Heben Sie Ihre Leistungen auf People@HES-SO hervor weitere Infos
PEOPLE@HES-SO - Verzeichnis der Mitarbeitenden und Kompetenzen
PEOPLE@HES-SO - Verzeichnis der Mitarbeitenden und Kompetenzen

PEOPLE@HES-SO
Verzeichnis der Mitarbeitenden und Kompetenzen

Hilfe
language
  • fr
  • en
  • de
  • fr
  • en
  • de
  • SWITCH edu-ID
  • Verwaltung
ID
« Zurück
Lorthe Elsa

Lorthe Elsa

Adjoint-e scientifique ou artistique HES

Hauptkompetenzen

epidemiology

women's health

preterm birth

social inequalities

perinatal health

obstetric interventions

  • Kontakt

  • Forschung

  • Publikationen

Hauptvertrag

Adjoint-e scientifique ou artistique HES

Haute école de santé - Genève
Avenue de Champel 47, 1206 Genève, CH
HEDS-GE
Bereich
Santé
Hauptstudiengang
Sage-femme
Es müssen keine Daten für diesen Abschnitt angezeigt werden.

Laufend

SOCRATES

Rolle: Mitarbeiter

Description du projet :

Stress Of Co-parents Related to A Traumatic Experience of Birth across Switzerland

Contexte : l'impact négatif de la naissance sur le bien-être des mères et co-parents pendant la période post-partum est peu étudié. Des problèmes de santé mentale, physique et sexuelle sont fréquents durant cette période. La santé mentale est particulièrement préoccupante, avec des taux de dépression postnatale et de trouble de stress post-traumatique lié à l'accouchement affectant respectivement 13% et 4,7% des femmes​​.

Justification : il existe un écart préjudiciable entre la période de suivi post-partum typique (56 jours en Suisse) et l'impact à long terme potentiel de la qualité des soins pendant l'accouchement sur le bien-être parental (jusqu'à un an après l'accouchement). Ce projet vise à combler ce manque de données fiables et basées sur la population en Suisse​​.

Matériel et Méthodes : une étude de cohorte prospective nationale sera menée dans tous les cantons de Suisse. Elle inclura des données sur toutes les naissances dans les unités de maternité suisses (N=98) sur une période de trois semaines, représentant un échantillon représentatif de la population (N=3200 naissances). Des questionnaires auto-administrés évalueront la santé mentale, physique et la qualité de vie jusqu'à un an après l'accouchement​​.

Résultats Attendus et Impact : cette étude fournira de nouvelles connaissances sur la santé et le bien-être des parents jusqu'à un an après l'accouchement, aidant ainsi à améliorer les politiques de santé périnatale. Elle identifiera les facteurs liés à la qualité des soins qui affectent la santé et le bien-être des parents après l'accouchement et recommandera des mesures fondées sur des preuves pour améliorer la qualité des soins et l'organisation des soins maternels​​.

Forschungsteam innerhalb von HES-SO: Gaucher Laurent , Desplanches Thomas , Lorthe Elsa , Di Vincenzo-Sormani Jessica , Castillo Cebollero Ana , Héritier Mathilde

Url des Projektstandortes: https://www.hesge.ch/heds/rad/projets/socrates

Statut: Laufend

Swiss Peristat Project

Rolle: Mitarbeiter

Description du projet :

Des complications potentiellement graves peuvent survenir au cours du travail, de l’accouchement ou de ses suites immédiates et avoir un impact à long terme sur la santé des mères et leurs nouveau-nés. Pour les prévenir, la majorité des naissances ont lieu en établissement de santé. Cette organisation génère des coûts importants qu’il est important de pouvoir mettre en regard de résultats. La Suisse se démarque notamment d’autres pays à haut niveau de revenu par une stagnation de la mortalité néonatale, alors que le recours à des interventions médicales (e.g. césarienne) est beaucoup plus fréquent. Ces soins peuvent être potentiellement iatrogènes comme en témoigne l’augmentation continue depuis 1993 des hémorragies du post-partum, principale cause de morbidité maternelle sévère. L’identification d’indicateurs de qualité des soins autour de la naissance et de ses déterminants représentent des leviers d’action importants pour améliorer la santé périnatale. Swiss Peristat Project a pour objectif d’évaluer si les bases médico-administratives de l’Office fédéral de la statistique (OFS) peuvent être exploitées en routine pour établir des indicateurs de qualité de soins autour de la naissance, éléments essentiels pour améliorer la santé des mères et des nouveau-nés.

