'Non-Mendelian' genetics of fetal growth

International audienceMendelian genetics showed that a few mutated genes, or errors in parental imprinting, can lead to major phenotypic changes (diseases) in pre-natal growth. Mendelian genetics, however, do not explain the individual subtle variability of size at birth within the normal range. Fetal growth is a complex multifactorial, multigenic trait made of various sub-traits, such as body mass, fat and muscle, brain mass, head circumference, skeletal growth of the spine and limbs. It is likely that multiple genetic factors and genomic variants are responsible for the variations of these sub-traits. A study has been launched to investigate the genetics of the variation of human birth weight, with the ultimate aim of identifying genomic variations that are within or near certain genes and are associated with variations of human height and weight at birth

Meta-Analysis of Maternal and Neonatal Outcomes Associated with the Use of Insulin Glargine versus NPH Insulin during Pregnancy

As glargine, an analog of human insulin, is increasingly used during pregnancy, a meta-analysis assessed its safety in this population. A systematic literature search identified studies of gestational or pregestational diabetes comparing use of insulin glargine with human NPH insulin, with at least 15 women in both arms. Data was extracted for maternal outcomes (weight at delivery, weight gain, 1st/3rd trimester HbA1c, severe hypoglycemia, gestation/new-onset hypertension, preeclampsia, and cesarean section) and neonatal outcomes (congenital malformations, gestational age at delivery, birth weight, macrosomia, LGA, 5 minute Apgar score >7, NICU admissions, respiratory distress syndrome, neonatal hypoglycemia, and hyperbilirubinemia). Relative risk ratios and weighted mean differences were determined using a random effect model. Eight studies of women using glargine (331) or NPH (371) were analyzed. No significant differences in the efficacy and safety-related outcomes were found between glargine and NPH use during pregnancy

Prevalence and incidence of postpartum depression and environmental factors: the IGEDEPP cohort

Background: IGEDEPP (Interaction of Gene and Environment of Depression during PostPartum) is a prospective multicenter cohort study of 3,310 Caucasian women who gave birth between 2011 and 2016, with follow-up until one year postpartum. The aim of the current study is to describe the cohort and estimate the prevalence and cumulative incidence of early and late postpartum depression (PPD). Methods: Socio-demographic data, personal and family psychiatric history, as well as stressful life events during childhood and pregnancy were evaluated at baseline. Early and late PPD were assessed at 8 weeks and 1 year postpartum respectively, using DSM-5 criteria. Results: The prevalence of early PPD was 8.3% (95%CI 7.3-9.3), and late PPD 12.9% (95%CI 11.5-14.2), resulting in an 8-week cumulative incidence of 8.5% (95%CI 7.4-9.6) and a one-year cumulative incidence of PPD of 18.1% (95%CI: 17.1-19.2). Nearly half of the cohort (N=1571, 47.5%) had a history of at least one psychiatric or addictive disorder, primarily depressive disorder (35%). Almost 300 women in the cohort (9.0%) reported childhood trauma. During pregnancy, 47.7% women experienced a stressful event, 30.2% in the first 8 weeks and 43.9% between 8 weeks and one year postpartum. Nearly one in five women reported at least one stressful postpartum event at 8 weeks. Conclusion: Incident depressive episodes affected nearly one in five women during the first year postpartum. Most women had stressful perinatal events. Further IGEDEPP studies will aim to disentangle the impact of childhood and pregnancy-related stressful events on postpartum mental disorders.Comment: 34 pages, 6 table

Pronostic périnatal du 2 jumeau selon les combinaisons tête-tête et tête-siège

PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Issues de grossesse en cas de diabète de type 1 avec néphropathie

