Maternal Blood Lead Levels and the Risk of Pregnancy-Induced Hypertension: The EDEN Cohort Study

International audienceBACKGROUND: Prior studies revealed associations of environmental lead exposure with risks of hypertension and elevated blood pressure. OBJECTIVE: We examined the effect of blood lead levels on blood pressure and the incidence of pregnancy-induced hypertension (PIH) in the second and third trimesters of pregnancy. METHODS: One thousand seventeen pregnant women were enrolled in two French municipalities between 2003 and 2005 for the EDEN (Etude des Déterminants pré et post natals du développement et de la santé de l' Enfant) cohort study. Blood lead concentrations were measured by atomic absorption spectrometry in mothers between 24 and 28 weeks of gestation. RESULTS: PIH was diagnosed in 106 subjects (10.9%). Age, parity, weight gain, alcohol, smoking habits, and calcium supplementation were comparable between hypertensive and nonhypertensive women. Lead levels were significantly higher in PIH cases (mean +/- SD, 2.2 +/- 1.4 mug/dL) than in normotensive patients (1.9 +/- 1.2 mug/dL; p = 0.02). Adjustment for potential confounder effects slightly attenuated but did not eliminate the significant association between blood lead levels and the risk of PIH (adjusted odds ratio of PIH = 3.3; 95% confidence interval, 1.1-9.7). We also observed geographic differences in lead exposure and in the incidence of PIH and found significant correlations between blood lead levels and unadjusted as well as adjusted systolic and diastolic blood pressures after 24 weeks of gestation. CONCLUSIONS: These findings confirm the relationship between blood lead levels at mid-pregnancy and blood pressure and suggest that environmental lead exposure may play an etiologic role in PIH

Maternal Personal Exposure to Airborne Benzene and Intrauterine Growth

International audienceBACKGROUND: Studies relying on outdoor pollutants measures have reported associations between air pollutants and birth weight. OBJECTIVE: Our aim was to assess the relation between maternal personal exposure to airborne benzene during pregnancy and fetal growth. METHODS: We recruited pregnant women in two French maternity hospitals in 2005-2006 as part of the EDEN mother-child cohort. A subsample of 271 nonsmoking women carried a diffusive air sampler for a week during the 27th gestational week, allowing assessment of benzene exposure. We estimated head circumference of the offspring by ultrasound measurements during the second and third trimesters of pregnancy and at birth. RESULTS: Median benzene exposure was 1.8 microg/m(3) (5th, 95th percentiles, 0.5, 7.5 microg/m(3)). Log-transformed benzene exposure was associated with a gestational age-adjusted decrease of 68 g in mean birth weight [95% confidence interval (CI), -135 to -1 g] and of 1.9 mm in mean head circumference at birth (95% CI, -3.8 to 0.0 mm). It was associated with an adjusted decrease of 1.9 mm in head circumference assessed during the third trimester (95% CI, -4.0 to 0.3 mm) and of 1.5 mm in head circumference assessed at the end of the second trimester of pregnancy (95% CI, -3.1 to 0 mm). CONCLUSIONS: Our prospective study among pregnant women is one of the first to rely on personal monitoring of exposure; a limitation is that exposure was assessed during 1 week only. Maternal benzene exposure was associated with decreases in birth weight and head circumference during pregnancy and at birth. This association could be attributable to benzene and a mixture of associated traffic-related air pollutants

Maternal exposure to air pollution before and during pregnancy related to changes in newborn's cord blood lymphocyte subpopulations. The EDEN study cohort

<p>Abstract</p> <p>Background</p> <p>Toxicants can cross the placenta and expose the developing fetus to chemical contamination leading to possible adverse health effects, by potentially inducing alterations in immune competence. Our aim was to investigate the impacts of maternal exposure to air pollution before and during pregnancy on newborn's immune system.</p> <p>Methods</p> <p>Exposure to background particulate matter less than 10 μm in diameter (PM₁₀) and nitrogen dioxide (NO₂) was assessed in 370 women three months before and during pregnancy using monitoring stations. Personal exposure to four volatile organic compounds (VOCs) was measured in a subsample of 56 non-smoking women with a diffusive air sampler during the second trimester of pregnancy. Cord blood was analyzed at birth by multi-parameter flow cytometry to determine lymphocyte subsets.</p> <p>Results</p> <p>Among other immunophenotypic changes in cord blood, decreases in the CD4+CD25+ T-cell percentage of 0.82% (p = 0.01), 0.71% (p = 0.04), 0.88% (p = 0.02), and 0.59% (p = 0.04) for a 10 μg/m³increase in PM₁₀levels three months before and during the first, second and third trimester of pregnancy, respectively, were observed after adjusting for confounders. A similar decrease in CD4+CD25+ T-cell percentage was observed in association with personal exposure to benzene. A similar trend was observed between NO₂exposure and CD4+CD25+ T-cell percentage; however the association was stronger between NO₂exposure and an increased percentage of CD8+ T-cells.</p> <p>Conclusions</p> <p>These data suggest that maternal exposure to air pollution before and during pregnancy may alter the immune competence in offspring thus increasing the child's risk of developing health conditions later in life, including asthma and allergies.</p

