaemic and inflammatory processes. Experimental studies on animal models show that clearing amniotic fluid from the digestive secretions by amnioexchange procedures reduces the inflammatory process. We evaluated the benefit of the amnioexchange procedure for fetal gastroschisis in humans. DESIGN Prospective, interventional, randomised study. SETTING Eight referral centres for fetal medicine. POPULATION Pregnant women carrying a fetus with gastroschisis. METHODS We compared, in utero, amnioexchange with a sham procedure. The protocol included, in both arms, steroid injections at 30 weeks of gestation and the use of postnatal minimal enteral feeding. MAIN OUTCOME MEASURES The primary outcome was a composite variable based on the duration of ventilation and parenteral nutrition. Secondary outcomes were the effectiveness and safety of the amnioexchange procedure, including the rate of perinatal death, time to full enteral feeding, primary closure, and late feeding disorders. RESULTS Sixty-four patients were randomised. There was no difference in the composite criteria between the amnioexchange and control groups. Based on an intention-to-treat analysis, there were no significant between-group differences in pregnancy outcome or complications. When studying the relationship between digestive compounds and amniotic fluid inflammatory markers, a clear correlation was found between bile acid and both ferritin and interleukin 1β (IL1β). CONCLUSIONS In humans, amnioexchange, as described in our protocol, is not an option for fetal care; however, we provide supplementary proof of the involvement of inflammation in the pathogenicity of gastroschisis and suggest that future research should aim at reducing inflammation. ClinicalTrials.gov: NCT00127946. TWEETABLE ABSTRACT A prospective, interventional, randomised study shows no benefit of amnioexchange for fetal gastroschisis in humans.
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Affiliation(s)
- D Luton
- Department of Obstetrics and Gynaecology, AP-HP, Bichat Hospital, Paris, France.,DHU Risks in Pregnancy, Paris, France.,Department of Obstetrics and Gynaecology, AP-HP, Bichat-Claude Bernard Hospital, Paris, France.,Université Paris VII, Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1141, Robert-Debré Hospital, Paris, France
| | - D Mitanchez
- Department of Neonatal Pediatrics, AP-HP, GHUEP, Armand Trousseau Hospital, Paris, France.,Faculty of Medicine, Sorbonne University, Paris, France
| | - N Winer
- Department of Obstetrics and Gynaecology, University Hospital of Nantes, CIC Mère enfant Nantes, UMR 1280 INRA Physiologie des Adaptations Nutritionnelles, Nantes, France
| | - F Muller
- INSERM U1141, Robert-Debré Hospital, Paris, France.,Department of Biochemistry and Hormonology, AP-HP, Robert Debré Hospital, Paris, France
| | - D Gallot
- Department of Obstetrics and Gynaecology, CHU de Clermont-Ferrand - Hôpital d'Estaing, Auvergne University, Clermont-Ferrand, France
| | - F Perrotin
- Department of Obstetrics and Gynaecology, CHRU de Tours, François Rabelais University, Tours, France
| | - J-M Jouannic
- Department of Obstetrics and Gynaecology, Faculty of Medicine, AP-HP, Armand Trousseau Hospital, Sorbonne University, Paris, France
| | - F Bretelle
- Department of Obstetrics and Gynaecology, CHU de Marseille, APHM, Aix Marseille University, Marseille, France
| | - P de Lagausie
- INSERM U1141, Robert-Debré Hospital, Paris, France.,Department of Paediatrics Surgery, AP-HP, Robert Debré Hospital, Paris, France
| | - Y Ville
- Department of Obstetrics and Gynaecology, AP-HP, Necker-Enfants Malades, Paris Descartes University, Paris, France
| | - J Guibourdenche
- Department of Biochemistry and Hormonology, AP-HP, Robert Debré Hospital, Paris, France
| | - J-F Oury
- Department of Obstetrics and Gynaecology, AP-HP, Robert Debré Hospital, Paris, France
| | - C Alberti
- INSERM U1141, Robert-Debré Hospital, Paris, France.,AP-HP, Inserm, Univ. Paris Diderot, Univ. Sorbonne Paris Cité, Robert Debré Hospital, CIC 1426, UMR-S 1123, Paris, France
| | - A Benachi
- Department of Obstetrics and Gynaecology, AP-HP, Antoine Béclère Hospital, Paris-Sud University, Clamart, France
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Cabridain C, Aubert H, Kaeffer B, Badon V, Boivin M, Dochez V, Winer N, Faurel-Paul E, Planche L, Riochet D, Maruani A, Perrotin F, Droitcourt C, Lassel L, Tching-Sin M, Rogers NK, Bodinier M, Barbarot S. Effectiveness of an antenatal maternal supplementation with prebiotics for preventing atopic dermatitis in high-risk children (the PREGRALL study): protocol for a randomised controlled trial. BMJ Open 2019; 9:e024974. [PMID: 31005913 PMCID: PMC6500253 DOI: 10.1136/bmjopen-2018-024974] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a chronic inflammatory disease affecting 10%-15% of children in Europe. There is a need for new primary preventive therapeutic strategies in at-risk populations. Recent research has indicated that atopic diseases are associated with a disrupted gut microbial 'balance' in early life raising the possibility that interventions which yield optimal patterns of microflora could improve host's health. Prebiotics, sugars with immunomodulatory properties that stimulate the diversity of the digestive microbiota, are ideal candidates for such research. So far, most clinical trials have focused on improving infant gut colonisation postnatally. However, prenatal life is a crucial period during which different tolerance mechanisms are put in place. We aim to determine whether antenatal prebiotics supplementation prevents AD in high-risk children. METHODS AND ANALYSIS This is a randomised, multicentre, double-blind, trial to evaluate the effectiveness of antenatal prebiotic maternal supplementation (galacto-oligosaccharide/inulin) in pregnant women versus placebo on the occurrence of AD at 1 year of age in at-risk children (defined as having a maternal history of atopic disease). Participating women will be randomised to daily ingestion of a prebiotics or placebo (maltodextrin) from 20 weeks' gestation until delivery. The primary outcome is the prevalence of AD at 1 year of age, using the version of the UK Working Party Diagnostic Criteria optimised for preventive studies. Key secondary endpoints are AD severity, quality of life and prebiotics tolerance. The target sample size is 376 women (188 patients per group) which will provide 80% power to detect a 33% reduction of the risk of AD in the verum group (α=0.05). The primary analysis will be based on the intention-to-treat principle. ETHICS AND DISSEMINATION Results will be presented in peer-reviewed journals and at international conferences. Ethics approval for the study was obtained from the institutional ethical review board of 'Comité de Protection des Personnes Sud Ouest-Outre-Mer III' of the University Hospital Centre of Bordeaux (2017/13). TRIAL REGISTRATION NUMBER NCT03183440; Pre-results.