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocSudocFranceF

Toxicité cardiaque des inhibiteurs calciques chez la femme enceinte

PARIS-BIUP (751062107) / SudocSudocFranceF

Problématique actuelle du placenta praevia

Objectif: Étude descriptive d une cohorte de patientes avec placenta praevia (PP) à l accouchement. Evaluer les conséquences de l absence de diagnostic prénatal de PP et du caractère recouvrant ou non sur la morbidité maternelle et néonatale. Matériel et méthodes: Étude rétrospective réalisée de Janvier 2000 à Octobre 2009 à la maternité de Saint-Vincent-de-Paul portant sur 149 patientes avec un diagnostic de PP à l accouchement. Résultats: Dix pour cents des PP n ont pas été diagnostiqués en prénatal. Le taux de prématurité inférieure à 37 semaines d aménorrhée (SA) était de 40%, et de 15% < 32 SA. L absence de diagnostic prénatal de PP était associée à une augmentation de la durée d hospitalisation en suites de couches (8 vs. 6 jours, p=.01) et de la déglobulisation perpartum (chute de l hémoglobine 2.9 vs. 1.7 g/dl, p=.01). Cinquante quatre pour cents des PP étaient recouvrants. Un PP recouvrant était associé à une augmentation de la durée d hospitalisation prénatale (19.7 +- 20.1 vs. 10.4 +- 14.0 jours, p=.001) et à une diminution de la prématurité < 32 SA (9% vs. 22%, p=.03). Conclusion: La prématurité associée au PP reste élevée. L erreur diagnostique de l insertion praevia n entraîne pas de conséquences majeures sur la morbidité maternelle et néonatale. Les grossesses compliquées d un PP recouvrant ont un pronostic maternel et périnatal qui diffère peu de celui des grossesses avec un PP non recouvrant excepté un taux plus faible de grands prématurés.Objective: Descriptive study of a cohort of women with placenta previa (PP) at birth. To access the consequences of the absence of prenatal diagnosis of PP and of complete PP on maternal and neonatal morbidity. Materials and methods: Retrospective study conducted from January 2000 to October 2009 in the maternity ward of St. Vincent de Paul on 149 patients diagnosed with PP at delivry. Results: Ten percent of PP have not been diagnosed prenatally. The rate of preterm delivry less than 37 weeks of gestation (WG) was 40% and 15% <32 WG. The absence of prenatal diagnosis of PP was associated with increased length of postpartum hospitalization (8 vs. 6 days, p =. 01) and perpartum déglobulisation (fall in hemoglobin 2.9 vs 1.7 g / dl, p =. 01). Fifty four percent of PP was completed. A complete PP was associated with an increased length of prenatal hospitalization (19.7 +- 20.1 vs. 10.4 +- 14.0 days, p =. 001) and reduced prematurity <32 WG (9% vs. 22%, p =. 03). Conclusion: Prematurity associated with PP remains high. The misdiagnosis of PP does not cause a major impact on maternal and neonatal morbidity. Pregnancies complicated by a complete PP have maternal and perinatal prognosis that differs little from that of pregnancies with non-complete PP except for a lower rate of very preterm infants.ST QUENTIN EN YVELINES-BU (782972101) / SudocSudocFranceF

'Non-Mendelian' genetics of fetal growth

International audienceMendelian genetics showed that a few mutated genes, or errors in parental imprinting, can lead to major phenotypic changes (diseases) in pre-natal growth. Mendelian genetics, however, do not explain the individual subtle variability of size at birth within the normal range. Fetal growth is a complex multifactorial, multigenic trait made of various sub-traits, such as body mass, fat and muscle, brain mass, head circumference, skeletal growth of the spine and limbs. It is likely that multiple genetic factors and genomic variants are responsible for the variations of these sub-traits. A study has been launched to investigate the genetics of the variation of human birth weight, with the ultimate aim of identifying genomic variations that are within or near certain genes and are associated with variations of human height and weight at birth

Intrahepatic cholestasis of pregnancy: Is a screening for differential diagnoses necessary?

International audienceObjective: To evaluate the benefit of performing a screening for differential diagnoses by hepatobiliary ultrasound and viral serologies, in case of suspected intrahepatic cholestasis of pregnancy (ICP).Methods: Retrospective single-center study in a tertiary maternity unit, including all women with a suspected ICP between January 2012 and September 2018. The primary outcome was the differential diagnosis rate obtained through initial screening. We described women characteristics, symptoms, and blood results that led to ICP suspicion. We evaluated the rate of differential diagnosis established by the initial screening. We described the population of women presenting with an ICP differential diagnosis.Results: The study included 254 women. Prevalence of differential diagnosis was 2 %. ICP was suspected in more than 50 % of cases in third trimester of pregnancy (79.5 %). Women presented with pruritus in 90.9 % of cases. Bile acid levels were between 20 and 40 μmol/L in 56.3 % of cases and above 40 μmol/L in 12.2 % of cases. The screening to rule out differential diagnosis of ICP was performed in half of the cases. When performed, the screening did not lead to the diagnosis of any differential disease.Conclusion: In this cohort, among the 254 women, one (0.4 %) would have been wrongly diagnosed with ICP if the initial screening for differential diagnosis had not been performed. Screening for differential diagnosis does not seem to provide any benefit regarding the management of suspected ICP and could therefore only be performed in case of atypical clinical presentation of ICP, resistance to treatment or persisting abnormal liver function tests in the postpartum period