Activité physique durant la grossesse : associations avec le poids de naissance et la composition corporelle du nouveau-né

Plusieurs études se sont penchées sur les effets de l’activité physique maternelle sur le poids du nouveau-né, un paramètre reflétant l’environnement intra-utérin associé au risque ultérieur d’obésité et de problèmes métaboliques. Devant les taux alarmants d’obésité infantile à travers le monde, l’identification d’interventions préventives efficaces devient un enjeu majeur dans la lutte contre l’obésité et ses complications. L’activité physique maternelle pourrait être une avenue intéressante, étant donné ses effets bénéfiques sur le gain de poids et le profil métabolique maternels et son potentiel de diminution du poids de naissance de l’enfant. Cependant, la dose optimale d’activité physique et ses effets sur la composition corporelle du nouveau-né sont encore méconnus. Par ailleurs, la majorité des femmes enceintes ne rencontrent pas les recommandations en matière d’activité physique durant la grossesse et les femmes obèses, chez qui les bienfaits de l’activité physique pourraient possiblement avoir le plus grand impact, présentent souvent les niveaux les plus bas. Curieusement, peu d’études ont évalué les effets d’une intervention d’activité physique durant la grossesse dans cette population. Ainsi, avant d’envisager l’activité physique comme une intervention thérapeutique non-pharmacologique durant la grossesse, il importe d’en évaluer la faisabilité et la sécurité et d’en connaître extensivement les effets. Notamment, il s’avère primordial de vérifier s’il est possible d’augmenter en toute sécurité les niveaux d’activité physique durant la grossesse, particulièrement chez les femmes obèses, et de distinguer les effets spécifiques de différents stimuli d’activité physique (variant en type, volume, intensité et moment de la grossesse) sur la croissance fœtale. Dans ce contexte, nous avons dans un premier temps entrepris une revue systématique de la littérature des études observationnelles portant sur l’association entre l’activité physique maternelle et les paramètres de croissance fœtale mesurés à la naissance. Dans un deuxième temps, 2 études de cohortes évaluant l’impact du type, du volume, de l’intensité et du trimestre de pratique de l’activité physique ont été menées afin de complémenter et d’approfondir les résultats de la revue systématique. Finalement, une étude d’intervention randomisée a été réalisée afin d’évaluer s’il est possible d’améliorer les niveaux d’activité physique durant la grossesse chez les femmes enceintes obèses. Nos travaux ont permis d’illustrer l’influence variable que différents stimuli d’activité physique maternelle peuvent avoir sur l’anthropométrie néonatale. La revue systématique a montré qu’un volume moyen d’activité physique est associé à une augmentation du poids de naissance comparativement à un volume plus faible, alors qu’un volume élevé est associé à une diminution du poids de naissance, comparativement à un volume plus faible. Nos données suggèrent également que l’association entre l’activité physique maternelle et le poids de naissance varie en présence de certaines caractéristiques maternelles. Notamment, nous avons montré pour la première fois que l’activité physique vigoureuse pratiquée en début de grossesse était associée à une diminution importante du poids de naissance chez les femmes qui reçoivent un diagnostic de pré-éclampsie en fin de grossesse. L’importance de l’intensité de l’activité physique dans la relation entre l’activité physique maternelle et la croissance fœtale a également été soulignée pour la première fois dans notre étude de cohorte avec mesure de la composition corporelle néonatale. Contrairement à l’activité physique d’intensité modérée, l’activité physique vigoureuse en début de grossesse est associée à une diminution du poids de naissance, principalement en raison d’une adiposité néonatale réduite. Finalement, les résultats de l’essai randomisé ont permis d’établir la faisabilité d’une intervention d’activité physique supervisée visant à augmenter la pratique d’activité physique chez des femmes enceintes obèses et le potentiel d’une telle intervention à favoriser le maintien de la condition physique et une meilleure gestion du gain de poids chez ces femmes. L’ensemble de ces résultats permet de mieux cerner l’impact de l’activité physique maternelle sur la croissance fœtale, en fonction des caractéristiques spécifiques du stimulus d’activité physique mais également de la population étudiée. La faisabilité d’une intervention d’activité physique prénatale dans une population de femmes obèses laisse entrevoir de nouvelles possibilités dans la prévention de l’obésité infantile et de ses complications. L’identification d’une dose optimale d’activité physique favorisant la santé de l’enfant à court et à long terme dans diverses populations de femmes enceintes et l’identification des facteurs permettant une meilleure adhérence aux recommandations qui en découleront constituent des pistes de recherche essentielles à la lutte contre l’obésité.Numerous studies have evaluated the effects of maternal physical activity on infant’s birth weight, an important pregnancy outcome reflecting the quality of the prenatal environment and associated with future cardiovascular and obesity risk. Given the alarming worldwide prevalence of childhood obesity, identifying effective preventive strategies becomes a major target in the fight against obesity and its complications. Maternal physical activity could be a promising avenue, considering its positive impact on gestational weight gain and maternal metabolic profile and its potential to decrease birth weight. Nevertheless, the optimal physical activity dose and its effect on infant’s body composition remain unknown. Moreover, most pregnant women do not reach recommended levels of physical activity and obese women, in whom physical activity could be most beneficial, are usually the least active pregnant women. Intriguingly, few physical activity interventions during pregnancy have focused on this population. Thus, before considering physical activity as non-pharmacological therapeutic intervention for pregnant women, a meticulous examination of its safety and effects is required, especially regarding the specificity of the effects of various physical activity stimuli (of different type, volume, intensity and timing) on fetal growth. Also, assessing the feasibility of an intervention aiming at increasing physical activity levels in obese pregnant women appears mandatory. In this context, we first performed a systematic review of observational studies focusing on the association between maternal physical activity and parameters of infant’s growth. Second, two cohort studies were conducted to complement and deepen findings from the systematic review. Finally, a physical activity randomised trial was completed with obese pregnant women to evaluate if such interventions can increase physical activity levels. The present work suggested that different maternal physical activity exposures exert a differential influence on neonatal anthropometry. The systematic review showed that moderate doses of physical activity were associated with an increased birth weight compared with lower doses, while high physical activity doses were associated with a decreased birth weight. Also, the association between maternal physical activity and birth weight was shown to differ in the presence of specific maternal characteristics. Notably, vigorous intensity physical activity in early pregnancy was associated with an important decrease in the birth weight of neonates born to women later diagnosed with preeclampsia. The importance of physical activity intensity in the maternal physical activity-fetal growth relationship was also emphasized by the results of our cohort study with neonatal body composition analysis. Unlike moderate intensity physical activity, vigorous intensity physical activity in early pregnancy seems responsible for the reduction in infant’s birth weight, mainly through a decreased neonatal adiposity. Finally, results from the randomised trial established the feasibility of a supervised physical activity intervention aiming at increasing physical activity levels in obese pregnant women and suggested that this kind of intervention can positively influence fitness and gestational weight gain in these women. Globally, these results contribute to a better understanding of the impact of maternal physical activity on fetal growth, considering specific characteristics of the physical activity stimulus and studied population. The feasibility of a physical activity intervention designed for obese pregnant women might provide new exciting possibilities for childhood obesity prevention. Ascertaining the optimal maternal physical activity dose allowing the improvement of a child’s short and long term health in various pregnant populations and identifying factors associated with a better adherence to physical activity guidelines during pregnancy are essential research avenues that can contribute to tackle the obesity epidemic

