Evidence for differential care in Down syndrome screening based on maternal origin: a population based survey in France

Background

Previous studies showed disparities in prenatal screening for Down syndrome according to socio-economic status and maternal place of birth. Thus, it remains uncertain that those disparities are related to access difficulties or lack of information offered to women. Our objective was to assess the opportunity for informed choice regarding Down syndrome screening according to maternal place of birth.

Methods

Data were based on French national perinatal surveys of 2010 and 2016. These surveys include several questions relative to Down syndrome screening, such as measurement of nuchal translucency and realization of maternal serum screening. We considered that women had the opportunity for choice in case of realization or refusal of prenatal screening, or realization of amniocentesis or chorionic villous sampling. We considered that women had no opportunity for choice in case of ignorance of the realization of the tests, or if the screening has not been performed because not proposed, late prenatal follow-up, or another reason or unknown reason. We used multinomial logistic regression models to assess the association between the use of the tests and women country of birth.

Results

The proportion of women undergoing measurement of nuchal translucency or maternal serum screening was higher in women born in France than women born in another country. After adjustment on the year of the survey, maternal age, parity, education level and type of maternity, and after exclusion of women without adequate prenatal follow-up, the opportunity for making an informed choice for Down syndrome screening was higher for women born in France than women born in another European country (ORa 2.36; 95%CI,1.8-3.0), in Maghreb (ORa 4.01; 95%CI,3.4-4.8) or in another African country (ORa 3.52(2.8-4.3).

Conclusions

Disparities in the use of Down syndrome screening according to women place of birth are almost partly related to differences in the opportunity of an informed choice.

Tobacco smoking in pregnant women: fifty years of evolution in France

Background

Smoking during pregnancy is a major modifiable risk factor for maternal and foetal morbidity. We aimed to describe 1/smoking trends in France between 1972 and 2016, 2/ the factors associated with smoking cessation and reduction during pregnancy in 2016.

Methods

French National Perinatal Surveys are routine surveys based on a representative sample of births (N = 11,733 in 2016). Data were collected in face-to-face interviews in postnatal wards and from the mother’s medical record. Smoking rates before pregnancy and during 3rd trimester were estimated for each study year and characteristics associated with smoking reduction (relative percent change in number of cigarettes smoked before and during pregnancy <50% or ≥ 50%) compared with smoking cessation were analysed using multinomial logistic regression.

Results

After significantly decreasing from 1995 onwards, smoking prevalence stagnates since 2010 both before pregnancy and in the 3rd trimester (30.1% and 16.2%, respectively in 2016). In 2016, 45.8% ceased smoking during pregnancy, 37.2% reduced by ≥ 50% their consumption and 16.9% reduced by < 50% or did not reduce at all. The more cigarettes women smoked before pregnancy, the greater this reduction was (p < 0,001). Moderate reduction (<50%) vs stopping was more frequent in multiparae compared to nulliparae (aOR=2,47 [IC95%:1,93-3,15]) and in women with low education (aOR(<High school vs university graduates)=7,20 [4,78-10,82]) and low income (aOR(<1500€per month/>3000€)=2,30 [1,51-3,50]).

Conclusions

Smoking rates were high before and during pregnancy in France in 2016. Socio-demographic factors should be considered when targeting women most at risk of continuing smoking during pregnancy.

Key messages

After significantly decreasing from 1995 onwards, smoking prevalence stagnates since 2010 both before pregnancy and in the 3rd trimester in France. Supporting female smokers of childbearing age in their attempts to quit and remain non-smokers even after pregnancy is crucial, especially in multiparae and women in poor social condition.

The Effect of Older Siblings on Language Development as a Function of Age Difference and Sex

The number of older siblings a child has is negatively correlated with the child’s verbal skills, perhaps because of competition for parents’ attention. In the current study, we examined the role of siblings’ sex and age gap as moderating factors, reasoning that they affect older siblings’ tendency to compensate for reduced parental attention. We hypothesized that children with an older sister have better language abilities than children with an older brother, especially when there is a large age gap between the two siblings. We reanalyzed data from the EDEN cohort ( N = 1,154) and found that children with an older sister had better language skills than those with an older brother. Contrary to predictions, results showed that the age gap between siblings was not associated with language skills and did not interact with sex. Results suggest that the negative effect of older siblings on language development may be entirely due to the role of older brothers. Our findings invite further research on the mechanisms involved in this effect.

Sexual harassment and menstrual disorders among Italian university women: A cross-sectional observational study

AIMS

Menstrual disorders and sexual harassment are common among young women and interfere with their life and activities. We aimed to describe the association of sexual harassment and menstrual disorders among female university students.

METHODS

This cross-sectional, observational study examined the association between sexual harassment and menstrual disorders in a sample of 349 university students in Italy. Students answered an anonymous self-administered questionnaire. Descriptive bivariate analyses and logistic regression analyses were performed. Main outcome measures were associations between levels of exposure to sexual harassment (none, levels 1 and 2) and five menstrual disorders (premenstrual symptoms, heavy bleeding, pain, irregular cycles, and amenorrhea).

RESULTS

Among the women interviewed (mean age 20.4 ± 1.45 years), 146 (41.8%) had experienced sexual harassment in the previous 12 months: 91 (26.1%) level 1 and 55 (15.7%) level 2. The frequency of premenstrual symptoms was 31.9% ( n=110); heavy bleeding, 35.3% ( n=124); pain, 51.4% ( n=181); irregular cycles, 55.5% ( n=195); and amenorrhea, 6.7% ( n=23). After adjustment for age, place of birth, being in a couple relationship and receiving hormone therapy, the frequency of menstrual disorders, except for amenorrhea, was increased with sexual harassment, with a regular gradient from no harassment to level 2 harassment. Introducing factors of depression, specific gynaecological problems and lifetime sexual violence did not change the results. For instance, the adjusted odds ratios of premenstrual symptoms were 2.10 [1.19-3.68] for women with level 1 harassment and 3.58 [1.83-7.03] for women with level 2 compared with women without harassment exposure.