Suivi des grossesses et des accouchements des patientes sous traitement anticoagulant à la maternité régionale A. Pinard de Nancy

[Résumé en français]Nous avons effectué une étude descriptive rétrospective de la grossesse et de l'accouchement chez 75 patientes ayant bénéficié d'un traitement anticoagulant.Les indications, les modalités du traitement anticoagulant ont été comparés aux recommandations de l'Agence Nationale d'Accréditation et d'Evaluation en Santé et de la Société Française d'Anesthésie et de Réanimation. Les complications ont été recensées ; l'accouchement et le mode d'anesthésie de ces patientes ont été décrits. Les héparines de bas poids moléculaires (HBPM) ont été utilisées chez 90.33% de nos patientes. Le taux de complications relevées ne semble pas augmenté par rapport à la population témoin. Pour les patientes traitées par faible dose d'HBPM, la césarienne ou le déclenchement de travail sont programmés autour de 39SA, 24h après l'arrêt des HBPM. Nous n'avons pas relevé d'augmentation des taux de complications, de césarienne ou d'accouchement sans anesthésie péri-médullaire. La gestion de l'accouchement et du traitement anticoagulant des patientes traitées par doses élevées d'anticoagulant est plus délicate et révèle une grande hétérogénéité de nos pratiques. Chez 32% des patientes, le traitement ne répondait pas aux indications et modalités décrites par les recommandations de références. Malgré un taux de complications acceptable, ce pourcentage nous oblige à réfléchir à nos pratiques cliniques et à la diffusion de ces recommandations.[Résumé en anglais]This is a descriptive retrospective study of 75 women who received anticoagulant therapy during their pregnancy. Indications, modalities of anticoagulant therapy have been compared to French recommendations. Complications of this anticoagulant therapy have been carefully notified and deliveries and anesthesia procedures have been described. Low Molecular Weight Heparins (LMWH) was used in 90.33% of ours patients. The rate of complications with LMWH use during pregnancy was not higher than for controls. LMWH are discontinued 24 hours before labor induction or cesarean section and no substitution for unfractionned heparin is made for patients receiving low-dose of LMWH. This method is safe and rates of complications, cesare an sections and deliveries without anesthesia are not increased. For women treated with adjusted doses of anticoagulants, management of deliveries and anticoagulant therapy is delicate and reveals heterogeneity of our practices. Thirty-two percent of women did not receive therapy according to referenced recommendations. Rate of complications is quite low but this percentage should make us to discuss our professional practices and diffusion of recommendations.NANCY1-SCD Medecine (545472101) / SudocPARIS-BIUM (751062103) / SudocNANCY1-Bib. numérique (543959902) / SudocSudocFranceF

Lupus et grossesse (influence réciproque et recommandations pour le suivi obstétrical)

La maladie lupique est définie comme un syndrome clinique de cause inconnue caractérisé par une atteinte systémique et par une évolution par poussées, atteignant un ou plusieurs appareils, entrecoupées de rémissions multiples. Le diagnostic pourra être confirmé par la présence d'autoanticorps dirigés contre les constituants du noyau. La grossese et le lupus présentent des interactions mutuelles. La grossesse et le post-partum sont une période à haut risque tant pour la mère que pour le foetus. Une prise en charge pluridisciplinaire est nécessaire pour mener à terme une grossesse. L'auteur propose un rappel sur la maladie lupique, ainsi que sur les effets de la grossesse sur le lupus et du lupus sur la grossesse. Une étude de 19 grossesses survenant chez 14 patientes a été réalisée, au cours de laquelle la surveillance clinique obstétricale et interniste et la morbidité foetale et maternelle ont été étudiées. La surveillance clinique obstétricale a été celle de toute grossesse pathologique. La surveillance de médecine interne n'a pas été identique pour toutes les patientes. La morbidité maternelle et foetale n'a pas été très importante mais compte tenu de notre faible effectif, les données ne sont que descriptives. L'auteur confronte ses résultats aux données de la littérature et aux recommandations pour le suivi de ces grossesses. Une surveillance pluridisciplinaire avec un dialogue entre chaque intervenant est nécessaire pour mener au mieux une grossesse chez une patiente lupique.NANCY1-Bib. numérique (543959902) / SudocSudocFranceF