Forschungsteam innerhalb von HES-SO: Desplanches Thomas , Gaucher Laurent , Castillo Cebollero Ana , Lorthe Elsa , Héritier Mathilde

Url des Projektstandortes: https://www.hesge.ch/heds/rad/projets/swiss-peristat-care-quality-indicators

Statut: Laufend

2025

Well-being of children and adolescents with and without special healthcare needs following the lifting of pandemic-related restrictions
Wissenschaftlicher Artikel ArODES

Elsa Lorthe, Roxane Dumont, Viviane Richard, Andrea Loizeau, Geraldine Blanchard-Rohner, Stephanie Schrempft, Hélène Baysson, María Eugenia Zaballa, Julien Lamour, Philippe Eigenmann, Stephanie Garcia Tarodo, Manel Mejbri, Nathalie Rock, Isabelle Ruchonnet-Métrailler, Mayssam Nehme, Rémy Barbe, Klara Posfay-Barbe, Idris Guessous, Silvia Stringhini, SEROCoV-KIDS study group

The journal of pediatrics,  2025, 281, 114528

Link zur Publikation

Zusammenfassung:

Objective : To examine the physical, psychological, and social well-being of children with and without special healthcare needs after pandemic-related restrictions were lifted. Study design : Drawing on three-wave data from the SEROCoV-KIDS prospective, population-based cohort, we performed an outcome-wide, longitudinal analysis to investigate the association of special healthcare needs (none, moderate, or complex needs) at Time 1 (September 2022 through February 2023) with physical, psychological, and social well-being (15 outcomes) at Time 2 (May through September 2023), adjusting for characteristics and prior outcome values at Time 0 (December 2021 through June 2022). Results : Of 1993 participants aged 2 through 17 years, 1533 completed the Time 1 questionnaire (median age 10, 49.6% female), with 10.6% having moderate needs, and 3.3% complex needs. Although children with special healthcare needs had not been more often infected with SARS-CoV-2 than healthy children, in 2023, they experienced more severe psychosocial consequences, especially poorer well-being, with a gradient according to the complexity of their needs. Children with moderate needs had more difficulties with physical (aOR 2.84 [95% CI 1.42-5.67]) and social functioning (2.20 [1.33-3.65]) as well as externalizing difficulties (3.68 [1.67-8.11]) compared with their healthy peers but showed similar levels of prosocial behavior or social support. Those with complex needs were particularly at risk of poor physical, psychological, and social well-being. Conclusions : Children and adolescents with special healthcare needs suffered from poor well-being after pandemic-related restrictions were lifted, with no obvious improvement over time. Establishing sustained monitoring and tailored interventions is crucial to improve their persistent suboptimal well-being as we move beyond the pandemic era.

Acne-related quality of life and mental health among adolescents :
Wissenschaftlicher Artikel ArODES
a cross-sectional analysis

Shireen Dumont, Elsa Lorthe, Andrea Loizeau, Viviane Richard, Mayssam Nehme, Klara Posfay-Barbe, Rémy Barbe, Laurence Toutous Trellu, Silvia Stringhini, Idris Guessous, Roxane Dumont, SEROCoV-KIDS study group

Clinical and experimental dermatology,  2025, 50, 4, 795-803

Link zur Publikation

Zusammenfassung:

Backgrounds : Acne vulgaris is one of the most common skin conditions worldwide among adolescents. Beyond its physical manifestations, acne can leave invisible psychological scars. Objectives : We aimed to examine the protective and risk factors of acne-related quality of life, and its association with mental health outcomes. Methods : The analysis included data collected in 2023 from adolescents enrolled in the SEROCoV-KIDS population-based cohort. By combining the Acne Severity and Acne-Quality of Life (Acne-QoL) scales, three groups were established: Acne-LowAQoL (adolescents with acne and low Acne-related Quality of Life), Acne-HighAQoL, and NoAcne-HighAQoL. We used multinomial and logistic regression to assess the association between health behaviours, these groups, and mental health outcomes. Results : Among 335 adolescents (mean age 16.1 years [SD 1.8], 56% female), 65 (19.4%) reported experiencing acne while maintaining a high Acne-QoL, 26 (7.7%) reported having acne and a low Acne-QoL and 244 (72.9%) reported having nearly no acne. Low engagement in physical activity (aOR: 0.30, 95% CI: 0.12-0.77), addictive use of social media (aOR: 3.78, 95%CI: 1.60-8.96), and prolonged screen time (aOR: 2.99, 95%CI: 1.26-7.08) were independently associated with Acne-LowAQoL. Conversely, those from the group Acne-HighAQoL reported higher social support (aOR: 1.95, 95%CI: 1.07-3.54). Adolescents with Acne-LowAQoL showed lower levels of self-esteem, resilience, and increased psychological distress. Conclusions : Among adolescents with acne, physical activity and social support were positively associated with good acne-related quality of life, which translated into better mental health. In contrast, screen time and social media use notably reduced it. Dermatologists should incorporate these considerations into clinical practice to ensure effective patient care.