CONCLUSIONS

Sexual harassment is related to the prevalence of menstrual disorders. Healthcare providers should encourage dialogue with patients and address the issue of sexual violence or harassment.

Employment, working conditions, and preterm birth: results from the Europop case-control survey

STUDY OBJECTIVE

To analyse the relation between preterm birth and working conditions in Europe using common measures of exposure and to test whether employment related risks varied by country of residence.

DESIGN

A case-control study in which cases included all consecutive singleton preterm births and controls included one of every ten singleton term births in each participating maternity unit. Data about working conditions were obtained by interview from women after delivery.

SETTING

Sixteen European countries.

PARTICIPANTS

The analysis included 5145 preterm and 7911 term births of which 2369 preterm and 4098 term births were to women employed during pregnancy. Analyses of working conditions were carried out for women working through at least the third month of pregnancy.

MAIN RESULTS

Employed women did not have an excess risk of preterm birth. Among working women, a moderate excess risk was observed for women working more than 42 hours a week (OR = 1.33, CI = 1.1 to 1.6), standing more than six hours a day (OR = 1.26, CI = 1.1 to 1.5), and for women with low job satisfaction (OR = 1.27, CI = 1.1 to 1.5). There were stronger links in countries with a lower overall level of perinatal health and a common practice of long prenatal leaves.

CONCLUSION

These findings show that specific working conditions affect the risk of preterm birth. They also suggest employment related risks could be mediated by the social and legislative context.

Physical load and psychological demand at work during pregnancy and preterm birth

OBJECTIVES

To evaluate the effect of physical workload and psychological demand on all preterm births, and to determine whether these risk factors have the same effect on different types of preterm birth (moderate versus very preterm birth) and different modes of delivery onset (spontaneous versus indicated preterm birth).

METHODS

A case-control study was carried out in two public general hospitals in the Valencia Region, Spain. All preterm births (228) which occurred between 22 and 36 completed weeks of amenorrhea and 348 controls of 37 or more completed weeks of amenorrhea were included. The information was collected by interviewing women within 2 days of their giving birth. Physical workload, psychological demand, weekly working hours and daily time spent commuting between home and work were used as explanatory variables. A polytomous logistic regression was carried out.

RESULTS

Exposure to medium or high level physical workload increases the risk of preterm birth, with an adjusted odds ratio (OR) of 1.59 and 2.31, respectively. The risk of moderate preterm birth was greater in women with a medium or high level of physical workload, OR: 1.73 and 2.35, respectively. The same trend was observed for very preterm birth. Physical workload showed a different effect on spontaneous and indicated preterm birth. The exposure to medium and high level physical workload increases the risk of indicated preterm birth, with an OR of 2.74 and 3.88, respectively. The same trend was seen in the case of spontaneous preterm birth. Psychological demands were not associated with preterm birth.

CONCLUSIONS

High physical exertion increases the risk of preterm birth in Spain. The magnitude of the effect of physical workload on moderate and very preterm birth is similar, but is higher on indicated preterm birth than on spontaneous preterm birth. Psychological demands show no effect on the risk of preterm birth.

Postpartum return to smoking among usual smokers who quit during pregnancy

BACKGROUND

Many women stop smoking while they are pregnant, but the majority resume smoking in the postpartum. The objective is to describe postpartum tobacco use of women who quit during pregnancy and factors predicting postpartum smoking relapse.

METHODS

Secondary analysis of two surveys of new mothers. Survey A conducted in three maternity hospitals, including 685 women interviewed after birth and who answered a postal questionnaire at 5 months postpartum; survey B conducted in four 'départements' (administrative areas), including 636 women who answered a postal questionnaire at 6 months postpartum. Response rates were respectively 90% and 68%. Smoking status was recorded for three time periods: before pregnancy, during pregnancy, and at 5-6 months. Social characteristics and preventive behaviour were compared for regular smokers who had quit smoking during pregnancy and those who had not, and among quitters, who had resumed smoking postpartum and those who had not.

RESULTS

In survey A, 37% were smokers before pregnancy, 34% of them stopped during pregnancy, and among the latter, 48% had resumed smoking 5-6 months after delivery. In survey B, the percentages were respectively 43, 54 and 57%. The most predictive factor of postpartum smoking relapse was the partner's smoking behaviour.

CONCLUSION

Return to smoking after delivery is frequent, but nearly half of the regular smokers who had stopped during pregnancy were still non-smokers 5-6 months after the birth. However, to increase this proportion, interventions need to include partners, especially if they are smokers.

Are risk factors the same for small for gestational age versus other preterm births?

OBJECTIVES

This article explores whether the impact of social and demographic risk factors for preterm birth differs for small for gestational age preterm births versus other preterm births.

STUDY DESIGN

This was a European case control study of the determinants of preterm birth (4700 cases and 6460 controls). Small for gestational age and non-small for gestational age preterm births were compared with a control group of term births; relationships were explored further by stratifying preterm births into subgroups by mode of onset, the presence of hypertension, and gestational age.