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Affiliation(s)
| | - Hélène Aubert
- Department of Dermatology, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | - Bertrand Kaeffer
- UMR PhAN, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | - Virginie Badon
- CIC FEA, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | - Marion Boivin
- CIC FEA, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | - Vincent Dochez
- CIC FEA, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
- Obstetrics and Gynecology Department, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | - Norbert Winer
- CIC FEA, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
- Obstetrics and Gynecology Department, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | - Elodie Faurel-Paul
- Department of Clinical Research, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | - Lucie Planche
- Platform Methodology and Biostatistics, Centre Hospitalier Departemental Vendee, La Roche-sur-Yon, Pays de la Loire, France
| | - David Riochet
- HUGOPEREN, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | - Annabel Maruani
- Department of Dermatology, Centre Hospitalier Regional Universitaire de Tours, Tours, Centre, France
- Clinical Investigation Center-INSERM 1415, Centre Hospitalier Regional Universitaire de Tours, Tours, Centre, France
| | - Franck Perrotin
- Department of Obstetrics, Gynecology and Fetal Medicine, Centre Hospitalier Regional Universitaire de Tours, Tours, France
- Maternité Olympe de Gouges, Hopital Bretonneau, Tours, Centre, France
| | - Catherine Droitcourt
- Department of Dermatology, Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France
- EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Universite de Rennes 1, Rennes, Bretagne, France
| | - Linda Lassel
- Obstetrics and Gynecology Department, Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France
| | - Martine Tching-Sin
- Department of Pharmacy, Centre Hospitalier Universitaire de Nantes, Nantes, UK
| | - Natasha K Rogers
- Centre of Evidence Based Dermatology, University of Nottingham School of Medicine, Nottingham, UK
| | - Marie Bodinier
- BIA UR1268, INRA Centre Angers-Nantes, Nantes, Pays de la Loire, France
| | - Sebastien Barbarot
- Department of Dermatology, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
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Bayer G, von Tokarski F, Thoreau B, Bauvois A, Barbet C, Cloarec S, Mérieau E, Lachot S, Garot D, Bernard L, Gyan E, Perrotin F, Pouplard C, Maillot F, Gatault P, Sautenet B, Rusch E, Buchler M, Vigneau C, Fakhouri F, Halimi JM. Etiology and Outcomes of Thrombotic Microangiopathies. Clin J Am Soc Nephrol 2019; 14:557-566. [PMID: 30862697 PMCID: PMC6450353 DOI: 10.2215/cjn.11470918] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 02/04/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Thrombotic microangiopathies constitute a diagnostic and therapeutic challenge. Secondary thrombotic microangiopathies are less characterized than primary thrombotic microangiopathies (thrombotic thrombocytopenic purpura and atypical hemolytic and uremic syndrome). The relative frequencies and outcomes of secondary and primary thrombotic microangiopathies are unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a retrospective study in a four-hospital institution in 564 consecutive patients with adjudicated thrombotic microangiopathies during the 2009-2016 period. We estimated the incidence of primary and secondary thrombotic microangiopathies, thrombotic microangiopathy causes, and major outcomes during hospitalization (death, dialysis, major cardiovascular events [acute coronary syndrome and/or acute heart failure], and neurologic complications [stroke, cognitive impairment, or epilepsy]). RESULTS We identified primary thrombotic microangiopathies in 33 of 564 patients (6%; thrombotic thrombocytopenic purpura: 18 of 564 [3%]; atypical hemolytic and uremic syndrome: 18 of 564 [3%]). Secondary thrombotic microangiopathies were found in 531 of 564 patients (94%). A cause was identified in 500 of 564 (94%): pregnancy (35%; 11 of 1000 pregnancies), malignancies (19%), infections (33%), drugs (26%), transplantations (17%), autoimmune diseases (9%), shiga toxin due to Escherichia coli (6%), and malignant hypertension (4%). In the 31 of 531 patients (6%) with other secondary thrombotic microangiopathies, 23% of patients had sickle cell disease, 10% had glucose-6-phosphate dehydrogenase deficiency, and 44% had folate deficiency. Multiple causes of thrombotic microangiopathies were more frequent in secondary than primary thrombotic microangiopathies (57% versus 19%; P<0.001), and they were mostly infections, drugs, transplantation, and malignancies. Significant differences in clinical and biologic differences were observed among thrombotic microangiopathy causes. During the hospitalization, 84 of 564 patients (15%) were treated with dialysis, 64 of 564 patients (11%) experienced major cardiovascular events, and 25 of 564 patients (4%) had neurologic complications; 58 of 564 patients (10%) died, but the rates of complications and death varied widely by the cause of thrombotic microangiopathies. CONCLUSIONS Secondary thrombotic microangiopathies represent the majority of thrombotic microangiopathies. Multiple thrombotic microangiopathies causes are present in one half of secondary thrombotic microangiopathies. The risks of dialysis, neurologic and cardiac complications, and death vary by the cause of thrombotic microangiopathies.