Dose repartition in alveoli, alveolar ducts and bronchi of rats exposed to radon and its progeny, preliminary results

Recently, micronuclei scoring has been performed to estimate doses delivered to the lungs after heterogenous irradiation induced after inhalation of radon and its progeny. These studies were limited to the deep lung after either extraction of alveolar macrophages (AM) by lavage (Taya et al., 1994, Johnson and Newton, 1994) or enzymatic dissociation of lung cells to initiate fibroblast cultures (Khan et al., 1994). Dose estimates were performed after comparison with micronuclei formation induced in vitro by irradiation with alpha particles

Challenges in mathematical cognition: a collaboratively-derived research agenda

This paper reports on a collaborative exercise designed to generate a coherent agenda for research on mathematical cognition. Following an established method, the exercise brought together 16 mathematical cognition researchers from across the fields of mathematics education, psychology and neuroscience. These participants engaged in a process in which they generated an initial list of research questions with the potential to significantly advance understanding of mathematical cognition, winnowed this list to a smaller set of priority questions, and refined the eventual questions to meet criteria related to clarity, specificity and practicability. The resulting list comprises 26 questions divided into six broad topic areas: elucidating the nature of mathematical thinking, mapping predictors and processes of competence development, charting developmental trajectories and their interactions, fostering conceptual understanding and procedural skill, designing effective interventions, and developing valid and reliable measures. In presenting these questions in this paper, we intend to support greater coherence in both investigation and reporting, to build a stronger base of information for consideration by policymakers, and to encourage researchers to take a consilient approach to addressing important challenges in mathematical cognition

Challenges in mathematical cognition: a collaboratively-derived research agenda

This paper reports on a collaborative exercise designed to generate a coherent agenda for research on mathematical cognition. Following an established method, the exercise brought together 16 mathematical cognition researchers from across the fields of mathematics education, psychology and neuroscience. These participants engaged in a process in which they generated an initial list of research questions with the potential to significantly advance understanding of mathematical cognition, winnowed this list to a smaller set of priority questions, and refined the eventual questions to meet criteria related to clarity, specificity and practicability. The resulting list comprises 26 questions divided into six broad topic areas: elucidating the nature of mathematical thinking, mapping predictors and processes of competence development, charting developmental trajectories and their interactions, fostering conceptual understanding and procedural skill, designing effective interventions, and developing valid and reliable measures. In presenting these questions in this paper, we intend to support greater coherence in both investigation and reporting, to build a stronger base of information for consideration by policymakers, and to encourage researchers to take a consilient approach to addressing important challenges in mathematical cognition