RESULTS

Of the social and demographic risk factors for preterm birth identified in this sample, high maternal age, smoking, and low and high maternal body mass index have a stronger effect on small for gestational age preterm births. In contrast, obstetric history, maternal education, and marital status have similar effects regardless of birth weight. Hypertension during pregnancy is strongly associated with small for gestational age preterm birth and contributes to an explanation of observed differences.

CONCLUSIONS

These results underline the importance of considering fetal growth restriction in the analysis of risk factors for preterm birth.

Employment status of pregnant women in central Poland and the risk of preterm delivery and small-for-gestational-age infants

BACKGROUND

Unemployment is one of the consequences of the ongoing transformation of the Polish economy. The main objective of the present study was to investigate the relationship between women's employment status and preterm delivery (PD) and/or small-for-gestational-age (SGA) infants, in Central Poland during the socio-economic transition.

METHODS

The study population comprised 8% random sample of 2,080 women from the Lodz macro region who gave birth to a child during a one-year period (1996-1997). Based on the employment status, three groups were distinguished: the employed (n = 1238), the unemployed (n = 128)--women who lost their job before pregnancy (at least 12 months prior to delivery) and were actively seeking employment, and the housewives (n = 714). Women with chronic medical problems diagnosed before pregnancy were excluded from the study.

RESULTS

The rates of preterm delivery were found to be 6.3%, 11.7% and 4.9%, respectively for the employed, unemployed, and housewives. After adjustment for age, marital status, education, maternal height, smoking, own apartment, presence of cervical insufficiency and uterine irritability, an excess risk of PD was observed among the unemployed women (OR = 1.92, 95% CI: 1.01-3.64). Unemployment was associated, though not significantly, with higher rates of SGA births.

CONCLUSION

In Central Poland, the unemployed pregnant women are characterised by an excess risk of preterm delivery. The impact of unemployment on the community's health, which seems to be underestimated, should be given more consideration in the national and local policies for public health.

Risk factors for 14-21 week abortions: a case-control study in Europe. The Europop Group

Data from a case-control survey in Europe, carried out between 1994 and 1997, were used to investigate the risk factors for spontaneous abortions at 14-21 weeks (late abortions), according to the vital status of the fetus before the onset of labour. Late abortions included 62 involving a fetus alive before the onset of labour, 216 late abortions of a fetus already dead, together with 4592 control pregnancies at term (>/=37 weeks) from seven countries. Histories of induced abortion, spontaneous abortion and preterm birth were more closely associated with late abortion of a live fetus than with late abortion of a dead fetus. Women aged >/=35 years and women living alone had a much higher risk of late abortions than women aged 20-24 years and married women, regardless of the vital status of the fetus before labour. These results provide evidence that obstetric history and socio-demographic factors are risk factors for late abortions but differences are observed according to the vital status of the fetus before labour.

Women's health after childbirth: a longitudinal study in France and Italy

OBJECTIVE

To describe the prevalence of various symptoms five months and twelve months after childbirth in two European countries, according to employment, financial difficulties and relationship with partner.

DESIGN

Longitudinal multicentre survey with a similar design in France and Italy. Women were interviewed three times: at birth and twice after childbirth. At 12 months after childbirth, the survey was postal in both countries.

POPULATION

Women who had been delivered of their first or second baby in three maternity units in France and five units in Italy. Women who had multiple pregnancies, a stillbirth or known neonatal death were excluded.

RESULTS

The response rates were 83% in France and 88% in Italy. Fifteen symptoms were considered. The results were similar in the two countries and showed that the prevalence of most symptoms was higher at 12 months than at five months after childbirth. When their baby was one year old, more than half of the women reported backache, anxiety and extreme tiredness. Around one-third of women reported headache, lack of sexual desire, sleep disorders and depression. Piles, constipation and painful intercourse were also common. One year postpartum women with financial problems or a difficult relationship reported poor psychological health more frequently.

CONCLUSION

Physical and emotional problems are common after birth, and they tend to increase over time. Backache, headache and piles can seriously interfere with day-to-day life. Sexual problems also may be a source of unhappiness for the woman and her partner. Extreme tiredness, anxiety and depression may make a woman feel guilty for not corresponding to the image of a healthy, happy and well-coping mother. There is a link between financial problems or a difficult relationship with her partner and her own wellbeing. Health professionals should be aware of the high prevalence of health problems among new mothers, and of the social context of women who are more likely to suffer from them. They should counsel the women in their care, in order to help them to find the best solution, be it medical or social in nature.

How is sex considered in recent epidemiological publications on occupational risks?

OBJECTIVES

Although women account for almost half the working population in industrialised countries, a sex bias persists in publications on medical research in general and occupational health in particular. The objective was to review recent publications on how sex is considered in epidemiological studies of occupational health, and to answer the following questions: are men and women studied equally, what are the respective characteristics of the studies which comprise only men, only women, and both, and what strategy of data analysis is chosen by the authors to take account of the sex factor in mixed studies.

MATERIALS

This review was based on publications in six journals during the year 1997, and included all the original articles reporting an epidemiological study of occupational health.

RESULTS

In all, 348 articles were reviewed. In 40 articles (11%), the sex of the study population was not specified. In 177 articles (51%), the study population was mixed. In 108 (31%), the population consisted exclusively of men, and in only 23 (7%), exclusively of women. Even when study populations were mixed, they included fewer women than men. The sex composition of the population was related to the occupational risk factor considered, and also to health outcome. Industrial sector workers, and exposure to chemicals were more likely to be studied in samples of men. Mortality and health outcomes such as neoplasms and cardiovascular diseases were also more often studied among men. Surprisingly, study design differed significantly according to the sex of the population, and prospective studies, cohort studies, and exposed versus non-exposed studies were more often carried out in samples of men. Among the 177 mixed studies, sex was not investigated in over a quarter (27%). In 26 articles (15%), sex was not taken into account, but the authors attempted to justify this decision. In 46 mixed studies (26%), the results were adjusted for sex, and in 46 (26%), the authors gave separate results for men and women. In 11 studies (6%), more complete strategies of data analysis were chosen, including research for interactions or adjustment, followed by stratification.