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Affiliation(s)
- Guillaume Bayer
- Service de Néphrologie-hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau et hôpital Clocheville
| | - Florent von Tokarski
- Service de Néphrologie-hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau et hôpital Clocheville
| | - Benjamin Thoreau
- Service de Néphrologie-hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau et hôpital Clocheville
| | - Adeline Bauvois
- Service de Néphrologie-hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau et hôpital Clocheville
| | - Christelle Barbet
- Service de Néphrologie-hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau et hôpital Clocheville
| | - Sylvie Cloarec
- Service de Néphrologie-hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau et hôpital Clocheville
| | - Elodie Mérieau
- Service de Néphrologie-hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau et hôpital Clocheville
| | | | - Denis Garot
- Service de Médecine Intensive Réanimation, Hôpital Bretonneau
| | - Louis Bernard
- Service de Maladies Infectieuses, Hôpital Bretonneau
| | - Emmanuel Gyan
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Bretonneau.,Équipe de Recherche Labellisée Centre National de la Recherche Scientifique 7001, Université de Tours, Tours, France
| | | | - Claire Pouplard
- Laboratoire d'Hématologie-Hémostase, Hôpital Trousseau.,Équipe d'accueil7501 and
| | | | - Philippe Gatault
- Service de Néphrologie-hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau et hôpital Clocheville.,Équipe d'accueil4245, François Rabelais University, Tours, France
| | - Bénédicte Sautenet
- Service de Néphrologie-hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau et hôpital Clocheville.,Institut National de la Santé et de la Recherche Médicale U1246, Hôpital Bretonneau, and
| | - Emmanuel Rusch
- Laboratoire de Santé Publique, Hôpital Bretonneau, Centre Hospitalier Universitaire Tours, Tours, France
| | - Matthias Buchler
- Service de Néphrologie-hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau et hôpital Clocheville.,Équipe d'accueil4245, François Rabelais University, Tours, France
| | - Cécile Vigneau
- Centre Hospitalier Universitaire Pontchaillou, Service de Néphrologie, Rennes, France.,Université Rennes 1, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1085, Rennes, France; and
| | - Fadi Fakhouri
- Centre de recherche en Transplantation et immunologie, Unité Mixte de Recherche 1064, Institut National de la Santé et de la Recherche Médicale, Université de Nantes et département de Néphrologie et Immunologie, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Jean-Michel Halimi
- Service de Néphrologie-hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau et hôpital Clocheville, .,Équipe d'accueil4245, François Rabelais University, Tours, France
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Diguisto C, Foix L'Helias L, Morgan AS, Ancel PY, Kayem G, Kaminski M, Perrotin F, Khoshnood B, Goffinet F. Neonatal Outcomes in Extremely Preterm Newborns Admitted to Intensive Care after No Active Antenatal Management: A Population-Based Cohort Study. J Pediatr 2018; 203:150-155. [PMID: 30270165 DOI: 10.1016/j.jpeds.2018.07.072] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/06/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the association between active antenatal management and neonatal outcomes in extremely preterm newborns admitted to a neonatal intensive care unit (NICU). STUDY DESIGN This population-based cohort study was conducted in 25 regions of France. Infants born in 2011 between 220/7 and 266/7 weeks of gestation and admitted to a NICU were included. Infants with lethal congenital malformations or death in the delivery room were excluded. A multilevel multivariable analysis was performed, accounting for clustering by mother (multiple pregnancies) and hospital plus individual characteristics, to estimate the association between the main exposure of no active antenatal management (not receiving antenatal corticosteroids, magnesium sulfate, or cesarean delivery for fetal indications) and a composite outcome of death or severe neonatal morbidity (including severe forms of brain or lung injury, retinopathy of prematurity, and necrotizing enterocolitis). RESULTS Among 3046 extremely preterm births, 783 infants were admitted to a NICU. Of these, 138 (18%) did not receive active antenatal management. The risk of death or severe morbidity was significantly higher for infants without active antenatal management (crude OR, 2.60; 95% CI, 1.44-4.66). This finding persisted after adjustment for gestational age (OR, 2.08; 95% CI, 1.19-3.62) and all confounding factors (OR, 1.86; 95% CI, 1.09-3.20). CONCLUSIONS The increased risk of severe neonatal outcomes for extremely preterm babies admitted to a NICU without optimal antenatal management should be considered in individual-level decision making and in the development of professional guidelines for the management of extremely preterm births.
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Affiliation(s)
- Caroline Diguisto
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Maternité Olympe de Gouges, Regional Univeristy Hospital, François Rabelais University, Tours, France.
| | - Laurence Foix L'Helias
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Service de Néonatologie Hopital Armand Trousseau, APHP, Pierre et Marie Curie University, Paris, France
| | - Andrei S Morgan
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Institute for Women's Health, University College London, London, United Kingdom
| | - Pierre-Yves Ancel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; URC CIC P1419, DHU Risk in Pregnancy, Cochin Hotel Dieu Hopital APHP, Paris, France
| | - Gilles Kayem
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Service de Gynécologie Obstétrique, Trousseau, APHP, Pierre et Marie Curie University, Paris, France
| | - Monique Kaminski
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Franck Perrotin
- Maternité Olympe de Gouges, Regional Univeristy Hospital, François Rabelais University, Tours, France
| | - Babak Khoshnood
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Francois Goffinet
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Maternity Unit of Port Royal, Paris Descartes University, Cochin Broca Hotel Dieu Hospitals, DHU Risk in Pregnancy, Cochin Hotel Dieu University Hospital, Assistance Publique des Hopitaux de Paris, Paris, France
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Sentilhes L, Winer N, Azria E, Sénat MV, Le Ray C, Vardon D, Perrotin F, Desbrière R, Fuchs F, Kayem G, Ducarme G, Doret-Dion M, Huissoud C, Bohec C, Deruelle P, Darsonval A, Chrétien JM, Seco A, Daniel V, Deneux-Tharaux C. Tranexamic Acid for the Prevention of Blood Loss after Vaginal Delivery. N Engl J Med 2018; 379:731-742. [PMID: 30134136 DOI: 10.1056/nejmoa1800942] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The use of tranexamic acid reduces mortality due to postpartum hemorrhage. We investigated whether the prophylactic administration of tranexamic acid in addition to prophylactic oxytocin in women with vaginal delivery would decrease the incidence of postpartum hemorrhage. METHODS In a multicenter, double-blind, randomized, controlled trial, we randomly assigned women in labor who had a planned vaginal delivery of a singleton live fetus at 35 or more weeks of gestation to receive 1 g of tranexamic acid or placebo, administered intravenously, in addition to prophylactic oxytocin after delivery. The primary outcome was postpartum hemorrhage, defined as blood loss of at least 500 ml, measured with a collector bag. RESULTS Of the 4079 women who underwent randomization, 3891 had a vaginal delivery. The primary outcome occurred in 156 of 1921 women (8.1%) in the tranexamic acid group and in 188 of 1918 (9.8%) in the placebo group (relative risk, 0.83; 95% confidence interval [CI], 0.68 to 1.01; P=0.07). Women in the tranexamic acid group had a lower rate of provider-assessed clinically significant postpartum hemorrhage than those in the placebo group (7.8% vs. 10.4%; relative risk, 0.74; 95% CI, 0.61 to 0.91; P=0.004; P=0.04 after adjustment for multiple comparisons post hoc) and also received additional uterotonic agents less often (7.2% vs. 9.7%; relative risk, 0.75; 95% CI, 0.61 to 0.92; P=0.006; adjusted P=0.04). Other secondary outcomes did not differ significantly between the two groups. The incidence of thromboembolic events in the 3 months after delivery did not differ significantly between the tranexamic acid group and the placebo group (0.1% and 0.2%, respectively; relative risk, 0.25; 95% CI, 0.03 to 2.24). CONCLUSIONS Among women with vaginal delivery who received prophylactic oxytocin, the use of tranexamic acid did not result in a rate of postpartum hemorrhage of at least 500 ml that was significantly lower than the rate with placebo. (Funded by the French Ministry of Health; TRAAP ClinicalTrials.gov number, NCT02302456 .).
