Diabetes and pregnancy:national trends over a 15 year period

Aims/hypothesis: We aimed to examine time trends in national perinatal outcomes in pregnancies complicated by pre-existing type 1 or type 2 diabetes. Methods: We analysed episode-level data on all obstetric inpatient delivery events (live or stillbirth) between 1 April 1998 and 31 March 2013 (n = 813,921) using the Scottish Morbidity Record (SMR02). Pregnancies to mothers with type 1 (n = 3229) and type 2 (n = 1452) diabetes were identified from the national diabetes database (Scottish Care Information-Diabetes), and perinatal outcomes were compared among women with type 1 diabetes, type 2 diabetes and those without diabetes. Results: The number of pregnancies complicated by diabetes increased significantly, by 44% in type 1 diabetes and 90% in type 2 diabetes, across the 15 years examined, to rates of 1 in 210 and 1 in 504 deliveries, respectively. Compared with women without diabetes, delivery occurred 2.6 weeks earlier (type 1 diabetes 36.7 ± 2.3 weeks) and 2 weeks earlier (type 2 diabetes 37.3 ± 2.4 weeks), respectively, showing significant reductions for both type 1 (from 36.7 weeks to 36.4 weeks, p = 0.03) and type 2 (from 38.0 weeks to 37.2 weeks, p < 0.001) diabetes across the time period. The proportions of preterm delivery were markedly increased in women with diabetes (35.3% type 1 diabetes, 21.8% type 2 diabetes, 6.1% without diabetes; p < 0.0001), and these proportions increased with time for both groups (p < 0.005). Proportions of elective Caesarean sections (29.4% type 1 diabetes, 30.5% type 2 diabetes, 9.6% without diabetes) and emergency Caesarean sections (38.3% type 1 diabetes, 29.1% type 2 diabetes, 14.6% without diabetes) were greatly increased in women with diabetes and increased over time except for stable rates of emergency Caesarean section in type 1 diabetes. Gestational age-, sex- and parity-adjusted z score for birthweight (1.33 ± 1.34; p < 0.001) were higher in type 1 diabetes and increased over time from 1.22 to 1.47 (p < 0.001). Birthweight was also increased in type 2 diabetes (0.94 ± 1.34; p < 0.001) but did not alter with time. There were 65 perinatal deaths in offspring of mothers with type 1 diabetes and 39 to mothers with type 2 diabetes, representing perinatal mortality rates of 20.1 (95% CI 14.7, 24.3) and 26.9 (16.7, 32.9) per 1000 births, respectively, and rates 3.1 and 4.2 times, respectively, those observed in the non-diabetic population (p < 0.001). Stillbirth rates in type 1 and type 2 diabetes were 4.0-fold and 5.1-fold that in the non-diabetic population (p < 0.001). Perinatal mortality and stillbirth rates showed no significant fall over time despite small falls in the rates for the non-diabetic population. Conclusions/interpretation: Women with diabetes are receiving increased intervention in pregnancy (earlier delivery, increased Caesarean section rates), but despite this, higher birthweights are being recorded. Improvements in rates of stillbirth seen in the general population are not being reflected in changes in stillbirth or perinatal mortality in our population with diabetes

Preconception Care in International Settings

Objectives: This literature review briefly describes international programs, policies, and activities related to preconception care and resulting pregnancy outcomes. Methods: Electronic databases were searched and findings supplemented with secondary references cited in the original articles as well as textbook chapters, declarations, reports, and recommendations. Results: Forty-two articles, book chapters, declarations, and other published materials were reviewed. Policies, programs, and recommendations related to preconceptional health promotion exist worldwide and comprise a readily identifiable component of historic and modern initiatives pertaining to women's health, reproductive freedom, and child survival. Conclusions: The integration of preconception care services within a larger maternal and child health continuum of care is well aligned with a prevention-based approach to enhancing global health

The ANTENATAL multicentre study to predict postnatal renal outcome in fetuses with posterior urethral valves: objectives and design