CONCLUSION

This review of recent publications in occupational health epidemiology showed that women are still less often studied than men, and that the sex factor is not investigated in many mixed studies. The results therefore underline the need for further research on occupational hazards among women, and on sex differences.

The relationship between intrauterine growth restriction and preterm delivery: an empirical approach using data from a European case-control study

OBJECTIVE

To test whether being small for gestational age, defined as having a birthweight less than the 10th centile of intrauterine growth references, is a risk factor for preterm delivery for singleton live births.

DESIGN

A case-control study.

SETTING

Maternity hospitals in 16 European countries.

SAMPLE

Four thousand and seven hundred preterm infants between 22 and 36 completed weeks of gestation and 6,460 control infants between 37 and 40 weeks of gestation.

METHODS

Newborn babies are identified as being small for gestational age using customized reference standards derived from models of fetal growth. The impact of being small for gestational age on preterm delivery is estimated using logistic regression.

MAIN OUTCOME MEASURE

Spontaneous or induced preterm delivery.

RESULTS

Being small for gestational age is significantly associated with preterm birth, although the magnitude of this association differs greatly by type of delivery and gestational age. Over 40% of induced preterm births for reasons other than the premature rupture of membranes are small for gestational age compared with 10.7% of control infants (OR 6.41). For spontaneous or premature rupture of membranes related preterm births, the association is also significant, but weaker (OR 1.51). The relationship between growth restriction and preterm delivery is strongest for preterm births before 34 weeks of gestation.

CONCLUSIONS

These findings highlight the phenomenon of abnormal fetal growth in all premature infants and, in particular, infants delivered by medical decision for reasons other than premature rupture of membranes. The observed association between being small for gestational age and preterm delivery among spontaneous preterm births merits further attention because the causal mechanisms are not well understood.

Unemployment and psychological distress one year after childbirth in France

STUDY OBJECTIVE

To analyse the relation between unemployment and the psychological distress of mothers one year after childbirth.

DESIGN

Multicentric survey concerning births occurring between September 1993 and July 1994.

SETTING

In France: two maternity units in the Parisian area and one in Champagne-Ardennes, in the east of France, comprising both urban and rural areas.

PARTICIPANTS

Primipara and secondipara women were interviewed three times: at birth by a face to face interview, five months and 12 months after the birth, by postal questionnaires, with a 83% response rate for the two postal questionnaires. The analysis includes 632 women who answered all three stages of the survey.

MEASUREMENTS

Psychological distress was mainly assessed one year after birth by the 12-item General Health Questionnaire.

RESULTS

After adjustment for unwanted pregnancy, marital conflicts, marital status, hospitalisation of the baby during the last year, lack of confiding relationship, depressive or anxious troubles before pregnancy, age, educational level and parity, unemployed women had an excess of psychological distress compared with employed women (OR = 1.87; 95% CI = 1.12, 3.13). The ratios for housewives were very close to those of employed women. Among the unemployed women, 60% had recently been without a job, since a few months before or after the birth. An excess of psychological distress among unemployed compared with employed women was observed in all social groups defined by the current or last occupation, but with various extents. Psychological distress was specially linked to the employment status in the group of women with the more qualified occupations.

CONCLUSION

Even after a birth, when women are very much involved in their maternal role, those seeking a job have worse mental health than those in a stable situation, either employed or housewives. In France, the unemployment rate among young women is high. It is specially important that social regulations protecting employment during and after pregnancy are adequately applied. Employers, legislators, such as medical doctors, have to be aware to this situation.

What makes new mothers unhappy: psychological distress one year after birth in Italy and France

The aim of this report is to present results on the factors associated with psychological distress in 724 Italian and 629 French women 12 months after birth. The prevalence of distress was ascertained by the 12-item Goldberg Health Questionnaire (GHQ), using a cut-off score of > 5. Results show that, in both countries, after controlling for previous psychological health, the variables significantly associated with mothers' distress were: an unsatisfactory couple relationship; lack of a confidante; a baby with serious health problems, financial worries. In Italy, also being an older mother and a discrepancy between actual and desired employment status were associated with a high GHQ score. These results point out to the high prevalence of mothers' psychological distress in Latin countries too, and stress the role played by family and social factors.

Very and moderate preterm births: are the risk factors different?

OBJECTIVE

To describe the risk factors for very preterm births and to compare the strengths of the associations between these risk factors and very and moderate preterm births.

DESIGN

A case-control study.

SETTING

Fifteen European countries.

METHODS

Between 1994 and 1997, 1675 very preterm births, 3652 moderate preterm births and an unmatched control group of 7965 births at term were included. Odds ratios for very and moderate preterm births (related to socioeconomic status, behavioural factors, maternal age, body mass index and obstetric history) were estimated and compared using polytomous logistic regression.

RESULTS

Underprivileged social situation, older maternal age and adverse previous pregnancy outcomes were significantly related to very and moderate preterm births. However, these factors were more strongly associated with very preterm births than with moderate preterm births, for both spontaneous and induced deliveries. Smoking during pregnancy, young maternal age and low body mass index were significantly related to very and moderate spontaneous preterm births, but no significant difference in odds ratios was observed between the two outcomes.