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Affiliation(s)
- Loïc Sentilhes
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Norbert Winer
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Elie Azria
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Marie-Victoire Sénat
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Camille Le Ray
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Delphine Vardon
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Franck Perrotin
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Raoul Desbrière
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Florent Fuchs
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Gilles Kayem
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Guillaume Ducarme
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Muriel Doret-Dion
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Cyril Huissoud
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Caroline Bohec
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Philippe Deruelle
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Astrid Darsonval
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Jean-Marie Chrétien
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Aurélien Seco
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Valérie Daniel
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
| | - Catherine Deneux-Tharaux
- From the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux (L.S.), the Departments of Obstetrics and Gynecology (L.S.), Pharmacy (A.D., V.D.), and Clinical Research (J.-M.C.), Angers University Hospital, Angers, the Department of Obstetrics and Gynecology, University Medical Center of Nantes and the Centre d'Investigation Clinique Mère Enfant, University Hospital, the National Institute of Agricultural Research, Physiology of Nutritional Adaptations, University of Nantes, the Institute of Digestive Disease and Centre de Recherche en Nutrition Humaine Ouest, Nantes (N.W.), the Maternity Unit, Paris Saint Joseph Hospital (E.A.), INSERM Unité 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, the Center for Epidemiology and Statistics, Sorbonne Paris Cité, University Hospital Department of Risks in Pregnancy (E.A., C.L.R., G.K., A.S., C.D.-T.), the Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Department of Risks in Pregnancy (C.L.R.), Paris Descartes University, the Department of Obstetrics and Gynecology, Bicêtre University Hospital, AP-HP (M.-V.S.), and the Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP (G.K.), Paris, the Department of Obstetrics and Gynecology, Caen University Hospital, Caen (D.V.), the Department of Obstetrics and Gynecology, Tours University Hospital, Tours (F.P.), the Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille (R.D.), the Department of Obstetrics and Gynecology, Montpellier University Hospital, Montpellier (F.F.), the Center for Research in Epidemiology and Population Health, INSERM Unité 1018, Reproduction and Child Development, Villejuif (F.F.), the Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon (G.D.), the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Department of Obstetrics and Gynecology, University Lyon 1 (M.D.-D.), and the Department of Obstetrics and Gynecology, Croix Rousse University Hospital (C.H.), Lyon, the Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau (C.B.), the Department of Obstetrics and Gynecology, Jeanne de Flandre University Hospital, Lille (P.D.), and the Production Pharmaceutique pour la Recherche Institutionnelle du Grand Ouest, Brest University Hospital, Brest (A.D., V.D.) - all in France
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Binet A, Serriere S, Morel B, Blechet C, Tranquart F, Perrotin F. Intrauterine growth restriction model by hyperthermia: quantitative analysis using Doppler and contrast-enhanced ultrasound imaging. CLIN EXP OBSTET GYN 2018. [DOI: 10.12891/ceog4271.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Diguisto C, Winer N, Benoist G, Laurichesse-Delmas H, Potin J, Binet A, Lardy H, Morel B, Perrotin F. In-utero aspiration vs expectant management of anechoic fetal ovarian cysts: open randomized controlled trial. Ultrasound Obstet Gynecol 2018; 52:159-164. [PMID: 29205608 DOI: 10.1002/uog.18973] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/22/2017] [Accepted: 11/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of in-utero aspiration (IUA) of anechoic fetal ovarian cysts. METHODS This multicenter, prospective, randomized open trial in two parallel groups included women from nine outpatient fetal medicine departments with singleton pregnancy ≥ 28 weeks of gestation and a female fetus with an ultrasound-diagnosed simple ovarian cyst, defined as a single fully anechoic cystic structure measuring ≥ 30 mm. They were allocated randomly to IUA under ultrasound guidance or expectant management. All procedures were performed by trained senior obstetricians. Primary outcome was need for neonatal intervention, by laparoscopy, laparotomy or transabdominal aspiration. Secondary outcomes were in-utero involution of the cyst and oophorectomy at birth. Analyses were conducted according to the intention-to-treat principle. RESULTS Of 61 participants, 34 were allocated to IUA and 27 to expectant management. Three IUA procedures (9%) could not be performed (one due to fetal position and two due to aspirations being dry). The remaining 31 IUA procedures were uneventful. The incidence of neonatal intervention did not differ significantly between the IUA and the expectant management groups (20.6% vs 37.0%; relative risk (RR), 0.55; 95% CI, 0.24-1.27). Nonetheless, IUA was associated with increased incidence of in-utero involution of the cyst (47.1% vs 18.5%; RR, 2.54; 95% CI, 1.07-6.05) and reduced rate of oophorectomy (3.0% vs 22.0%; RR, 0.13; 95% CI, 0.02-1.03) compared with expectant management. CONCLUSION IUA of anechoic fetal ovarian cysts, compared with expectant management, was not associated with a reduction in overall neonatal interventions but was associated with a reduced oophorectomy rate. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Diguisto
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, Tours, France
- Université François-Rabelais de Tours, Tours, France
| | - N Winer
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Nantes, CIC Mère-Enfant, Nantes, France
| | - G Benoist
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Caen, Caen, France
| | - H Laurichesse-Delmas
- CHU Clermont-Ferrand, Department of Obstetrics, Gynecology and Fetal Medicine, Estaing Hospital, Clermont-Ferrand, France
| | - J Potin
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, Tours, France
- Université François-Rabelais de Tours, Tours, France
| | - A Binet
- Université François-Rabelais de Tours, Tours, France
- Pediatric Surgery Department, University Hospital of Tours, Tours, France
| | - H Lardy
- Université François-Rabelais de Tours, Tours, France
- Pediatric Surgery Department, University Hospital of Tours, Tours, France
| | - B Morel
- Université François-Rabelais de Tours, Tours, France
- Pediatric Radiology Department, University Hospital of Tours, Tours, France
| | - F Perrotin
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, Tours, France
- Université François-Rabelais de Tours, Tours, France
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Arthuis CJ, Mendes V, Même S, Même W, Rousselot C, Winer N, Novell A, Perrotin F. Comparative determination of placental perfusion by magnetic resonance imaging and contrast-enhanced ultrasound in a murine model of intrauterine growth restriction. Placenta 2018; 69:74-81. [PMID: 30213488 DOI: 10.1016/j.placenta.2018.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Exploration of placental perfusion is essential in screening for dysfunctions impairing fetal growth. The objective of this study was to assess the potential value of contrast-enhanced ultrasonography (CEUS) and magnetic resonance imaging (MRI) for examining placental perfusion in a murine model of intrauterine growth restriction (IUGR). We also studied the reproducibility of perfusion quantification by CEUS. METHODS Pregnant Sprague Dawley rat models of IUGR were studied during the third trimester. Unilateral uterine artery ligation induced IUGR. Placental perfusion was evaluated by CEUS and perfusion MRI with gadolinium for both ligated and control fetoplacental units. The kinetic parameters of the two imaging modalities were then compared. RESULTS The analysis included 20 rats. The study showed good reproducibility of the CEUS indicators. The CEUS perfusion index approximated the blood flow rate and was halved in the ligation group (27.9 [u.a] (±14.8)) versus 61 [u.a] (±22.3) on the control side (P = 0.0003). MRI with gadolinium injection showed a clear reduction in the blood flow rate to 51.2 mL/min/100 mL (IQR 34.9-54.9) in the ligated horn, compared with 90.9 mL/min/100 mL (IQR 85.1-95.7) for the control side (P < 0.0001). The semiquantitative indicators obtained from the kinetic curves for both CEUS and MRI showed similar trends. Nonetheless, values were more widely dispersed with CEUS than MRI. DISCUSSION The similar results for the quantification of placental perfusion by MRI and CEUS reinforce the likelihood that CEUS can be used to identify IUGR in a murine model induced by uterine vessel ligation.
