Les facteurs de risque de la naissance prématurée en Guyane Française

Context and objective: French Guiana, an overseas department and region, has nearly 8,000 births per year.Since 1992, the proportion of premature births, although stable, has remained high at around 13.5%, almost double that of France (7%) (data from the Pregnancy Outcome Register and national perinatal survey). While in most countries we see an increase in prematurity, we could, wrongly, be satisfied with a non-increase in the prematurity rate that would reflect progress. However, deaths from perinatal causes remain one of the main causes of premature mortality in French Guiana and partly explain the gap with France in terms of life expectancy at birth.Given this lack of improvement in the prematurity rate, it seems important to better understand the factors that make prematurity so frequent and so difficult to control in French Guiana. The thesis focused on identifying the predictive factors of prematurity with the ultimate aim of contributing to improving the care of pregnant women and curbing the curve of the prematurity rate. Methodology: This research work is divided into 4 areas of investigation:- A descriptive retrospective study, based on data from the RIGI (Register of Computerized Pregnancy Outcomes) 2013-2014 of 12,983 viable births in the department,- The development of a predictive prematurity score from the 2013-2014 RIGI, compared to the 2015 RIGI data of 6,914 viable births,- A case-control etiological study of extreme prematurity, monocentric, from February 2016 to January 2017 in the only type III health-care institution in the French Guiana Region,- Analysis of the average term at birth and morbidity and mortality from the RIG (Register of Pregnancy Outcomes) 2002-2007 of 35,648 viable births and the RIGI 2013-2014.Results:Over the study period, the proportion of preterm births was 13.5% (1,755/12,983). The proportion of spontaneous prematurity was 51.3% , compared to 48.7% of induced prematurity. More than half (57.2% or 7 421/12 983) of the study population had social security, but 9.3% had no social security coverage. The lack of social security coverage was a risk factor for prematurity with an adjusted OR of 1.9 CI at 95% [1.6-2.3] p=0.0001. Similarly, with regard to pregnancy management, the absence of prenatal care as well as that of birth preparation would double the risk of premature birth. For pathologies associated with pregnancy, pre-eclampsia syndrome was the main dysgravidia associated with the risk of prematurity (OR adjusted by 6.7[95% CI =5.6-8.1] p=0.0001). Finally, the fairly common hypothesis that part of the high prematurity rate is related to the fact that black babies are more mature and black mothers give birth physiologically a little earlier did not emerge in our analyses. Indeed, there was no statistically significant difference in morbidity and mortality for infants born to Afro-Caribbean mothers and Caucasian women. Conclusion: The work carried out has identified many factors associated with prematurity, factors already described elsewhere. Although at the individual level it was impossible to predict who would give birth prematurely, the weight of social factors and poor follow-up suggested that a population-based approach might be appropriate. Thus, the most vulnerable women often reside in well-identified areas that could be the subject of targeted actions to improve follow-up and identify complications. This problem of social inequalities in health goes well beyond prematurity and is found for almost all pathologies, suggesting that there are synergies to be sought and that the population scale is undoubtedly strategic. The weight of preeclampsia as a risk factor for induced prematurity in French Guiana raises questions: indeed, it seems much more important than elsewhere for reasons