CONCLUSION

These results suggest that risk factors for very and moderate preterm births are similar, but the strength of the associations differ, especially for social factors and obstetric history.

Social differences of very preterm birth in Europe: interaction with obstetric history. Europop Group

Social differences of very preterm birth (22-32 completed weeks of amenorrhea) were studied using data from a large case-control survey in Europe between 1994 and 1997; 1,675 very preterm births and 7,965 full-term births were included. The relation between social factors and very preterm birth was studied according to obstetric history and the mode of delivery onset. Very preterm birth was significantly related to low educational level among women with no previous adverse pregnancy outcome (odds ratio (OR) = 2.67, 95 percent confidence interval (CI) 1.66-4.28) and among primigravid women and those with previous first-trimester abortion (OR = 2.01, 95 percent CI 1.56-2.58). In this group, unemployment of all household members was associated with a double risk of very preterm birth. No significant association between very preterm birth and socioeconomic status was observed among women with previous second-trimester abortion or preterm birth. Socioeconomic indicators remained significantly associated with both spontaneous and induced very preterm births among women with no previous late fetal loss or preterm birth. The results are consistent with social factors affecting the risk of very preterm birth, but the relation differs according to obstetric history.

Ectopic pregnancy and occupational exposure of hospital personnel

OBJECTIVES

An earlier study found a relationship between occupational exposure to antineoplastic drugs and ectopic pregnancy. The present investigation aimed at confirming this finding in a larger and specifically planned study and at analyzing the relationship between ectopic pregnancy and other chemical or physical agents in the hospital work environment.

METHODS

A case-referent study (140 cases and 279 referents) was carried out in 1995 in a population of women working in hospitals throughout France. The sample size was computed to have an 80% statistical power to detect a 2-fold increased risk of ectopic pregnancy (odds ratio 2). Information was collected about past and present work conditions (exposures to antineoplastic drugs, solvents, disinfectants, anesthetic gases and ionizing radiation), and known risk factors of ectopic pregnancy. Multivariate analysis was performed using logistic regression.

RESULTS

No significant association between occupational exposure and ectopic pregnancy was found, either when past exposure was considered or when exposure was considered within the 3 months before conception. The relationships remained nonsignificant after adjustment for job category and for the known risk factors of ectopic pregnancy.

CONCLUSIONS

It was concluded that the results of this study should be interpreted as an absence of relationship between exposure to chemical or physical agents and ectopic pregnancy.

Sex as a variable can be a surrogate for some working conditions: factors associated with sickness absence

More than twice as many workdays are lost to illness than for personal or family reasons. We examine possible workplace determinants of sickness absence among French workers in the food processing industry. These workers are exposed to a variety of environmental and organizational constraints: cold, uncomfortable postures, assembly-line work, and irregular schedules. In 1987-1988, a medical examination and questionnaire were administered to 558 men and 790 women as part of a study of 17 poultry slaughterhouses and 6 canning factories. Women's and men's working conditions were very different, and their sickness absences for musculoskeletal and respiratory illnesses were related to some of their specific working conditions: cold exposure, ill-adapted work stations, and problems with their supervisors and co-workers. If male and female workers were combined into a single analysis that adjusted for sex, many of the associations operant for a single sex could no longer be seen.

[The rejoining of the workforce of mothers during the first year of life of their child]

OBJECTIVES

To study the return to paid work between the 5th and 12th month after the birth of a child depending on socioeconomic and occupational characteristics of employed mothers. Furthermore, to analyse the differences at the time of returning to work (5th or 12th month) according to these characteristics.

METHODS

Longitudinal study carried out on a sample of 528 primiparous or secundiparous women who have had a child in a public hospital in the city of Valencia and who have carried out a professional activity during pregnancy. Three cross-sectional cut off points were made; the first two days after childbirth, the second five months later and the third a year after the child was born. The information collection was conducted by means of a questionnaire. Uni and multivariate statistical analysis techniques have been used.

RESULTS

Five months after childbirth the probability of returning to work was greater in women who worked with permanent contracts in the private sector (ORadjusted: 7.4) or public sector (ORadjusted: 7.8). Likewise it is higher in service workers (ORadjusted: 2.0), administrative staff (ORadjusted: 2.5) and professionals or technical workers (ORadjusted: 2.9). The probability of returning to paid work a year after childbirth is higher in the mother who works in the public sector with permanent or temporary contracts (ORadjusted: 21.0 and 5.1 respectively) and in the private sector with permanent contracts (ORadjusted: 5.1). It is also higher in service workers (ORadjusted: 2.2), in administrative staff (ORadjusted: 2.7) and professionals or technical workers (ORadjusted: 4.7).

CONCLUSIONS

Childbirth may lead to a break in the working career of the woman. The socio-demographic and professional factors which might explain this break are low professional qualifications and unstable employment in private sector companies.

[Marital violence after birth]

OBJECTIVE

The purpose was to estimate the prevalence of marital violence during the year after childbirth in France.

METHODS

a survey has been carried out in three maternity units among primipara and secondipara women in 1993-1994. The women were interviewed in the three days after the delivery and they received a postal questionnaire 5 and 12 months later. The analysis includes 706 women.

RESULTS

the prevalence of marital violence during the 12 months after childbirth is equal to 4.1% (2.6%-5.6%). This percentage is higher among women living an unstable relationship with their partner or when the partner has not a job. These women who reported marital violence had a higher prevalence of previous miscarriage. They used more often psychotropic drugs and reported more often depressive symptoms than the other women.