Abstract Background Posterior urethral valves (PUV) account for 17% of paediatric end-stage renal disease. A major issue in the management of PUV is prenatal prediction of postnatal renal function. Fetal ultrasound and fetal urine biochemistry are currently employed for this prediction, but clearly lack precision. We previously developed a fetal urine peptide signature that predicted in utero with high precision postnatal renal function in fetuses with PUV. We describe here the objectives and design of the prospective international multicentre ANTENATAL (multicentre validation of a fetal urine peptidome-based classifier to predict postnatal renal function in posterior urethral valves) study, set up to validate this fetal urine peptide signature. Methods Participants will be PUV pregnancies enrolled from 2017 to 2021 and followed up until 2023 in >30 European centres endorsed and supported by European reference networks for rare urological disorders (ERN eUROGEN) and rare kidney diseases (ERN ERKNet). The endpoint will be renal/patient survival at 2 years postnatally. Assuming α = 0.05, 1–β = 0.8 and a mean prevalence of severe renal outcome in PUV individuals of 0.35, 400 patients need to be enrolled to validate the previously reported sensitivity and specificity of the peptide signature. Results In this largest multicentre study of antenatally detected PUV, we anticipate bringing a novel tool to the clinic. Based on urinary peptides and potentially amended in the future with additional omics traits, this tool will be able to precisely quantify postnatal renal survival in PUV pregnancies. The main limitation of the employed approach is the need for specialized equipment. Conclusions Accurate risk assessment in the prenatal period should strongly improve the management of fetuses with PUV

Détermination numérique des mouvements d'un coin salé

Salt wedges are apt to form in river estuaries under certain flow conditions and eventually to extend several kilometres upstream. Where the river bed is fairly even and the tide not strong enough for sudden flow reversals to take place, there is little exchange between the two layers and an interface can be assumed to exist. Slight exchange does in fact frequently take place, however, and the interface can be defined as the locus of points at which the fluid density is the mean of those of the two layers. The problem is thus one of unsteady flow of two fluids of different densities with a free surface and an interface. The equations assuming gradually varying flows lead to a differential system comprising equations (7), (8), (10), (11), (14) and (15). Equation (23) gives the slopes of the four characteristics in each section and relationship (30) is satisfied on each characteristic. If condition (28) is satisfied the four characteristics are real and the problem is hyperbolic. Equation (23) enables the characteristics of the internal wave system to be distinguished from those of the external wave system ; relationship (29) gives an approximate value for the internal wave system slopes c. The considered region comprises an upstream part without a salt layer and a downstream part with the two layers one above the other ; the salt wedge front progressing at the same speed as the lower layer V1 comes between the two layers. The problem is solved numerically for the normal point with the aid of a Lax-wendroff explicit finite difference scheme. The characteristics are used at the ends of the integration domain, but as only those originating inside the domain are used, boundary conditions are required. A discharge/time or stage/time relationship is assumed upstream, and downstream (at the river mouth) a real surface variation relationship. If a second downstream condition is required, a critical section is assumed to become established at the mouth of the river. The steady flow conditions obtained by numerical integration of system (36) are taken as the initial conditions. A computation programme has been developed for a study of salt wedge movements in the Grand Rhône below Arles

Rapport II-3. Un modèle mathématique des courants dans une eau stratifiée en bicouche

There is a presentation of a calculation code by finished difference, in order to determine the two dimensions flow of a two layers stratified water. The solution scheme uses the fractional steps method. The authors give an application of such a calculation code to the case of Loch Ness, where the wind excitation has a frequency very close to the first natural frequency within the basin internal wave. The comparison with in situ measurements proves the model validity.Présentation d’un code de calcul en différences finies pour déterminer l’écoulement bidimensionnel d’un fluide stratifié en deux couches. Le schéma de résolution utilise la méthode des pas fractionnaires. Application de ce code de calcul au cas du Loch Ness où l’excitation par le vent a une fréquence proche de celle de la première fréquence propre en onde interne du bassin. La comparaison avec des mesures nature permet de justifier la validité du modèle.Boulot François, Benque J. P., Parot J. M. Rapport II-3. Un modèle mathématique des courants dans une eau stratifiée en bicouche. In: La mécanique des fluides et l'environnement. Prévision et maîtrise de la qualité de l'eau et de l'air. Compte rendu des quatorzièmes journées de l'hydraulique. Paris, 7-9 septembre 1976. Tome 1, 1977