that remain to be clarified.Contexte et objectif : La Guyane Française, département-région d’outre-mer, compte près de 8 000 naissances par année.Depuis 1992, la proportion de naissances prématurées y est importante aux alentours de 13,5% ; soit presque le double de celle de la France (7%). Contrairement à la plupart des pays où une augmentation de la prématurité est observée, en Guyane, son taux est stable. Certes, on pourrait se satisfaire de cette non-augmentation, cependant, les décès liés à la périnatalité restent l’une des principales causes de mortalité prématurée dans ce département. Si en Guyane, le taux de prématurité n’augmente pas, il ne régresse pas non plus. Devant cette absence de régression, il semble important de comprendre les facteurs qui font qu’en Guyane, la prématurité reste si fréquente et si difficile à endiguer. Méthodologie : Ce travail de recherche se décline en quatre axes d'investigations : Une étude rétrospective descriptive, à partir des données du RIGI (Registre d’Issue de Grossesses Informatisé) 2013-2014 de 12 983 naissances viables du département. L’élaboration d’un score prédictif de prématurité à partir du RIGI 2013-2014, confronté aux données du RIGI 2015 de 6 914 naissances viables. Une étude étiologique cas-témoins de la grande prématurité, monocentrique, de Février 2016 à Janvier 2017 dans l’unique établissement de santé de type III de la Région. Enfin, l’analyse du terme moyen à la naissance et de la morbi-mortalité à partir du RIG (Registre d’Issue de Grossesses) 2002-2007 de 35 648 naissances viables et du RIGI 2013-2014. Résultats :Sur la période d’étude, la proportion de naissances prématurées était de 13,5% (1 755/12 983). La proportion de prématurité spontanée et induite était respectivement de 51,3% et 48,7% selon le RIGI 2013-2014.Plus de la moitié (57,2%) de la population d’étude bénéficiait de la sécurité sociale, néanmoins 9,3% (1 211/12 983) n’avait aucune couverture sociale. L’absence de couverture sociale représentait un facteur de risque de prématurité avec un OR ajusté de 1,9 IC à 95% [1,6-2,3] p=0,0001. De même, l’absence d’entretien prénatal tout comme celui de préparation à la naissance multiplieraient par deux le risque de naissance prématurée. D’autre part, le syndrome pré-éclamptique était la principale dysgravidie associée au risque de prématurité (OR ajusté de 6,7 [IC 95% =5,6-8,1] p=0,001). Enfin, l’hypothèse assez répandue, suggérant qu’une partie du taux de prématurité élevée serait liée du fait que les bébés « noirs » seraient plus matures et que les mères « noires » d’ascendance afro-caraibéenne accoucheraient physiologiquement plus tôt, ne ressortait pas dans nos analyses. En effet, il n’y avait pas de différence statistiquement significative de morbi-mortalité pour les nouveau-nés de mères d’origine afro-caribéennes et ceux de femmes caucasiennes.Conclusion : Les travaux réalisés ont retrouvé nombre de facteurs associés à la prématurité, pour certains déjà décrits par ailleurs. Bien qu’à l’échelle individuelle, il était impossible de prédire qui accoucherait prématurément, le poids des facteurs sociaux et du mauvais suivi de grossesse, suggéraient qu’une approche populationnelle pourrait être pertinente. Ainsi les femmes les plus vulnérables résidaient souvent dans des zones bien identifiées qui pourraient faire l’objet d’actions ciblées pour améliorer le suivi et dépister les complications. Cette problématique d’inégalités sociales de santé va bien au-delà de la prématurité et se retrouve pour presque toutes les pathologies, ce qui suggère qu’il y a des synergies à rechercher et que l’échelle populationnelle est sans doute stratégique. Le poids du syndrome pré-éclamptique comme facteur de risque de prématurité induite en Guyane pose question, il semble nettement plus important qu’ailleurs pour des raisons qui restent à élucider