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Affiliation(s)
- C-J Arthuis
- UMR Inserm U930, University of Tours, 10 bd ter Tonnellé, 37032, Tours Cedex 1, France; Department of Obstetrics and Gynecology, University Hospital Regional Center Tours, 10bd Tonnellé, 37044, Tours, France; Department of Obstetrics and Gynecology, University Hospital of Nantes, CIC Mère Enfant Nantes, UMR 1280, INRA Phan Physiologie des Adaptations Nutritionnelles, France.
| | - V Mendes
- UMR Inserm U930, University of Tours, 10 bd ter Tonnellé, 37032, Tours Cedex 1, France; Department of Obstetrics and Gynecology, University Hospital Regional Center Tours, 10bd Tonnellé, 37044, Tours, France
| | - S Même
- CNRS, Center of Molecular Biophysics, Rue Charles Sadron, 45071, Orléans Cedex, France
| | - W Même
- CNRS, Center of Molecular Biophysics, Rue Charles Sadron, 45071, Orléans Cedex, France
| | - C Rousselot
- Department of Anatomy, Cytology and Pathology, University Hospital Regional Center Tours, 10 bd Tonnellé, 37044, Tours, France
| | - N Winer
- Department of Obstetrics and Gynecology, University Hospital of Nantes, CIC Mère Enfant Nantes, UMR 1280, INRA Phan Physiologie des Adaptations Nutritionnelles, France
| | - A Novell
- UMR Inserm U930, University of Tours, 10 bd ter Tonnellé, 37032, Tours Cedex 1, France
| | - F Perrotin
- UMR Inserm U930, University of Tours, 10 bd ter Tonnellé, 37032, Tours Cedex 1, France; Department of Obstetrics and Gynecology, University Hospital Regional Center Tours, 10bd Tonnellé, 37044, Tours, France
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Simon EG, Callé S, Perrotin F, Remenieras JP. Measurement of shear wave speed dispersion in the placenta by transient elastography: A preliminary ex vivo study. PLoS One 2018; 13:e0194309. [PMID: 29621270 PMCID: PMC5886409 DOI: 10.1371/journal.pone.0194309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 02/28/2018] [Indexed: 12/31/2022] Open
Abstract
Background Placental elasticity may be modified in women with placental insufficiency. Shear wave elastography (SWE) can measure this, using acoustic radiation force, but the safety of its use in pregnant women has not yet been demonstrated. Transient elastography (TE) is a safer alternative, but has not yet been applied to the placenta. Moreover, the dispersion of shear wave speed (SWS) as a function of frequency has received relatively little study for placental tissue, although it might improve the accuracy of biomechanical assessment. Objective To explore the feasibility and reproducibility of TE for placental analysis, to compare the values of SWS and Young’s modulus (YM) from TE and SWE, and to analyze SWS dispersion as a function of frequency ex vivo in normal placentas. Materials and methods Ten normal placentas were analyzed ex vivo by an Aixplorer ultrasound system as shear waves were generated by a vibrating plate and by using an Aixplorer system. The frequency analysis provided the value of the exponent n from a fractional rheological model applied to the TE method. We calculated intra- and interobserver agreement for SWS and YM with 95% prediction intervals, created Bland-Altman plots with 95% limits of agreement, and estimated the intraclass correlation coefficient (ICC). Main results The mean SWS was 1.80 m/s +/- 0.28 (standard deviation) with the TE method at 50 Hz and 1.82 m/s +/-0.13 with SWE (P = 0.912). No differences were observed between the central and peripheral regions of placentas with either TE or SWE. With TE, the intraobserver ICC for SWS was 0.68 (0.50–0.82), and the interobserver ICC for SWS 0.65 (0.37–0.85). The mean parameter n obtained from the fractional rheological model was 1.21 +/- 0.12, with variable values of n for any given SWS. Conclusions TE is feasible and reproducible on placentas ex vivo. The frequency analysis of SWS provides additional information about placental elasticity and appears to be able to distinguish differences between placental structures.
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Affiliation(s)
- Emmanuel G. Simon
- UMR 1253, iBrain, University of Tours, Inserm, Tours, France
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital Center of Tours, Tours, France
- * E-mail:
| | - Samuel Callé
- UMR 1253, iBrain, University of Tours, Inserm, Tours, France
- GREMAN, UMR CNRS 7347, University of Tours, Tours, France
| | - Franck Perrotin
- UMR 1253, iBrain, University of Tours, Inserm, Tours, France
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital Center of Tours, Tours, France
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Belin O, Espitalier F, Remerand F, Perrotin F, Laffon M. Transverse subglottic diameter assessment in the third gestation trimester: Preeclampsia versus control. Anaesth Crit Care Pain Med 2018; 38:81-82. [PMID: 29627430 DOI: 10.1016/j.accpm.2018.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/16/2018] [Accepted: 03/11/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Olivier Belin
- Anaesthesiology and Critical Care Department, CHRU de Tours, 37000 Tours, France
| | - Fabien Espitalier
- Anaesthesiology and Critical Care Department, CHRU de Tours, 37000 Tours, France
| | - Francis Remerand
- Anaesthesiology and Critical Care Department, CHRU de Tours, 37000 Tours, France; Medical University, François Rabelais University, 37000 Tours, France
| | - Franck Perrotin
- Obstetric and Gynaecology Department, CHRU de Tours, 37000 Tours, France; Medical University, François Rabelais University, 37000 Tours, France
| | - Marc Laffon
- Anaesthesiology and Critical Care Department, CHRU de Tours, 37000 Tours, France; Medical University, François Rabelais University, 37000 Tours, France.
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Denis de Senneville B, Novell A, Arthuis C, Mendes V, Dujardin PA, Patat F, Bouakaz A, Escoffre JM, Perrotin F. Development of a Fluid Dynamic Model for Quantitative Contrast-Enhanced Ultrasound Imaging. IEEE Trans Med Imaging 2018; 37:372-383. [PMID: 28858788 DOI: 10.1109/tmi.2017.2743099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) is a non-invasive imaging technique extensively used for blood perfusion imaging of various organs. This modality is based on the acoustic detection of gas-filled microbubble contrast agents used as intravascular flow tracers. Recent efforts aim at quantifying parameters related to the enhancement in the vascular compartment using time-intensity curve (TIC), and at using these latter as indicators for several pathological conditions. However, this quantification is mainly hampered by two reasons: first, the quantification intrinsically solely relies on temporal intensity variation, the explicit spatial transport of the contrast agent being left out. Second, the exact relationship between the acquired US-signal and the local microbubble concentration is hardly accessible. This paper introduces the use of a fluid dynamic model for the analysis of dynamic CEUS (DCEUS), in order to circumvent the two above-mentioned limitations. A new kinetic analysis is proposed in order to quantify the velocity amplitude of the bolus arrival. The efficiency of proposed methodology is evaluated both in-vitro, for the quantitative estimation of microbubble flow rates, and in-vivo, for the classification of placental insufficiency (control versus ligature) of pregnant rats from DCEUS. Besides, for the in-vivo experimental setup, we demonstrated that the proposed approach outperforms the performance of existing TIC-based methods.