Rapport V.4. Calcul tridimensionnel permanent de la dilution des rejets d’eau chaude en mer

A warm waters discharge into a sea stream is, from the point of view of fluids mechanics, a bearing throwing into a crossing stream with a free surface. This phenomenon is expressed thermically by a transport-diffusion equation and dynamically by Navier-Stokes’ equations as well as the continuity equation. From such a system of equations, that it is possible to simplify by the use of certain assumptions, is presented herein a permanent three dimensions model that allows the calculation of speed and temperature fields induced by such a discharge. Some examples of calculation and comparison with the experience are given for two cases : immerged discharge and surface discharge perpendicular to the stream.Un rejet d’eau chaude dans une mer à courant constitue du point de vue de la mécanique des fluides un jet portant dans un écoulement traversier à surface libre. Ce phénomène est décrit sur le plan thermique par une équation de transport-diffusion et sur celui de la dynamique par les équations de Navier-Stokes et l’équation de continuité. A partir de ce système qu’on simplifie par certaines hypothèses, nous présentons un modèle tridimensionnel permanent permettant de calculer les champs de vitesse et de température induits par une tel rejet. Des exemples de calcul et de comparaison avec l’expérience sont donnés, pour les cas d’un rejet immergé et d’un rejet en surface perpendiculaires au courant.Boulot F., Benque J. P., Viollet Pierre-Louis. Rapport V.4. Calcul tridimensionnel permanent de la dilution des rejets d’eau chaude en mer. In: La mécanique des fluides et l'environnement. Prévision et maîtrise de la qualité de l'eau et de l'air. Compte rendu des quatorzièmes journées de l'hydraulique. Paris, 7-9 septembre 1976. Tome 2, 1977

Place de l’accompagnement psychologique dans les CPDPN de France : état des lieux

International audienceAIM:Create a record of the role given to members of the psychological professions in CPDPN Centers (multidisciplinary prenatal diagnosis). After more than 10 years in operation, describe the work methods of the different centers and their members, evaluate the possible diversity of practices and clarify the scope of interventions used by psychologists with patients and members of the CPDPN.METHOD:A descriptive survey consisting of 71 questions sent to psychologists, paediatricians and psychiatrists involved with the 48 CPDPN Centers in France. The main parameters studied are the means used by the CPDPN and their organization in the field of psychology, pre-medical counseling for the termination of pregnancy (IMG), conditions of hospitalization and post-IMG counseling.RESULTS:The survey revealed a high-level of homogeneous practices in the French CPDPN Centers between members of the medical and psychological professions, through joint consultations, ethical committees or specific case meetings for complex fetal pathologies.CONCLUSIONS AND PERSPECTIVES:This study has established a working relationship between members of the psychological professions working in the French CPDPN Centers and has led to the creation of a listing/directory, which facilitates the exchange of information. Video-conferencing is currently being considered in order to share respective practices

Conductrices d’hémophilie : expérience d’un CHRU en France

International audienceOBJECTIVES:To report the management of carriers of haemophilia in a French university hospital and assess different issues of these patients.PATIENTS AND METHODS:Retrospective study of the carriers of haemophilia who consulted at the university hospital of Montpellier, France, between 1995 and 2011. Information were obtained from medical records and from a questionnaire sent to carriers. We recorded data about biological characteristics, bleeding tendency and management of pregnancies.RESULTS:Sixty-four carriers of haemophilia A or B were included. Their median FVIII or FIX level was 52 % (range, 15-137 %). Menstrual bleeding lasted more than 7 days in 31 % of carriers. A total of 142 pregnancies started in 54 carriers, and 101 resulted in live births with 26 boys with haemophilia. Sixty-two prenatal diagnoses carried out, 15 have terminated their pregnancy because of a hemophiliac male fetus. Seventy-six percent of deliveries were vaginal delivery and 49 % took place in a level-3 maternity. There were 10.8 % and 8.5 % primary and secondary post-partum hemorrhage, respectively.CONCLUSION:The risk of bleeding among carriers of haemophilia is associated with their antihemophilic factor level. To improve the management of carriers, a multidisciplinary and standardized medical record, with a specific questionnaire to evaluate bleedings, could be considered. A regional register that lists all carriers, regardless of their antihemophilic factor level, would also be useful