Risk factors for premature birth in French Guiana

Contexte et objectif : La Guyane Française, département-région d’outre-mer, compte près de 8 000 naissances par année.Depuis 1992, la proportion de naissances prématurées y est importante aux alentours de 13,5% ; soit presque le double de celle de la France (7%). Contrairement à la plupart des pays où une augmentation de la prématurité est observée, en Guyane, son taux est stable. Certes, on pourrait se satisfaire de cette non-augmentation, cependant, les décès liés à la périnatalité restent l’une des principales causes de mortalité prématurée dans ce département. Si en Guyane, le taux de prématurité n’augmente pas, il ne régresse pas non plus. Devant cette absence de régression, il semble important de comprendre les facteurs qui font qu’en Guyane, la prématurité reste si fréquente et si difficile à endiguer. Méthodologie : Ce travail de recherche se décline en quatre axes d'investigations : Une étude rétrospective descriptive, à partir des données du RIGI (Registre d’Issue de Grossesses Informatisé) 2013-2014 de 12 983 naissances viables du département. L’élaboration d’un score prédictif de prématurité à partir du RIGI 2013-2014, confronté aux données du RIGI 2015 de 6 914 naissances viables. Une étude étiologique cas-témoins de la grande prématurité, monocentrique, de Février 2016 à Janvier 2017 dans l’unique établissement de santé de type III de la Région. Enfin, l’analyse du terme moyen à la naissance et de la morbi-mortalité à partir du RIG (Registre d’Issue de Grossesses) 2002-2007 de 35 648 naissances viables et du RIGI 2013-2014. Résultats :Sur la période d’étude, la proportion de naissances prématurées était de 13,5% (1 755/12 983). La proportion de prématurité spontanée et induite était respectivement de 51,3% et 48,7% selon le RIGI 2013-2014.Plus de la moitié (57,2%) de la population d’étude bénéficiait de la sécurité sociale, néanmoins 9,3% (1 211/12 983) n’avait aucune couverture sociale. L’absence de couverture sociale représentait un facteur de risque de prématurité avec un OR ajusté de 1,9 IC à 95% [1,6-2,3] p=0,0001. De même, l’absence d’entretien prénatal tout comme celui de préparation à la naissance multiplieraient par deux le risque de naissance prématurée. D’autre part, le syndrome pré-éclamptique était la principale dysgravidie associée au risque de prématurité (OR ajusté de 6,7 [IC 95% =5,6-8,1] p=0,001). Enfin, l’hypothèse assez répandue, suggérant qu’une partie du taux de prématurité élevée serait liée du fait que les bébés « noirs » seraient plus matures et que les mères « noires » d’ascendance afro-caraibéenne accoucheraient physiologiquement plus tôt, ne ressortait pas dans nos analyses. En effet, il n’y avait pas de différence statistiquement significative de morbi-mortalité pour les nouveau-nés de mères d’origine afro-caribéennes et ceux de femmes caucasiennes.Conclusion : Les travaux réalisés ont retrouvé nombre de facteurs associés à la prématurité, pour certains déjà décrits par ailleurs. Bien qu’à l’échelle individuelle, il était impossible de prédire qui accoucherait prématurément, le poids des facteurs sociaux et du mauvais suivi de grossesse, suggéraient qu’une approche populationnelle pourrait être pertinente. Ainsi les femmes les plus vulnérables résidaient souvent dans des zones bien identifiées qui pourraient faire l’objet d’actions ciblées pour améliorer le suivi et dépister les complications. Cette problématique d’inégalités sociales de santé va bien au-delà de la prématurité et se retrouve pour presque toutes les pathologies, ce qui suggère qu’il y a des synergies à rechercher et que l’échelle populationnelle est sans doute stratégique. Le poids du syndrome pré-éclamptique comme facteur de risque de prématurité induite en Guyane pose question, il semble nettement plus important qu’ailleurs pour des raisons qui restent à élucider.Context and objective: French Guiana, an overseas department and region, has nearly 8,000 births per year.Since 1992, the proportion of premature births, although stable, has remained high at around 13.5%, almost double that of France (7%) (data from the Pregnancy Outcome Register and national perinatal survey). While in most countries we see an increase in prematurity, we could, wrongly, be satisfied with a non-increase in the prematurity rate that would reflect progress. However, deaths from perinatal causes remain one of the main causes of premature mortality in French Guiana and partly explain the gap with France in terms of life expectancy at birth.Given this lack of improvement in the prematurity rate, it seems important to better understand the factors that make prematurity so frequent and so difficult to control in French Guiana. The thesis focused on identifying the predictive factors of prematurity with the ultimate aim of contributing to improving the care of pregnant women and curbing the curve of the prematurity rate. Methodology: This research work is divided into 4 areas of investigation:- A descriptive retrospective study, based on data from the RIGI (Register of Computerized Pregnancy Outcomes) 2013-2014 of 12,983 viable births in the department,- The development of a predictive prematurity score from the 2013-2014 RIGI, compared to the 2015 RIGI data of 6,914 viable births,- A case-control etiological study of extreme prematurity, monocentric, from February 2016 to January 2017 in the only type III health-care institution in the French Guiana Region,- Analysis of the average term at birth and morbidity and mortality from the RIG (Register of Pregnancy Outcomes) 2002-2007 of 35,648 viable births and the RIGI 2013-2014.Results:Over the study period, the proportion of preterm births was 13.5% (1,755/12,983). The proportion of spontaneous prematurity was 51.3% , compared to 48.7% of induced prematurity. More than half (57.2% or 7 421/12 983) of the study population had social security, but 9.3% had no social security coverage. The lack of social security coverage was a risk factor for prematurity with an adjusted OR of 1.9 CI at 95% [1.6-2.3] p=0.0001. Similarly, with regard to pregnancy management, the absence of prenatal care as well as that of birth preparation would double the risk of premature birth. For pathologies associated with pregnancy, pre-eclampsia syndrome was the main dysgravidia associated with the risk of prematurity (OR adjusted by 6.7[95% CI =5.6-8.1] p=0.0001). Finally, the fairly common hypothesis that part of the high prematurity rate is related to the fact that black babies are more mature and black mothers give birth physiologically a little earlier did not emerge in our analyses. Indeed, there was no statistically significant difference in morbidity and mortality for infants born to Afro-Caribbean mothers and Caucasian women. Conclusion: The work carried out has identified many factors associated with prematurity, factors already described elsewhere. Although at the individual level it was impossible to predict who would give birth prematurely, the weight of social factors and poor follow-up suggested that a population-based approach might be appropriate. Thus, the most vulnerable women often reside in well-identified areas that could be the subject of targeted actions to improve follow-up and identify complications. This problem of social inequalities in health goes well beyond prematurity and is found for almost all pathologies, suggesting that there are synergies to be sought and that the population scale is undoubtedly strategic. The weight of preeclampsia as a risk factor for induced prematurity in French Guiana raises questions: indeed, it seems much more important than elsewhere for reasons that remain to be clarified