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Bardou M, Crépon B, Bertaux AC, Godard-Marceaux A, Eckman-Lacroix A, Thellier E, Falchier F, Deruelle P, Doret M, Carcopino-Tusoli X, Schmitz T, Barjat T, Morin M, Perrotin F, Hatem G, Deneux-Tharaux C, Fournel I, Laforet L, Meunier-Beillard N, Duflo E, Le Ray I. NAITRE study on the impact of conditional cash transfer on poor pregnancy outcomes in underprivileged women: protocol for a nationwide pragmatic cluster-randomised superiority clinical trial in France. BMJ Open 2017; 7:e017321. [PMID: 29084796 PMCID: PMC5665235 DOI: 10.1136/bmjopen-2017-017321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Prenatal care is recommended during pregnancy to improve neonatal and maternal outcomes. Women of lower socioeconomic status (SES) are less compliant to recommended prenatal care and suffer a higher risk of adverse perinatal outcomes. Several attempts to encourage optimal pregnancy follow-up have shown controversial results, particularly in high-income countries. Few studies have assessed financial incentives to encourage prenatal care, and none reported materno-fetal events as the primary outcome. Our study aims to determine whether financial incentives could improve pregnancy outcomes in women with low SES in a high-income country. METHODS AND ANALYSIS This pragmatic cluster-randomised clinical trial includes pregnant women with the following criteria: (1) age above 18 years, (2) first pregnancy visit before 26 weeks of gestation and (3) belonging to a socioeconomically disadvantaged group. The intervention consists in offering financial incentives conditional on attending scheduled pregnancy follow-up consultations. Clusters are 2-month periods with random turnover across centres. A composite outcome of maternal and neonatal morbidity and mortality is the primary endpoint. Secondary endpoints include maternal or neonatal outcomes assessed separately, qualitative assessment of the perception of the intervention and cost-effectiveness analysis for which children will be followed to the end of their first year through the French health insurance database. The study started in June 2016, and based on an expected decrease in the primary endpoint from 18% to 14% in the intervention group, we plan to include 2000 women in each group. ETHICS AND DISSEMINATION Ethics approval was first gained on 28 September 2014. An independent data security and monitoring committee has been established. Results of the main trial and each of the secondary analyses will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02402855; pre-results.
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Affiliation(s)
- Marc Bardou
- Centre d’Investigation Clinique INSERM 1432, Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France
- Centre de Recherche INSERM LNC-UMR1231, UFR Sciences Santé, Dijon, France
- Université Bourgogne-Franche Comté, Dijon, France
| | - Bruno Crépon
- Centre de Recherche en Economie Statistique (CREST), Malakoff, France
| | - Anne-Claire Bertaux
- Unité de Soutien Méthodologique à la Recherche, CHU Dijon-Bourgogne, Dijon, Bourgogne, France
| | - Aurélie Godard-Marceaux
- Neurosciences Intégratives et cliniques EA 481, Université Bourgogne Franche-Comté, Besançon, France
- “Ethique et Progrès médical”, CIC INSERM 1431, Centre Hospitalier et Universitaire de Besançon, Besançon, France
| | | | - Elise Thellier
- Service de Gynécologie Obstétrique, CHU de Bicetre, Paris, France
| | | | | | - Muriel Doret
- Service de Gynécologie Obstétrique, Hospices Civils de Lyon—Hôpital Femme Mère Enfant, Lyon, Rhône-Alpes, France
| | - Xavier Carcopino-Tusoli
- Service de Gynécologie Obstétrique, CHU de Marseille Hôpital Nord, Marseille, Provence-Alpes-Côte d’Azu, France
| | - Thomas Schmitz
- Service de Gynécologie Obstétrique, CHU Robert Debré, Paris, Île-de-France, France
| | - Thiphaine Barjat
- Service de Gynécologie Obstétrique, CHU de Saint Etienne, Saint Etienne, France
| | - Mathieu Morin
- Service de Gynécologie Obstétrique, CHU de Toulouse, Toulouse, Midi-Pyrénées, France
| | - Franck Perrotin
- Service de Gynécologie Obstétrique, CHU Bretonneau, Tours, France
| | - Ghada Hatem
- Service de Gynécologie Obstétrique, Centre Hospitalier de Saint Denis, Saint Denis, Île-de-France, France
| | - Catherine Deneux-Tharaux
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris France, Paris, France
| | - Isabelle Fournel
- Centre d’Investigation Clinique INSERM 1432, Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France
| | - Laurent Laforet
- Centre d’Investigation Clinique INSERM 1432, Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France
| | - Nicolas Meunier-Beillard
- Neurosciences Intégratives et cliniques EA 481, Université Bourgogne Franche-Comté, Besançon, France
| | - Esther Duflo
- Department of Economics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Isabelle Le Ray
- Service de Gynécologie Obstétrique, CHRU Strasbourg, Strasbourg, Alsace, France
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Beauruelle C, Pastuszka A, Horvath P, Perrotin F, Mereghetti L, Lanotte P. CRISPR: A Useful Genetic Feature to Follow Vaginal Carriage of Group B Streptococcus. Front Microbiol 2017; 8:1981. [PMID: 29075246 PMCID: PMC5641575 DOI: 10.3389/fmicb.2017.01981] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/25/2017] [Indexed: 11/16/2022] Open
Abstract
Clustered regularly interspaced short palindromic repeats (CRISPR) and Cas (CRISPR-associated proteins) play a critical role in adaptive immunity against mobile genetic elements, especially phages, through their ability to acquire novel spacer sequences. Polarized spacer acquisition results in spacer polymorphism and temporal organization of CRISPR loci, making them attractive epidemiological markers. Group B Streptococcus (GBS), a genital commensal for 10 to 30% of healthy women and a major neonatal pathogen, possesses a ubiquitous and functional CRISPR1 locus. Our aim was to assess the CRISPR1 locus as an epidemiological marker to follow vaginal carriage of GBS in women. This study also allowed us to observe the evolution of the CRISPR1 locus in response to probable phage infection occurring in vivo. We followed carriage of GBS among 100 women over an 11-year period, with a median duration of approximately 2 years. The CRISPR1 locus was highly conserved over time. The isolates that show the same CRISPR1 genotype were collected from 83% of women. There was an agreement between CRISPR genotyping and other typing methods [MLVA (multilocus variable number of tandem repeat Analysis) and MLST (multilocus sequence typing)] for 94% of the cases. The CRISPR1 locus of the isolates from 18 women showed modifications, four of which acquired polarized spacer, highlighting the in vivo functionality of the system. The novel spacer of one isolate had sequence similarity with phage, suggesting that phage infection occurred during carriage. These findings improve our understanding of CRISPR-Cas evolution in GBS and provide a glimpse of host-phage dynamics in vivo.