CONCLUSION

physicians may be helpful by listening and counseling these women who receive low emotional and social support.

Conformity of Workers' and Occupational Health Physicians' Descriptions of Working Conditions

To determine whether workers, describing their own work, and occupational physicians, describing typical workstations, would report the same working conditions, and whether the relationships between health status and working conditions described by these two sources would be similar. An epidemiologic survey was carried out in 1987-88 in 17 poultry slaughterhouses and six canneries in France. The data were collected in two ways: workers described their own working conditions, and occupational physicians described the working conditions at workstations in the same factories. The study included 507 workers who worked at fixed workstations that had been described by the 24 occupational physicians. Health data were obtained from the workers by the physicians during their annual visits. The agreement between workers and physicians in the descriptions of seven working conditions was analyzed. On the whole, the prevalences of exposures to the seven selected working conditions estimated by the two sources were similar. Nevertheless, the observed agreement was not necessarily high. When agreement existed about specific working conditions, the relationships observed between those conditions and workers' health were generally similar for the two sources. This result was stronger for physical health problems than for mental health problems. When both sources agreed that the worker was being exposed to a risk factor, the risk estimation was higher compared with the cases of discordant judgment. This study confirms the usefulness of information provided by experts but also the necessity to interview workers themselves about their working conditions.

Risk factors for high blood pressure among workers in French poultry slaughterhouses and canneries

The aim of the present study is to examine the relationship between the working conditions of employees in the food industry and blood pressure. An epidemiological survey was conducted between 1987 and 1988 in 17 poultry slaughterhouses and 6 canneries in the French regions of 'Bretagne' and 'Pays de Loire'. One thousand, four hundred and seventy-four workers were included in the study. Data was collected in the course of the medical visit organized annually for employees. Mean diastolic (DBP) and systolic blood pressure (SBP) were analyzed separately for male and female workers. The results indicate a significant relationship between blood pressure, and age and obesity. Amongst the various features of working condition studies, loud noise and the number of work breaks were found to be associated with heightened mean values of DBP or SBP in men only. Type and size of the factory was found to be associated with blood pressure readings for both sexes. A number of working conditions giving rise to heightened mental strain were found to be related to a lowering in mean blood pressure: for example, irregular work finishing times for men and production-line work for women. A discussion of these results reveals the complexity of the relationships which exist between physical and environmental factors in this type of setting and blood pressure of employees.

Work in operating rooms and pregnancy outcome among nurses

The aim of this study was to analyse the relationship between work in an operating room and pregnancy outcome, as described by the rates of spontaneous abortion and of birth defects. The population comprised the female nurses of 17 hospitals in Paris, interviewed in 1987-1989. An exposed group included all operating room nurses, and a control group was composed of female nurses in other departments matched by hospital, age and duration of service. Each woman described all prior pregnancies. In total, 776 pregnancies were described by 418 nurses who were first pregnant in 1970 or thereafter; ectopic pregnancies, those terminated by voluntary induced abortion and those leading to multiple births were excluded. The rate of spontaneous abortion was significantly higher for pregnancies during which women worked in an operating room than for the other pregnancies. Birth defects were not significantly related to work in an operating room during pregnancy. These results are in agreement with others showing a significant relationship between occupational exposure to operating rooms and spontaneous abortion, although identification of the responsible factor remains difficult. They suggest that effective ventilating systems should be installed in all operating rooms and that special preventive measures must be taken for women of childbearing age.

Mothers' health after the birth of the first child: the case of employed women in an Italian city

While the number of mothers resuming employment soon after the birth of a child is growing, knowledge about the effect that having both a baby and a job has on mental and physical health is still scarce. In this paper, we studied the health of 141 Italian first-time mothers, who were all employed during pregnancy. When their child was 15 months old, 84% were back at work; 24-36% suffered from lack of sleep, extreme tiredness and backache; more than half had experienced some feelings of depression since the birth. Considering the whole sample, poorly educated and unmarried mothers reported more physical health problems. Being employed per se showed no influence, but poorly educated mothers and those with a less qualified job reported more problems. On the basis of our results, we suggest that future research on new mothers, work and health should systematically include "domestic" variables and the characteristics of the paid job; and should analyze more thoroughly the influence of marriage status and educational level on health.

Ectopic pregnancy and occupational exposure to antineoplastic drugs

The incidence of ectopic pregnancy has risen substantially during the past two decades, but the aetiology of a third of cases remains unknown. We have used data from a survey of nurses in Paris, France, to examine the relation between ectopic pregnancy and various occupational exposures. We studied two groups of women--operating-theatre staff and nurses from other departments. The women were asked about outcomes of all pregnancies and occupational exposure to anaesthetic gases, formol, ionising radiation, and antineoplastic drugs during the first trimester of pregnancy. Of 734 pregnancies reported, 15 (2%) had been ectopic. In chi-square analysis, there were significant associations (p < 0.02) between ectopic pregnancy and exposure to antineoplastic drugs, the woman's age, and the number of previous pregnancies. Other occupational exposures and working in an operating theatre did not show significant associations. In logistic regression analysis with adjustment for gravidity, the odds ratio (by the exact method) for ectopic pregnancy associated with occupational exposure to antineoplastic drugs was 10.0 (95% CI 2.1-56.2). Because we had only small numbers of ectopic pregnancies, the odds ratios we estimated have wide confidence intervals. Our findings should be confirmed by a larger study specifically designed to investigate the relation between antineoplastic exposure and ectopic pregnancy.