PLACE DU DOSAGE DE LA FIBRONECTINE FOETALE CERVICO-VAGINALE DANS LE DEPISTAGE DE L'ACCOUCHEMENT PREMATURE (ETUDE PROSPECTIVE DE 183 CAS A LA MATERNITE REGIONALE DE NANCY)

NANCY1-SCD Medecine (545472101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Anthropologie de la croissance : référentiels, normes et variabilité individuelle

Ouvrage sous la direction de GUIHARD-COSTA Anne-Marie, BOETSCH Gilles, Froment Alain, GUERCI Antonio et ROBERT-LAMBLIN JoëlleAu-delà des standards : l'adaptabilité des processus de croissance chez l'homme actuel. L'estimation de l'âge au cours de la croissance : une problématique au carrefour de plusieurs disciplines. Un exemple d'étude multidisciplinaire de la croissance : anthropométrie et données socio-comportementales. Perspective

[Fetal weight estimation during labour: Comparison of the clinical and ultrasonographic approaches.]: Fetal Weight Estimation

International audienceOBJECTIVE: The estimation of the fetal weight is of major interest in many situations when the route of delivery has to be determined: breech presentations, diabetes and suspected macrosomia. The objective was to evaluate the accuracy of different methods for estimating fetal weight (EFW) during labour. A quality audit of the ultrasound images was also performed. PATIENTS AND METHODS: This was a prospective study performed in thirty patients at 37 weeks gestation or more, during the second stage of labour. The accuracy of clinical versus ultrasonographic (US) approach for EFW was tested (by two formulas according to Hadlock, with one that does not account head circumference [HC]). The ultrasound images' quality was also evaluated. RESULTS: The clinical assessment was significantly more accurate (-1±8.5 %) than the US approach using the formula with HC (-8±9.8 %) (P<0.01). This difference was not found when choosing the formula without HC. Analysis of ultrasound images for abdomen and femur showed 74% and 89% of satisfactory measurements respectively, but only 43% for HC. CONCLUSION: These results did not demonstrate a superiority of the US over the clinical approach for EFW during labour. Taking into account the cephalic measurements appeared as a limitation of the accuracy of US formulas

Maternal weight change before pregnancy in relation to birthweight and risks of adverse pregnancy outcomes.: Maternal weight change related to birthweight

International audienceMaternal weight change before pregnancy can be considered as an indicator of maternal energy balance and nutritional status before conception, and may be involved in early life programming. We aimed to investigate the association of maternal Weight Change Before Pregnancy (WCBP) with fetal growth and adverse pregnancy outcomes. Data are from the French EDEN mother-child cohort where 1,756 mother-child pairs had information on mother's weight at 20 years, weight just before pregnancy, fetal anthropometry at second and third trimesters, infant's birthweight and pregnancy complications. The average annual WCBP between 20 years and start of pregnancy (in kg/year) was categorized as: "Weight Loss" (n = 320), "Moderate weight gain" (n = 721) and "High weight gain" (n = 715). The associations of WCBP with fetal and newborn characteristics and with adverse pregnancy outcomes were analyzed, adjusting for maternal and pregnancy characteristics, including the mother's prepregnancy BMI. Interactions between WCBP and prepregnancy BMI were tested. Birthweight and estimated fetal weight in the third trimester increased significantly with increasing WCBP in mothers with BMI <25 kg/m(2). In these mothers, weight loss before pregnancy was associated with a higher risk of newborns small for gestational age (SGA). Whatever the prepregnancy BMI, WCBP was positively associated with a maternal risk of gestational diabetes and hypertension. The ponderal history of mothers before pregnancy can impact on fetal growth and on pregnancy outcomes such as gestational diabetes or hypertension. Our analysis is the first to report that in non-overweight women, those who lost weight before pregnancy are at higher risk of having SGA newborns