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Affiliation(s)
- Clémence Beauruelle
- Université François Rabelais de Tours, UMR1282 Infectiologie et Santé Publique, Tours, France.,INRA, UMR1282 Infectiologie et Santé Publique, Nouzilly, France.,Service de Bactériologie-Virologie, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Adeline Pastuszka
- Université François Rabelais de Tours, UMR1282 Infectiologie et Santé Publique, Tours, France.,INRA, UMR1282 Infectiologie et Santé Publique, Nouzilly, France.,Service de Bactériologie-Virologie, Centre Hospitalier Universitaire de Tours, Tours, France
| | | | - Franck Perrotin
- Inserm U930, Université François Rabelais de Tours, Tours, France.,Département d'Obstétrique de Gynécologie et de Médecine Fœtale, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Laurent Mereghetti
- Université François Rabelais de Tours, UMR1282 Infectiologie et Santé Publique, Tours, France.,INRA, UMR1282 Infectiologie et Santé Publique, Nouzilly, France.,Service de Bactériologie-Virologie, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Philippe Lanotte
- Université François Rabelais de Tours, UMR1282 Infectiologie et Santé Publique, Tours, France.,INRA, UMR1282 Infectiologie et Santé Publique, Nouzilly, France.,Service de Bactériologie-Virologie, Centre Hospitalier Universitaire de Tours, Tours, France
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Diguisto C, Gouge AL, Giraudeau B, Perrotin F. Mechanical cervicAl ripeninG for women with PrOlongedPregnancies (MAGPOP): protocol for a randomised controlled trial of a silicone double balloon catheter versus the Propess system for the slow release of dinoprostone for cervical ripening of prolonged pregnancies. BMJ Open 2017; 7:e016069. [PMID: 28912192 PMCID: PMC5640144 DOI: 10.1136/bmjopen-2017-016069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Induction of labour for prolonged pregnancies (PP) when the cervix is unfavourable is a challenging situation. Cervical ripening by pharmacological or mechanical techniques before oxytocin administration is used to increase the likelihood of vaginal delivery. Both techniques are equally effective in achieving vaginal delivery but excessive uterine activity, which induces fetal heart rate (FHR) anomalies, is more frequent after the pharmacological intervention. We hypothesised that mechanical cervical ripening could reduce the caesarean rate for non-reassuring FHR especially in PP where fetuses are already susceptible to this. METHODS AND ANALYSIS A multicentre, superiority, open-label, parallel-group, randomised controlled trial that aims to compare cervical ripening with a mechanical device (Cervical Ripening Balloon, Cook-Medical Europe, Ireland) inserted in standardised manner for 24 hours to pharmacological cervical ripening (Propess system for slow release system of 10 mg of dinoprostone, Ferring SAS, France) before oxytocin administration. Women (n=1220) will be randomised in a 1:1 ratio in 15 French units. Participants will be women with a singleton pregnancy, a vertex presentation, a term ≥41+0 and≤42+0 week's gestation, and for whom induction of labour is planned. Women with a Bishop score ≥6, a prior caesarean delivery, premature rupture of membranes or with any contraindication for vaginal delivery will be excluded. The primary endpoint is the caesarean rate for non-reassuring FHR. Secondary outcomes are related to delivery and perinatal morbidity. As study investigators and patients cannot be masked to treatment assignment, to compensate for the absence of blinding, an independent endpoint adjudication committee, blinded to group allocation, will determine whether the caesarean for non-reassuring FHR was justified. ETHICS AND DISSEMINATION Written informed consent will be obtained from all participants. The Tours Research ethics committee has approved this study (2016-R23, 29 November 2016). Study findings will be submitted for publication and presented at relevant conferences. TRIAL REGISTRATION NUMBER NCT02907060; pre-results.
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Affiliation(s)
- Caroline Diguisto
- Maternité Olympe de Gouges, Centre Hospitalier Régional Universitaire Tours, Tonnellé, France
- Université François Rabelais Tours, Tonnellé, France
| | | | - Bruno Giraudeau
- Université François Rabelais Tours, Tonnellé, France
- INSERM CIC 1415, CHRU de Tours, Tours, France
| | - Franck Perrotin
- Maternité Olympe de Gouges, Centre Hospitalier Régional Universitaire Tours, Tonnellé, France
- Université François Rabelais Tours, Tonnellé, France
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Fievet A, Morel B, Sembély-Taveau C, Thoreau B, Perrotin F, Sirinelli D. [Fetal MRI practices in a university prenatal center]. ACTA ACUST UNITED AC 2017; 45:276-282. [PMID: 28343908 DOI: 10.1016/j.gofs.2017.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 02/20/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Fetal MRI is a third intention examination to prenatal diagnosis. If its diagnostic value is well known in many pathologies, its place in the management of pregnancies remains unclear. METHODS We collected retrospectively demographical, radiological (fetal MRI indications, fetal anatomical region and diagnostic information provided by fetal MRI) and obstetrical data of pregnant patients in university prenatal center during a 5 years' period. RESULTS Among 2439 patients of the prenatal center, 196 (8%) patients with fetal MRI were included. The main anatomical regions studied were the brain (n=132, 67%), the thorax (n=31, 16%) and the abdomen (n=25, 13%). No cardiac fetal MRI was performed. Ninety-five percent of fetal MRI was consecutively of an ultrasound sign. Fetal brain MRI was abnormal in 65% of cases, the thoracic and abdominopelvic MRI in 81.5%. The ultrasound diagnosis was unchanged in 42%, completed in 50% and redirected in 8% of cases. A termination of pregnancy was deemed admissible in 31% of patients with MRI versus 21% in patients without MRI (P=0.001). CONCLUSION Fetal MRI requires selective indications and provides additional diagnostic information with important implications for the future of the pregnancy, particularly in case of severe and incurable pathologies. Our results could be useful as a reference basis for the comparison with others prenatal center practices.