Challenges in Mathematical Cognition: A Collaboratively-Derived Research Agenda

This paper reports on a collaborative exercise designed to generate a coherent agenda for research on mathematical cognition. Following an established method, the exercise brought together 16 mathematical cognition researchers from across the fields of mathematics education,psychology and neuroscience. These participants engaged in a process in which they generated an initial list of research questions with the potential to significantly advance understanding of mathematical cognition, winnowed this list to a smaller set of priority questions, and refined the eventual questions to meet criteria related to clarity, specificity and practicability. The resulting list comprises 26 questions divided into sixbroad topic areas: elucidating the nature of mathematical thinking, mapping predictors and processes of competence development, charting developmental trajectories and their interactions, fostering conceptual understanding and procedural skill, designing effective interventions, and developing valid and reliable measures. In presenting these questions in this paper, we intend to support greater coherence in both investigation and reporting, to build a stronger base of information for consideration by policymakers, and to encourage researchers to take a consilient approach to addressing important challenges in mathematical cognition.</p

Risk assessment : a tool for the choice of toxicity reference value

Toxicological Reference Value (TRV) are developed by international organisms (WHO, US EPA, ATSDR, OEHHA, RIVM, Health Canada, ANSES, EFSA, etc.) and used in order to quantify risk in safety risk assessments. These values are developed to protect human for acute (1-14 days), intermediate (several weeks) or chronic (all the life) exposure by both oral and inhalation routes. These values are elaborated for threshold effect or not depending on the mechanism of action of each substance. In its database 'chemicals portal', INERIS proposes tools for risk assessment corresponding to physico-chemical parameters, toxicological and ecotoxicological data for about 900 substances. Moreover, for the most usual environmental pollutants, summary of the key toxicological data and a choice of the most relevant TRV are established. Each TRV is analyzed for its quality taking into account the mechanism of action of the compound, the duration and the route of the exposure as previously described by Doornaert and Pichard (2006). If several values are availed the best one is preferred. If the quality is not judged sufficient the value is disallowed. But, in certain cases of effective risk, in order to protect populations these values have to be used by default. INERIS propose a set of choice of TRV for numerous usual environmental pollutants like organics (perchloroethylene, trichloroethylene, dichloroethylene, toluene, benzene, xylenes), or metals (cadmium, copper, cobalt). Actually the choice are performed for about forty substances. All results are publicly available on the database of INERIS 'chemicals portal' website: http://www.ineris.fr/substances/fr/

Short term exposures, proposal of a methodology

The development of threshold toxicity values for chemicals for human health is an essential step of health and safety risk assessments. A method based on the use of existing values and/or the development of new values has been developed for short term exposure period (1-14 days) for both oral and inhalation exposures. Some existing toxicological reference values (TRV) developed for those periods of exposure could be used. Guideline values could be an useful alternative when they were determined as TRV. If several values are available, the most appropriate value has to be chosen. This choice is performed by analysis of the quality of the key-study in relation to the period of short term exposure. The parameters for the building of the TRV are evaluated and benchmark approach is preferred than those using No Observed Effect Level (NOAEL) or Low Observed Effect Level (LOAEL). Then, each uncertainty factor is studied in relation to key-study, database and TRV construction. If only one value is available its quality is verified. Finally, in the absence of existing values, a new threshold value may be established by our method. This method is not applicable for carcinogenic effects. The method is an easy tool to use and allowed the selection of values checked qualitatively and considered in line with the most appropriate available scientific data. However, the methodology could be applied for the selection and the establishment of short term threshold values by public health actors

Le concept de collusion appliqué à l'industrie laitière canadienne

Rapport de rechercheNuméro de référence interne originel : a1.1 g 80

Identification of early effects induced in case of exceeding toxicological threshold value : A tool for risks manager for communication to exposed populations

When exposure levels exceed recommended toxicological threshold value, calculated to protect human from adverse effects, the conclusion of the risk assessment identifies a potential risk for the exposed population. The construction of these threshold values includes a margin of safety in order to cover uncertainties and extrapolations to be sufficiently protective over a lifetime. In practice, encountered situations include cases where, levels are just above recommend values corresponding to low level of exposure and the duration of exposure is usually between few months and 2–3 years. In this context, it could be useful to propose a new analysis of the data to give more effective tools to risk managers in order to communicate information to the population. We propose an analysis of all the data available and more especially those from epidemiologic studies, in the range of duration and level of exposure related, to this kind of events. The analysis is made taking into account the quality of the studies. Two substances are presented as two case-studies: perchloroethylene (tetrachloroethylene) and mercury (inorganic form). In both cases, first results show that changes of the neurologic parameters are the most sensitive effects. They have also underlined the lack of appropriate epidemiologic data and the difficulty to use experimental ones in this case. A schematic representation of all the data could bring an overview of the potential effects of the substance. This representation could be easily analyzed by risk managers and useful for the communication to exposed population

Participants' data

Participants' dat