Perceived financial hardship and sleep in an adult population-based cohort :
Wissenschaftlicher Artikel ArODES
the mediating role of psychosocial and lifestyle-related factors

Ambra Chessa, Stephanie Schrempft, Viviane Richard, Helene Baysson, Nick Pullen, María Eugenia Zaballa, Elsa Lorthe, Mayssam Nehme, Idris Guessous, Silvia Stringhini, Specchio study group

Sleep health,  2025, 11, 2, 222-229

Link zur Publikation

Zusammenfassung:

Background : Social inequalities in sleep have been reported, but there is less research on the mechanisms underlying this association. This study investigates the relationship between financial hardship and sleep within the general adult population, focusing on the mediating effects of psychosocial and lifestyle-related factors. Methods : We used data from the Specchio cohort, a population-based study in Geneva, Switzerland, initiated in December 2020. Perceived financial hardship and sleep outcomes (insomnia, sleep quality, and sleep duration) were assessed by questionnaire in 2020 to 2021. Counterfactual mediation analysis was conducted to examine the extent to which perceived financial hardship impacts sleep through psychosocial (psychological distress and loneliness) and lifestyle-related (weight, smoking, and physical inactivity) pathways. Models were adjusted for age, sex, education, living alone, and chronic disease. Results : Among 4388 participants, those experiencing financial hardship had a greater risk of insomnia (odds ratio: 2.11; 95% confidence interval: 1.70-2.61), poor sleep quality (odds ratio: 1.69; 95%confidence interval: 1.41-2.02), and not meeting sleep duration guidelines (odds ratio: 1.40; 95% confidence interval: 1.18-1.66) compared to those without financial difficulties. Psychosocial factors explained 40% of the relationship of financial hardship with insomnia, 35% of the relationship with poor sleep quality, and 10% of the association with suboptimal sleep duration. The contribution of lifestyle-related factors was 8%, 12%, and 17%, respectively. Conclusion : Perceived financial hardship is a significant predictor of poor sleep, and this association is mediated by psychosocial and, to a lesser extent, lifestyle-related factors. These findings highlight the need for integrative approaches addressing social inequalities in sleep.

Mental health of informal caregivers during the COVID-19 pandemic :
Wissenschaftlicher Artikel ArODES
a Swiss cohort study

Cédric Follonier, Nick Pullen, Helene Baysson, María Eugenia Zaballa, Francesco Pennacchio, Stephanie Schrempft, Sara Levati, Mayssam Nehme, Idris Guessous, Silvia Stringhini, Elsa Lorthe, Specchio-COVID19 study group

Swiss medical weekly,  155, 3, 3884

Link zur Publikation

Zusammenfassung:

Aims of the study: The COVID-19 pandemic and related public health measures have disrupted healthcare systems and may have impacted informal caregivers’ mental health due to increased responsibilities and limited access to support services. This study aimed to examine the prevalence of mental distress among caregivers and non-caregivers and identify risk and protective factors for mental distress in caregivers during the COVID-19 pandemic. Methods: Data were collected from participants in Specchio-COVID19, a population-based cohort in Geneva, Switzerland. Mental distress was measured using the 12-item General Health Questionnaire (GHQ-12) in June 2021. The prevalence of distress was compared between caregivers and non-caregivers. Risk and protective factors for mental distress among caregivers were explored using logistic regressions. Results: Among the 5416 participants, 1086 (20%) reported helping someone in a non-professional manner with activities of daily life and were considered caregivers. Mental distress was more frequent in caregivers than in non-caregivers (41% vs 37%, p = 0.010). In caregivers, limited social support (adjusted odds ratio [aOR] = 1.25 [95% confidence interval: 1.10, 1.42]), caring for an individual with a mental condition (aOR = 1.21 [1.05, 1.41]), living over 10 km away from the care recipient (aOR = 1.17 [1.02, 1.34]), feeling more isolated in one’s caregiving role (aOR = 1.20 [1.08, 1.32]), worrying about caregiving ability in case of COVID-19 or quarantine (aOR = 1.18 [1.08, 1.28]) and experiencing reduced availability of healthcare professionals (aOR = 1.11 [1.02, 1.22]) were associated with increased odds of mental distress. Conclusion: Informal caregivers experienced higher levels of mental distress than non-caregivers during the COVID-19 pandemic. This study highlights the need for public health policies that enhance both formal and informal support networks and include rapidly implementable solutions for caregiving continuity, benefiting both caregivers and their care recipients.

Association between SARS-CoV-2 infection and anti-apolipoprotein A-1 antibody in children
Wissenschaftlicher Artikel ArODES

Nicolas Vuilleumier, Sabrina Pagano, Elsa Lorthe, Julien Lamour, Mayssam Nehme, Catherine Juillard, Rémy Barbe, Klara Posfay-Barbe, Idris Guessous, Silvia Stringhini, SEROCoV-KIDS study group, Arnaud Gregoire L'Huillier

Frontiers in immunology,  2025, 16, 1521299

Link zur Publikation

Zusammenfassung:

Background and aims: Autoantibodies against apolipoprotein A-1 (AAA1) are elicited by SARS-CoV-2 infection and predict COVID-19 symptoms persistence at one year in adults, but whether this applies to children is unknown. We studied the association of SARS-CoV-2 exposure with AAA1 prevalence in children and the association of AAA1 seropositivity with symptom persistence. Methods: Anti-SARS-CoV-2 and AAA1 serologies were examined in 1031 participants aged 6 months to 17 years old from the prospective SEROCOV-KIDS cohort and recruited between 12.2021 and 02.2022. Four SARS-CoV-2 serology-based groups were defined: “Infected-unvaccinated (I+/V-)”, “Uninfected-vaccinated (I-/V+)”, “Infected-Vaccinated (I+/V+)”, and “Naïve (I-/V-)”. Reported outcomes were collected using online questionnaires. Associations with study endpoints were assessed using logistic regression. Results: Overall, seropositivity rates for anti-RBD, anti-N, and AAA1 were 71% (736/1031), 55% (568/1031), and 5.8% (60/1031), respectively. AAA1 showed an inverse association with age but not with any other characteristics. The I+/V- group displayed higher median AAA1 levels and seropositivity (7.9%) compared to the other groups (p ≤ 0.011), translating into a 2-fold increased AAA1 seroconversion risk (Odds ratio [OR]: 2.11, [95% Confidence Interval (CI)]: 1.22-3.65; p=0.008), unchanged after adjustment for age and sex. AAA1 seropositivity was independently associated with a 2-fold odds of symptoms persistence at ≥ 4 weeks (p ≤ 0.03) in the entire dataset and infected individuals, but not ≥ 12 weeks. Conclusions: Despite the limitations of the study (cross-sectional design, patient-related outcomes using validated questionnaires), the results indicate that SARS-CoV-2 infection could elicit an AAA1 response in children, which could be independently associated with short-time symptoms persistence.

Maternal prepregnancy obesity and offspring intelligence quotient at 5?years :
Wissenschaftlicher Artikel ArODES
a multicohort analysis

Courtney Dow, Elsa Lorthe, Jonathan Bernard, Cédric Galera, Laetitia Marchand-Martin, Muriel Tafflet, Pierre-Yves Ancel, Marie Aline Charles, Barbara Heude

Paediatric and perinatal epidemiology,  2025, to be published

Link zur Publikation

Zusammenfassung:

Background : The relationship between maternal obesity and childhood cognitive development remains unclear. Prior studies did not adjust for important confounders, and preterm infants are a developmentally distinct group that remains scarcely examined. Objectives : To determine whether maternal prepregnancy body mass index (BMI) is associated with offspring intelligence quotient (IQ) up to 5 years and whether this relationship varies with gestational age. Methods : Data from two French birth cohorts, EDEN (all gestational ages) and EPIPAGE-2 (preterm children born between 24 and 34 weeks of gestation), were used for this study. Maternal prepregnancy weight and height were used to calculate prepregnancy BMI. The Wechsler Preschool and Primary Scale of Intelligence was used to assess child IQ around 5 years. Multivariable models were adjusted for confounders, including socioeconomic status and paternal BMI. Results : Analytical cohorts included 1100 children from EDEN and 2629 from EPIPAGE-2. Lower intellectual functioning (full-scale IQ < 85) was observed in 8.1% of children in EDEN and 19.6% in EPIPAGE-2. The prevalence of maternal obesity was 13.6% (EDEN) and 21.3% (EPIPAGE-2) among children with lower intellectual functioning compared to 8.9% (EDEN) and 12.9% (EPIPAGE-2) among children with normal intellectual functioning. Maternal prepregnancy obesity was associated with an approximately 3-point decrease in full-scale IQ scores in fully adjusted models (adjusted β −2.8, 95% confidence interval [CI] −5.6, −0.1 and −2.6, 95% CI −4.7, −0.6 in EDEN and EPIPAGE-2, respectively). In EDEN, maternal obesity was associated with lower scores in the verbal IQ domain. Among infants born preterm (EPIPAGE-2), maternal obesity was associated with lower scores in the processing, reasoning, and verbal IQ domains. Adjustment for paternal BMI did not change the magnitude of the relationship with maternal obesity. Conclusions : High maternal prepregnancy BMI is associated with child cognitive development around 5 years of age.

Covid-19 pandemic-related changes in teleworking, emotional exhaustion, and occupational burnout :
Wissenschaftlicher Artikel ArODES
a cross-sectional analysis of a cohort study

Anshu Uppal, Nick Pullen, Helene Baysson, Stephanie Schrempft, Aminata Rosalie Bouhet, María Eugenia Zaballa, Julien Lamour, Mayssam Nehme, Idris Guessous, Silvia Stringhini, Elsa Lorthe, Specchio-COVID19 study group

BMC public health,  2025, 25, 285

Link zur Publikation

Zusammenfassung:

Background : The COVID-19 pandemic prompted significant shifts to teleworking, raising questions about potential impacts on employee wellbeing. This study examined the association between self-reported changes to teleworking frequency (relative to before the pandemic) and two indicators of occupational burnout: emotional exhaustion and professionally diagnosed burnout. Methods : Data were derived from two samples from a digital cohort study based in Geneva, Switzerland: one population-based, and one from a sample of workers who were likely mobilized in the early stages of the COVID-19 pandemic. Emotional exhaustion was measured using the Maslach Burnout Inventory (EE-MBI), while self-reported diagnosed burnout was assessed by asking participants if they had received a professional diagnosis of occupational burnout within the previous 12 months. Participants were categorized based on self-reported telework frequency changes: “no change,” “increase,” “decrease,” “never telework,” and “not possible to telework.” Adjusted regression models for each of the study samples were used to estimate associations between telework changes and burnout outcomes, accounting for sociodemographic, household, and work-related factors. Results : In the population-based sample of salaried employees (n = 1,332), the median EE-MBI score was 14 (interquartile range: 6–24), and 7.3% reported diagnosed burnout. Compared to those reporting no change in telework frequency (19% of the sample), those reporting a decrease (4%) and those reporting that teleworking was not possible (28.7%) had significantly higher emotional exhaustion scores (adjusted beta (aβ) 5.26 [95% confidence interval: 1.47, 9.04] and aβ 3.51 [0.44, 6.59], respectively) and additionally reported higher odds of diagnosed burnout (adjusted odds ratio (aOR) 10.59 [3.24, 34.57] and aOR 3.42 [1.22, 9.65], respectively). “Increased” (28.9%) and “never” (19.4%) telework statuses were not significantly associated with burnout outcomes. These trends were mirrored in the “mobilized-workers” sample, with the exception that those reporting that teleworking was not possible did not report significantly higher odds of diagnosed burnout compared to those reporting no change in telework frequency. Conclusions : Decreased teleworking frequency and not having the possibility of telework were associated with higher emotional exhaustion and diagnosed burnout. As organizations reconsider their telework policies in a post-pandemic era, they should consider the impact of such organizational changes on employee wellbeing.

Maternal social deprivation and preterm birth
Wissenschaftlicher Artikel
the PreCARE cohort study

E. Gottardi, Lorthe Elsa, T. Schmitz, L. Mandelbrot, D. Luton, C. Estellat, E. Azria

Paediatric and perinatal epidemiology, 2025 , vol.  39, no  1, pp.  1-11

Link zur Publikation

Zusammenfassung:

Background : Maternal exposure to unfavourable social conditions is associated with a higher rate of perinatal complications, such as placental vascular pathologies. A higher risk of preterm birth (PTB) has also been reported, and variations across studies and settings suggest that different patterns may be involved in this association. Objective : To assess the association between maternal social deprivation and PTB (overall and by phenotype). Methods : We analysed 9365 patients included in the PreCARE cohort study. Four dimensions (social isolation, insecure housing, no income from work and absence of standard health insurance) defined maternal social deprivation (exposure). They were considered separately and combined into a social deprivation index (SDI). The associations between social deprivation and PTB <37 weeks (primary outcome) were analysed with univariable and multivariable log-binomial models (adjusted for maternal age, parity, education level and birthplace). Then we used multinomial analysis to examine the association with preterm birth phenotypes (secondary outcome): spontaneous labour, preterm prelabour rupture of membranes (PPROM) and placental vascular pathologies. Results : In all, 66.3%, 17.8%, 8.9% and 7.0% of patients had an SDI of 0, 1, 2 and 3, respectively. Social isolation affected 4.5% of the patients, insecure housing 15.5%, no income from work 15.6% and no standard health insurance 22.4%. Preterm birth complicated 7.0% of pregnancies (39.8% spontaneous labour, 28.3% PPROM, 21.8% placental vascular pathologies and 10.1% other phenotypes). Neither the univariable nor multivariable analyses found any association between social deprivation and the risk of preterm birth overall (SDI 1 versus 0: aRR 1.02, 95% confidence interval [CI] 0.83, 1.26; 2 versus 0: aRR 1.05, 95% CI 0.80, 1.38; 3 versus 0: aRR 0.92, 95% CI 0.66, 1.29) or its different phenotypes. Conclusions : In the French PreCARE cohort, we observed no association between markers of social deprivation and the risk of preterm birth, regardless of phenotype.

Mental health of informal caregivers during the COVID-19 pandemic
Wissenschaftlicher Artikel
a Swiss cohort study

C. Follonier, N. Pullen, H. Baysson, M. E. Zaballa, F. Pennacchio, S. Schrempft, S. Levati, M. Nehme, I. Guessous, S. Stringhini, Lorthe Elsa

Swiss medical weekly, 2025 , vol.  155, no  3

Link zur Publikation

Zusammenfassung:

AIMS OF THE STUDY: The COVID-19 pandemic and related public health measures have disrupted healthcare systems and may have impacted informal caregivers’ mental health due to increased responsibilities and limited access to support services. This study aimed to examine the prevalence of mental distress among caregivers and non-caregivers and identify risk and protective factors for mental distress in caregivers during the COVID-19 pandemic. METHODS: Data were collected from participants in Specchio-COVID19, a population-based cohort in Geneva, Switzerland. Mental distress was measured using the 12-item General Health Questionnaire (GHQ-12) in June 2021. The prevalence of distress was compared between caregivers and non-caregivers. Risk and protective factors for mental distress among caregivers were explored using logistic regressions. RESULTS: Among the 5416 participants, 1086 (20%) reported helping someone in a non-professional manner with activities of daily life and were considered caregivers. Mental distress was more frequent in caregivers than in non-caregivers (41% vs 37%, p = 0.010). In caregivers, limited social support (adjusted odds ratio [aOR] = 1.25 [95% confidence interval: 1.10, 1.42]), caring for an individual with a mental condition (aOR = 1.21 [1.05, 1.41]), living over 10 km away from the care recipient (aOR = 1.17 [1.02, 1.34]), feeling more isolated in one’s caregiving role (aOR = 1.20 [1.08, 1.32]), worrying about caregiving ability in case of COVID-19 or quarantine (aOR = 1.18 [1.08, 1.28]) and experiencing reduced availability of healthcare professionals (aOR = 1.11 [1.02, 1.22]) were associated with increased odds of mental distress. CONCLUSION: Informal caregivers experienced higher levels of mental distress than non-caregivers during the COVID-19 pandemic. This study highlights the need for public health policies that enhance both formal and informal support networks and include rapidly implementable solutions for caregiving continuity, benefiting both caregivers and their care recipients.