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Affiliation(s)
- A Fievet
- Radiologie pédiatrique, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France
| | - B Morel
- Radiologie pédiatrique, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France; Faculté de médecine, université François-Rabelais, 10, boulevard Tonnellé, 37044 Tours cedex 9, France.
| | - C Sembély-Taveau
- Radiologie pédiatrique, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France
| | - B Thoreau
- Médecine interne, hôpital Bretonneau, CHRU de Tours, 10, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - F Perrotin
- Faculté de médecine, université François-Rabelais, 10, boulevard Tonnellé, 37044 Tours cedex 9, France; Pôle de gynécologie-obstétrique, médecine fœtale, médecine et biologie de la reproduction, centre Olympe-de-Gouges, hôpital Bretonneau, CHRU de Tours, 10, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - D Sirinelli
- Radiologie pédiatrique, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France; Faculté de médecine, université François-Rabelais, 10, boulevard Tonnellé, 37044 Tours cedex 9, France
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Diguisto C, Piver E, Gouge AL, Eboue F, Vaillant CL, Maréchaud M, Goua V, Giraudeau B, Perrotin F. First trimester uterine artery Doppler, sFlt-1 and PlGF to predict preeclampsia in a high-risk population. J Matern Fetal Neonatal Med 2017; 30:1514-1519. [DOI: 10.1080/14767058.2016.1183631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Caroline Diguisto
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, 2 Boulevard Tonnellé, Tours Cedex 9, France
- Department of Medicine, University François Rabelais, Tours, France
| | - Eric Piver
- Department of Medicine, University François Rabelais, Tours, France
- Department of Biochemistry, University Hospital Tours, Tours, France
| | | | - Florence Eboue
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, 2 Boulevard Tonnellé, Tours Cedex 9, France
- Maternité Notre Dame de Bon Secours, Groupe Hospitalier Saint Joseph, Paris, France
| | | | - Martine Maréchaud
- Department of Obstetrics, University Hospital of Poitiers, Poitiers, France
| | - Valérie Goua
- Department of Obstetrics, University Hospital of Poitiers, Poitiers, France
| | - Bruno Giraudeau
- Department of Medicine, University François Rabelais, Tours, France
- INSERM CIC 1415, University Hospital Tours, Tours, France
| | - Franck Perrotin
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, 2 Boulevard Tonnellé, Tours Cedex 9, France
- Department of Medicine, University François Rabelais, Tours, France
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Diguisto C, Winer N, Descriaud C, Tavernier E, Weymuller V, Giraudeau B, Perrotin F. Amnioinfusion for women with a singleton breech presentation and a previous failed external cephalic version: a randomized controlled trial. J Matern Fetal Neonatal Med 2017; 31:993-999. [PMID: 28279119 DOI: 10.1080/14767058.2017.1304909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Our trial aimed to assess the effectiveness of amnioinfusion for a second attempt at external cephalic version (ECV). MATERIAL AND METHODS This open randomized controlled trial was planned with a sequential design. Women at a term ≥36 weeks of gestation with a singleton fetus in breech presentation and a first unsuccessful ECV were recruited in two level-3 maternity units. They were randomly allocated to transabdominal amnioinfusion with a 500-mL saline solution under ultrasound surveillance or no amnioinfusion before the second ECV attempt. Trained senior obstetricians performed all procedures. The primary outcome was the cephalic presentation rate at delivery. Analyses were conducted according to intention to treat (NCT00465712). RESULT Recruitment difficulties led to stopping the trial after a 57-month period, 119 women were randomized: 59 allocated to amnioinfusion + ECV and 60 to ECV only. Data were analyzed without applying the sequential feature of the design. The rate of cephalic presentation at delivery did not differ significantly according to whether the second version attempt was or was not preceded by amnioinfusion (20 versus 12%, p = .20). Premature rupture of the membranes occurred for 15% of the women in the amnioinfusion group. CONCLUSION Amnioinfusion before a second attempt to external version does not significantly increase the rate of cephalic presentation at delivery.
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Affiliation(s)
- Caroline Diguisto
- a Department of Obstetrics, Gynecology and Fetal Medicine , University Hospital of Tours , Tours , France.,b Université François-Rabelais de Tours , Tours , France
| | - Norbert Winer
- c Department of Obstetrics, Gynecology and Fetal Medicine , University Hospital of Nantes , Nantes , France
| | - Celine Descriaud
- a Department of Obstetrics, Gynecology and Fetal Medicine , University Hospital of Tours , Tours , France.,d Department of Obstetrics, Gynecology , Centre Hospitalier Régional Orléans , Orléans , France
| | - Elsa Tavernier
- b Université François-Rabelais de Tours , Tours , France.,e INSERM CIC 1415 , Tours , France
| | - Victoire Weymuller
- a Department of Obstetrics, Gynecology and Fetal Medicine , University Hospital of Tours , Tours , France.,b Université François-Rabelais de Tours , Tours , France
| | - Bruno Giraudeau
- b Université François-Rabelais de Tours , Tours , France.,e INSERM CIC 1415 , Tours , France
| | - Franck Perrotin
- a Department of Obstetrics, Gynecology and Fetal Medicine , University Hospital of Tours , Tours , France.,b Université François-Rabelais de Tours , Tours , France
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Diguisto C, Simon EG, Callé S, Ternifi R, Remeniéras JP, Hervé P, Perrotin F. Ultrasonic elastography exploration of the foetal brain: A case of atypical choroid plexus papilloma. J OBSTET GYNAECOL 2017; 37:525-527. [PMID: 28421905 DOI: 10.1080/01443615.2017.1281893] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Caroline Diguisto
- a Department of Obstetrics, Gynecology and Fetal Medicine , University Hospital of Tours , Tours Cedex 9 , France.,b UFR de Médecine, University François Rabelais , Tours Cedex 1 , France
| | - Emmanuel G Simon
- a Department of Obstetrics, Gynecology and Fetal Medicine , University Hospital of Tours , Tours Cedex 9 , France.,b UFR de Médecine, University François Rabelais , Tours Cedex 1 , France.,c INSERM U930 , University François Rabelais , Tours Cedex 1 , France
| | - Samuel Callé
- c INSERM U930 , University François Rabelais , Tours Cedex 1 , France
| | - Redouane Ternifi
- c INSERM U930 , University François Rabelais , Tours Cedex 1 , France
| | | | - Philipe Hervé
- a Department of Obstetrics, Gynecology and Fetal Medicine , University Hospital of Tours , Tours Cedex 9 , France
| | - Franck Perrotin
- a Department of Obstetrics, Gynecology and Fetal Medicine , University Hospital of Tours , Tours Cedex 9 , France.,b UFR de Médecine, University François Rabelais , Tours Cedex 1 , France.,c INSERM U930 , University François Rabelais , Tours Cedex 1 , France
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Affiliation(s)
- C J Arthuis
- University Hospital Center of Tours, Department of Obstetrics, Gynecology and Fetal Medicine, Tours, France
- Inserm U930, François-Rabelais University, Tours, France
| | - F Perrotin
- University Hospital Center of Tours, Department of Obstetrics, Gynecology and Fetal Medicine, Tours, France
- Inserm U930, François-Rabelais University, Tours, France
| | - E G Simon
- University Hospital Center of Tours, Department of Obstetrics, Gynecology and Fetal Medicine, Tours, France
- Inserm U930, François-Rabelais University, Tours, France
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