Factors associated with dysmenorrhea among workers in French poultry slaughterhouses and canneries

The food and agriculture industry employs 15% of the female industrial work force in France. Workers in this industry are exposed to a variety of environmental and organizational constraints: cold, uncomfortable postures, assembly-line work, irregular schedules. In 1987 to 1988, a medical examination and questionnaire were administered to 726 menstruating women who had not been pregnant during the 2 previous years, as part of a study of French workers in 17 poultry slaughterhouses and 6 canning factories. Dysmenorrhea during the previous year was more prevalent among younger women and smokers, and less prevalent among users of oral contraceptives. After adjustment for nonoccupational variables, dysmenorrhea was significantly related to several parameters expressing cold exposure and physical work load. Other parameters such as job satisfaction and hours of domestic work were not associated with dysmenorrhea.

Fair law, unfair practices? Benefiting from protective legislation for pregnant workers in Italy and France

Protective Maternity Legislation (PML) for pregnant workers is well established in Italy and France, but little is known about the way it fulfils some of its aims, such as the protection of mothers' and babies' health and of the rights of women workers. In this paper, we present the results of two surveys, one carried out in Italy and the other in France, concerned with the implementation of these regulations. Results show that women who were regularly employed generally could benefit from PML, while non-eligible workers, most of them holding manual jobs, were not protected at all. Among eligible workers, inequalities existed: women with less qualified jobs and those employed in the private sector were less likely to benefit from the protective measures considered. A number of specific measures, such as the possibility of taking an early maternity leave for work reasons and of being moved to another job within the same firm were underused in both countries. Some limitations of PML are discussed, namely the fact it covers some but not all pregnant workers, that it ignores domestic work and the tendency to remove the pregnant worker rather than to modify her working conditions.

Menstrual-cycle characteristics and work conditions of workers in poultry slaughterhouses and canneries

The food and agriculture industry employs 14.6% of the female industrial work force in France. Workers are exposed to a variety of environmental and organizational constraints (eg, irregular schedules, cold, uncomfortable postures, repetitive movements). In 1987-1988 a medical examination and questionnaire were administered to 726 workers with menstrual periods in 17 poultry slaughterhouses and six canning factories. Anomalies (irregular cycles, amenorrhea, long cycles) during the previous year were associated with work conditions. After adjustment for relevant nonoccupational variables, irregular cycles were significantly related to schedule variability and cold exposure, amenorrhea was associated with cold exposure, and long cycles with schedule variability. Other parameters such as repetitive work, standing posture, lifting weights, job satisfaction, and hours of domestic work were not associated with cycle anomalies. Cycle anomalies may be a useful indicator of occupational effects on female reproduction, analogous to the use of sperm parameters to warn of effects on male workers.

An indicator of adverse pregnancy outcome in France: not receiving maternity benefits

STUDY OBJECTIVE

The aim was to compare the social characteristics, the pregnancy outcome, and the antenatal care of women in France who did not receive maternity benefits to women who did. These benefits (860 FF, approx 86 pounds per month) are given to every pregnant woman, starting in the second trimester. Payments are made on the condition that at least three antenatal visits are made, the first being before the end of the first trimester.

DESIGN

The study involved a random sample of women who were interviewed after delivery during their stay in hospital. Data on pregnancy outcome were collected from medical records.

SETTING

The study was carried out in four public maternity units in different regions of France.

PARTICIPANTS

1692 women were included in the analysis (86.8% of the selected sample). Of 257 exclusions, 40 had multiple pregnancies, 189 had missing data, and 28 did not answer the question concerning maternity benefits.

MEASUREMENTS AND MAIN RESULTS

4.3% of the women did not receive any maternity benefits. These women lived in poorer social conditions than the women who received the benefits. They had a higher preterm delivery rate, after controlling for risk factors in a logistic regression. Women without maternity benefits were characterised by a lower level of care, yet the majority began their antenatal care during the first trimester or had more than six visits.

CONCLUSIONS

Not receiving maternity benefits during pregnancy is an index of an underprivileged situation and a risk factor for pregnancy outcome.

High blood pressure during pregnancy and working conditions among hospital personnel

The relationship between working conditions and high blood pressure during pregnancy was analysed in a sample of 621 women hospital employees in the Paris region over the period 1979-1981. Data were collected by interviews during the routine medical visit at the end of postnatal leave. Women who had to work standing up for extended periods of time, who had to carry heavy loads or who had to perform heavy cleaning tasks had high blood pressure during their pregnancy more often than women not exposed to these working conditions. The accumulation of two out of the three or these three working conditions by the same woman was strongly related to high blood pressure. This relation remained significant when other risk factors of hypertension, such as age, parity, corpulence and tobacco use, were taken into account in a multiple logistic regression.

Is preterm delivery still related to physical working conditions in pregnancy?

STUDY OBJECTIVE

The aim was to determine the relationship between working conditions during pregnancy, women's occupation, and preterm birth.

DESIGN

This was a retrospective survey.

SETTING

The study was carried out in four public maternity units in France in 1987 and 1988.

SUBJECTS

1949 women were interviewed after the delivery during their stay in hospital. Of these, 1002 held a job during pregnancy, but this report is confined to 875 women who had a single live birth and who had worked for more than the first trimester of pregnancy.

MEASUREMENTS AND MAIN RESULTS

Information about social and occupational status was obtained through interviews, and data about gestational length were obtained from medical records. The primary results showed that preterm birth did not vary significantly according to working conditions whereas it differed according to occupational group.