Antepartum severe maternal morbidity in women with preterm delivery
Wissenschaftlicher Artikel
a national cohort study

J. Blanc, Lorthe Elsa, M. P. Bonnet, L. Marchand-Martin, I. Guellec, C. D'Ercole, G. Kayem, L. Sentilhes, P. Y. Ancel, C. Deneux-Tharaux, Epipage-Obstetric Writing group

European journal of obstetrics & gynecology and reproductive biology, 2025 , vol.  307, pp.  98-104

Link zur Publikation

Zusammenfassung:

Introduction : The literature extensively documents neonatal and paediatric outcomes related to preterm delivery, but maternal health in this circumtances remains underexplored. This study aimed to identify women with antepartum severe maternal morbidity (SMM) among those delivering preterm and explore whether they delivered in hospitals with risk-appropriate maternal care facilities. Material and methods : Women giving birth at 22–34 weeks of gestation were identified from the French national prospective EPIPAGE-2 cohort study in 2011; terminations of pregnancy for fetal congenital malformations were excluded. Antepartum SMM was defined as a composite outcome of severe maternal morbid events preceding labour onset or the delivery decision. We described antepartum SMM and compared women with and without SMM regarding the characteristics of the hospital of delivery. Results : Among 5,690 women included, 886 (16.0 %, 95 % CI, 14.7, 17.0) experienced antepartum SMM, primarily due to severe pregnancy-related hypertensive disorders or major obstetric bleeding. Women with antepartum SMM were more likely to deliver in level III maternity units (level of neonatal care) compared with women without antepartum SMM (68.0 % vs 59.3 %, P < 0.001). However, 18.3 % of women with antepartum SMM delivered in hospitals without an onsite adult critical care unit, a proportion not significantly different from those without SMM (22.0 %, P = 0.23). Conclusions : Antepartum SMM affected one in six women delivering at 22–34 weeks’ gestation. Many did not deliver in hospitals equipped with adult critical care unit. Delivery locations for women with SMM at risk of preterm birth should address the needs of both the mother and the newborn.

Preterm premature rupture of the membranes
Wissenschaftlicher Artikel
Guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF)

T. Schmitz, L. Sentilhes, Lorthe Elsa, D. Gallot, H. Madar, M. Doret-Dion, G. Beucher, C. Charlier, C. Cazanave, P. Delorme, C. Garabedian, E. Azria, V. Tessier, M. V. Senat, G. Kayem

European journal of obstetrics & gynecology and reproductive biology, 2025

Link zur Publikation

Zusammenfassung:

In France, the frequency of premature rupture of the membranes (PROM) is 2%–3% before 37 weeks' gestation (level of evidence [LE] 2) and less than 1% before 34 weeks (LE2). Preterm delivery and intrauterine infection are the major complications of preterm PROM (PPROM) (LE2). Prolongation of the latency period is beneficial (LE2). Compared with other causes of preterm delivery, PPROM is associated with a clear excess risk of neonatal morbidity and mortality only in cases of intrauterine infection, which is linked to higher rates of in utero fetal death (LE3), early neonatal infection (LE2), and necrotizing enterocolitis (LE2).

The diagnosis of PPROM is principally clinical (professional consensus). Tests to detect IGFBP-1 or PAMG-1 are recommended in cases of uncertainty (professional consensus).

Hospitalization is recommended for women diagnosed with PPROM (professional consensus). Adequate evidence does not exist to support recommendations for or against initial tocolysis (Grade C). If tocolysis is prescribed, it should not continue longer than 48 h (Grade C). The administration of antenatal corticosteroids is recommended for fetuses with a gestational age less than 34 weeks (Grade A) and magnesium sulfate if delivery is imminent before 32 weeks (Grade A). The prescription of antibiotic prophylaxis at admission is recommended (Grade A) to reduce neonatal and maternal morbidity (LE1). Amoxicillin, third-generation cephalosporins, and erythromycin (professional consensus) can each be used individually or eythromycin and amoxicillin can be combined (professional consensus) for a period of 7 days (Grade C). Nonetheless, it is acceptable to stop antibiotic prophylaxis when the initial vaginal sample is negative (professional consensus). The following are not recommended for antibiotic prophylaxis: amoxicillin-clavulanic acid (professional consensus), aminoglycosides, glycopeptides, first- or second-generation cephalosporins, clindamycin, or metronidazole (professional consensus).

Women who are clinically stable after at least 48 h of hospital monitoring can be managed at home (professional consensus).