Risk factors for premature birth in French Guiana: the importance of reducing health inequalities

International audienceObjectives: French Guiana has the highest birth rate in South America. This French territory alsohas the highest premature birth rate and perinatal mortality rate of all French territories. Theobjective was to determine the premature birth rate and to identify the prevalence of risk factorsof premature birth in French Guiana.Methods: A retrospective study of all births in French Guiana was conducted between January2013 and December 2014 using the computerized registry compiling all live births over 22weeks of gestation on the territory.Results: During this period 12 983 live births were reported on the territory. 13.5% of newbornswere born before 37 (1755/12 983). The study of the registry revealed that common sociodemographicrisk factors of prematurity were present. In addition, past obstetrical history was alsoimportant: a scarred uterus increased the risk of prematurity adjusted odds ratio ¼1.4, 95%CI(1.2–1.6). Similarly, obstetrical surveillance, the absence of preparation for birth or of prenatalinterview increased the risk of prematurity by 2.4 and 2.3, the excess fraction in the populationwas 69% and 72.2%, respectively.Conclusions: Known classical risk factors are important. In the present study excess fractionswere calculated in order to prioritize interventions to reduce the prematurity rate

Risk Factors for Very Preterm Births in French Guiana: The Burden of Induced Preterm Birth

Abstract Background Early preterm births are still represented as a major public health problem in French Guiana. The objective of the present study was to study factors associated with early preterm birth in French Guiana. Methods A monocentric age-matched case control study was conducted at the sole level 3 maternity in French Guiana. In utero fetal deaths and multiple pregnancies were not included. Cases were defined as giving birth prematurely between 22 and 32 weeks of pregnancy. Controls were defined as women delivering on term. For each case three controls were matched on age. In utero deaths, medical pregnancy interruptions and multiple pregnancies (a known major cause of preterm delivery) were excluded from the study. Sociodemographic variables, medical and obstetrical history, the complications of the current pregnancy, and the results of the last vaginal swab before delivery were recorded in the second or the third trimester. Thematic conditional logistic regression models were computed. Results Overall 94 cases and 282 matched controls were included. Preterm delivery was spontaneous in 47.9% (45/94) of the cases and induced in 52.1% (49/94).A history of preterm birth was associated with both spontaneous and induced preterm delivery. The absence of health insurance was associated with spontaneous early preterm delivery AOR (adjusted odd ratio) = 9.1 (2.2–38.3), p = 0.002 but not induced preterm delivery adjusted odd ratio (AOR) = 2.1 (0.6–6.7), p = 0.2. Gravidic hypertension, placenta praevia, intrauterine growth retardation and mostly preeclampsia (66%, 32/49) were linked to induced preterm delivery but not spontaneous delivery. Gardnerellavaginalis and group B Streptococcus infections were significantly associated with induced early preterm delivery but not spontaneous early preterm delivery. Conclusions Social factors were associated with spontaneous early preterm delivery, suggesting that efforts to reduce psychosocial stressors could lead to potential improvements. Vaginal infections were also associated with induced preterm labor suggesting that early diagnosis and treatment could reduce induced early preterm delivery. Preeclampsia was a major contributor to induced early preterm delivery. Reliable routine predictors of preeclampsia are still not available which makes its prevention impossible in first pregnancies

Small for Gestational Age Newborns in French Guiana: The Importance of Health Insurance for Prevention

International audienceObjectives: Small for gestational age (SGA) newborns have a higher risk of poor outcomes. French Guiana (FG) is a territory in South America with poor living conditions. The objectives of this study were to describe risk factors associated with SGA newborns in FG. Methods : We used the birth cohort that compiles data from all pregnancies that ended in FG from 2013 to 2021. We analysed data of newborns born after 22 weeks of gestation and/or weighing more than 500 g and their mothers. Results: 67,962 newborns were included. SGA newborns represented 11.7% of all newborns. Lack of health insurance was associated with SGA newborns ( p < 0.001) whereas no difference was found between different types of health insurance and the proportion of SGA newborns ( p = 0.86). Mothers aged less than 20 years (aOR = 1.65 [1.55–1.77]), from Haiti (aOR = 1.24 [1.11–1.39]) or Guyana (aOR = 1.30 [1.01–1.68]) and lack of health insurance (aOR = 1.24 [1.10–1.40]) were associated with SGA newborns. Conclusion: Immigration and precariousness appear to be determinants of SGA newborns in FG. Other studies are needed to refine these results