CONCLUSIONS

Occupation, but not working conditions, affected the incidence of preterm birth. This result is discordant with other studies which underlined the excess of preterm births among women with strenuous working conditions. Reasons for this discrepancy may include (1) change in perception of "strenuous working conditions"; (2) improved working conditions; (3) the development of "preventive" strategies by pregnant women. Occupation is a more reliable indicator of risk than self described working conditions.

Healthy worker effect and pregnancy: role of adverse obstetric history and social characteristics

Data from a survey conducted in 1981 on a national sample of 5508 births in France were used to analyse the role of a history of previous adverse pregnancy outcome (spontaneous abortion, perinatal death or adverse fetal condition) in the selection mechanisms of women with regard to occupational activity, and the impact on the relation between work and preterm delivery. The study, carried out separately in each parity group, showed that occupational activity was associated with a more favourable outcome for women of parity one: the preterm delivery rate was significantly higher among women who had never worked than among those who continued working during pregnancy. However, the hypothesis of a "healthy worker effect" linked to a history of adverse obstetric outcome was not confirmed in this study. A selection effect of women from a history of spontaneous abortions was observed, but these were not linked to preterm delivery. Among multiparous women, a history of perinatal death or adverse fetal condition did not seem to modify women's behaviour towards their work. Selection mechanisms of women towards occupational activity according to sociodemographic factors were also analysed and showed that the higher percentage of younger women among those who had never worked explained the higher rate of preterm delivery in that group.

Pregnancy outcome and social conditions of women under 20: evolution in France from 1972 to 1981

Two studies based on national samples of births in France in 1972 and 1981 have enabled a comparison of the changes in perinatal risk and social situation of women under 20 years of age with those of women 20 and over. Preterm delivery among women under 20 remained stable during the 10-year period, while it declined significantly among older women. Also, the social situation of teenagers deteriorated in terms of occupational activity, educational level, presence of the child's father in the home, and his occupation. The changes in these social characteristics do not adequately explain the increased relative risk of preterm delivery among women under 20.

Pregnant women's working conditions and their changes during pregnancy: a national study in France

In a study of 2387 employed women who had worked for more than three months of their pregnancy the data were extracted from a survey carried out on a national sample of births in France in 1981. Manual, service and shop workers had a higher preterm delivery rate than professional, administrative, or clerical workers. Assembly line work was associated with a higher preterm delivery rate even when production workers only were considered. Cumulated physically tiring working conditions--standing work, carrying of heavy loads, assembly line work, and considerable physical effort--were related to higher preterm delivery and low birthweight rate. During pregnancy, sickness absences were commoner when the working conditions were arduous. Changes in the working conditions were less clearly related to arduous work than sick leaves; they were not significantly more frequent for standing work or for assembly line work. Refusals from employers to grant favourable arrangements were more frequent when the working conditions were tiring and sick leaves were more common among women whose requests had been refused.

Pregnant immigrant women: occupational activity, antenatal care and outcome

Data from a national sample of births in France in 1981 were used to analyse the relationship between occupational activity, antenatal care and pregnancy outcome among immigrant women. On the whole, occupational activity was less common among immigrant than among French women, although the occupational activity rate varied according to country of origin. Among French women, work during pregnancy was related to better antenatal care and more favourable outcome. The same tendency was observed among immigrant women whatever their origin, though they had less qualified occupations and harder working conditions than those of French women. Occupational activity of immigrant women was more frequent among women with a higher educational level, better knowledge of the French language, and residence in France for a longer time. These characteristics were also associated with better antenatal care, but the relationship between work and antenatal care remained significant after taking them into account.

Pregnancy and its outcome among hospital personnel according to occupation and working conditions

Relationships between occupation, working conditions, and the development and outcome of pregnancy were analysed on a sample of women employed in hospital during their pregnancy. Ancillary staff members experienced more uterine contractions during pregnancy, more preterm deliveries, and more low birthweight infants than those performing other duties; this remained true after adjusting for social characteristics. The rate of preterm delivery was significantly higher in the presence of at least two of the following arduous working conditions: stand-up work, carrying heavy loads (exclusive of patients), and heavy cleaning tasks; this was so, whatever the occupation.

[Forms of care, health evaluation at 10 months, and maternal behavior]

The purpose of this survey was the comparison of 4 forms of day care: day care center, baby minder, care at home by the mother herself or care at home by someone else. A sample of 1,010 children, born to French mothers in a public hospital in Paris, was examined at a check-up clinic organized by National Social Security for 10 months old children. Home care by the mother herself was more frequent for mothers with primary level education or for families with 2 children or more; care at home by someone else was often chosen by families with high social level. The health and psychosocial and motor development of the children were not very different according to the type of day care. There was a higher frequency of acute respiratory tract infections and a lower weight gain for children in day care centers. Mothers whose children went to a day care center were more anxious about medical symptoms and more often called for a doctor.

Impact of the French system of statutory visits on antenatal care

A survey of a representative sample of births in France in 1976 showed that the great majority of women receive at least the minimum antenatal care laid down by law: 4% of women missed one of the three statutory visits linked to payment of the antenatal allowance and 6% missed the fourth visit that should take place in the ninth month. A smaller study conducted in two hospitals, one in the Paris region and the other in Nord-Pas-de-Calais, showed that the date of the first visit did not depend on a knowledge of the regulations. In one of the hospitals, where about 95% of women made more than the four statutory visits, the actual number of visits made was independent of a knowledge of the statutory number, In contrast, in the other hospital, where the mean number of visits was nearer to the statutory minimum, about half the women who said that four visits were required made exactly that number of visits and about half of those who gave three as the number made three visits.