Monitoring should include checking for clinical and laboratory factors suggestive of intrauterine infection (professional consensus). No guidelines can be issued about the frequency of this monitoring (professional consensus). Adequate evidence does not exist to support a recommendation for or against the routine initiation of antibiotic therapy when the monitoring of an asymptomatic woman produces a single isolated positive result (e.g., elevated CRP, or hyperleukocytosis, or a positive vaginal sample) (professional consensus).

In cases of intrauterine infection, the immediate intravenous administration (Grade B) of antibiotic therapy combining a beta-lactam with an aminoglycoside (Grade B) and early delivery of the child are both recommended (Grade A). Cesarean delivery of women with intrauterine infections is reserved for the standard obstetric indications (professional consensus).

Expectant management is recommended for uncomplicated PROM before 37 weeks (Grade A), even when a sample is positive for Streptococcus B, as long as antibiotic prophylaxis begins at admission (professional consensus). Oxytocin and prostaglandins are two possible options for the induction of labor in women with PPROM (professional consensus).

2024

Future time perspectives and concerns among adolescents in 2022
Wissenschaftlicher Artikel ArODES

Roxane Dumont, Elsa Lorthe, Viviane Richard, Andrea Loizeau, Klara Posfay-Barbe, Rémy Barbe, Silvia Stringhini, Idris Guessous

BMJ paediatrics open,  2024, 8, 1, e002367

Link zur Publikation

Zusammenfassung:

Future time perspectives (FTP) and future-related concerns in adolescence remain underexplored. We aimed to identify factors associated with limited FTP and describe future-related concerns. Data were drawn from a population-based sample of adolescents aged 14–17 participating in the SEROCoV-KIDS cohort study, in Geneva, Switzerland (October 2022). Of 329 adolescents, 56/329 (17%) reported limited FTP; determinants included prior low mental well-being, limited social support, sexual minority identity, academic difficulties and excessive screen time. Adolescents’ main future-oriented concerns encompassed failure, education and climate change. These results underscore the need to address future perspectives/concerns among young people and implement interventions that strengthen adolescent resilience.

Socioeconomic status and adherence to preventive measures during the COVID-19 pandemic in Switzerland
Wissenschaftlicher Artikel
a population based digital cohort analysis

S. Tancredi, B. W. A. van der Linden, A. Chiolero, S. Cullati, M. Imboden, N. Probst-Hensch, D. Keidel, M. Witzig, J. Dratva, G. Michel, E. Harju, I. Frank, Lorthe Elsa, H. Baysson, S. Stringhini, C. R. Kahlert, J. B. Bardoczi, M. L. Haller, P. O. Chocano-Bedoya, N. Rodondi, R. Amati, E. Albanese, L. Corna, L. Crivelli, M. Kaufmann, A. Frei, V. von Wyl

International journal of public health, 2024 , vol.  69, no  article 1606861

Link zur Publikation

Zusammenfassung:

Objectives: To assess the association between socioeconomic status (SES) and self-reported adherence to preventive measures in Switzerland during the COVID-19 pandemic. Methods: 4,299 participants from a digital cohort were followed between September 2020 and November 2021. Baseline equivalised disposable income and education were used as SES proxies. Adherence was assessed over time. We investigated the association between SES and adherence using multivariable mixed logistic regression, stratifying by age (below/above 65 years) and two periods (before/after June 2021, to account for changes in vaccine coverage and epidemiological situation). Results: Adherence was high across all SES strata before June 2021. After, participants with higher equivalised disposable income were less likely to adhere to preventive measures compared to participants in the first (low) quartile [second (Adj.OR, 95% CI) (0.56, 0.37–0.85), third (0.38, 0.23–0.64), fourth (0.60, 0.36–0.98)]. We observed similar results for education. Conclusion: No differences by SES were found during the period with high SARS-CoV-2 incidence rates and stringent measures. Following the broad availability of vaccines, lower incidence, and eased measures, differences by SES started to emerge. Our study highlights the need for contextual interpretation when assessing SES impact on adherence to preventive measures.

Prevalence of and risk factors for suicidal ideation in adolescents during the COVID-19 pandemic
Wissenschaftlicher Artikel
a cross-sectional study

R. Dumont, Lorthe Elsa, V. Richard, A. Loizeau, G. Fernandez, D. De Ridder, J. Lamour, M. E. Zaballa, H. Baysson, K. M. Posfay-Barbe, R. P. Barbe, S. Stringhini, I. Guessous

Swiss medical weekly, 2024 , vol.  154, no  article 3461

Link zur Publikation

Zusammenfassung:

BACKGROUND AND OBJECTIVES: Pandemic-related life changes may have had a deleterious impact on suicidal behaviours. Early detection of suicidal ideation and identification of subgroups at increased risk could help prevent suicide, one of the leading causes of death among adolescents worldwide. Here, we aimed to investigate the prevalence of and risk factors for suicidal ideation in adolescents using a population-based sample from Switzerland, two years into the pandemic. METHODS: Between December 2021 and June 2022, adolescents aged 14 to 17 years already enrolled in a population-based cohort study (State of Geneva, Switzerland) were asked about suicidal ideation over the previous year. In addition to a regression model, we conducted a network analysis of exposures which identified direct and indirect risk factors for suicidal ideation (i.e. those connected through intermediate risk factors) using mixed graphical models. RESULTS: Among 492 adolescents, 14.4% (95% CI: 11.5–17.8) declared having experienced suicidal ideation over the previous year. Using network analysis, we found that high psychological distress, low self-esteem, identifying as lesbian, gay or bisexual, suffering from bullying, extensive screen time and a severe COVID-19 pandemic impact were major risk factors for suicidal ideation, with parent-adolescent relationship having the highest centrality strength in the network. CONCLUSION: Our results show that a significant proportion of adolescents experience suicidal ideation, yet these rates are comparable with pre-pandemic results. Providing psychological support is fundamental, with a focus on improving parent-adolescent relationships.

Psychosocial factors mediate social inequalities in health-related quality of life among children and adolescents
Wissenschaftlicher Artikel

V. Richard, Lorthe Elsa, R. Dumont, A. Loizeau, H. Baysson, S. Schrempft, M. E. Zaballa, J. Lamour, R. P. Barbe, K. M. Posfay-Barbe, I. Guessous, S. Stringhini

BMC public health, 2024 , vol.  24, no  article 2986

Link zur Publikation

Zusammenfassung:

Background : The present analysis aimed to assess the mediating role of psychosocial and behavioural factors in socio-economic inequalities in health-related quality of life (HRQoL) among children and adolescents. Methods : Cross-sectional data was drawn from the randomly selected SEROCoV-KIDS cohort study in Geneva, Switzerland. Associations of socio-economic conditions (parents’ highest education, household financial situation) with HRQoL, psychosocial (parent–child relationship, school difficulties, friends, extracurricular activities) and behavioural factors (screen time, physical activity, green spaces time, sleep duration), along with associations of psychosocial and behavioural factors with HRQoL, were evaluated with generalized estimating equations. Counterfactual mediation analyses were conducted to test pathways linking socio-economic conditions to HRQoL. Results : Of 965 children and 816 adolescents, those with disadvantaged financial circumstances were more likely to have a poor HRQoL (adjusted Odds Ratio [aOR]: 3.80; 95% confidence interval [CI]: 1.96–7.36 and aOR: 3.66; 95%CI: 2.06–6.52, respectively). Psychosocial characteristics mediated 25% (95%CI: 5–70%) and 40% (95%CI: 18–63%) of financial disparities in HRQoL among children and adolescents, respectively. Health behaviours were weakly patterned by socio-economic conditions and did not contribute to financial differences in HRQoL. Conclusions : These findings provide empirical evidence for mechanisms explaining socio-economic disparities in child HRQoL and could inform interventions aimed to tackle health inequalities.

Mental health trajectories among the general population and higher-risk groups following the COVID-19 pandemic in Switzerland, 2021-2023
Wissenschaftlicher Artikel

S. Schrempft, N. Pullen, H. Baysson, M. E. Zaballa, J. Lamour, Lorthe Elsa, M. Nehme, I. Guessous, S. Stringhini, Specchio Covid study group

Journal of affective disorders, 2024 , vol.  359, pp.  277-286

Link zur Publikation

Zusammenfassung:

Background : Mental health deteriorated in the early stages of the COVID-19 pandemic, but improved relatively quickly as restrictions were eased, suggesting overall resilience. However, longer-term follow-up of mental health in the general population is scarce. Methods : We examined mental health trajectories in 5624 adults (58 % women; aged 18–97 years) from the Specchio-COVID19 cohort, using the Generalized Anxiety Disorder scale-2 and the Patient Health Questionnaire-2, administered each month from February to June 2021, and in Spring 2022 and 2023. Results : Depressive and anxiety symptoms declined during a pandemic wave from February to May 2021 (β = −0.06 [−0.07, −0.06]; −0.06 [−0.07, −0.05]), and remained lower at longer-term follow-up than at the start of the wave. Loneliness also declined over time, with the greatest decline during the pandemic wave (β = −0.25 [−0.26, −0.24]). Many higher-risk groups, including socioeconomically disadvantaged individuals, those with a chronic condition, and those living alone had poorer mental health levels throughout the study period. Women and younger individuals had a faster improvement in mental health during the pandemic wave. Loneliness trajectories were associated with mental health trajectories throughout the study period. Limitations : We cannot definitively conclude that the observed changes in mental health were due to experiences of the pandemic. Conclusions : While there was a need for additional mental health support during stricter policy responses to COVID-19, overall, mental health improved relatively soon after measures were eased. Nevertheless, the persistence of mental health disparities highlights the need for further efforts from the government and healthcare practitioners to support vulnerable groups beyond the pandemic.

Associations between bedtime media use and sleep outcomes in an adult population-based cohort
Wissenschaftlicher Artikel

S. Schrempft, H. Baysson, A. Chessa, Lorthe Elsa, M. E. Zaballa, S. Stringhini, I. Guessous, M. Nehme, Specchio study group

Sleep medicine, 2024 , vol.  121, pp.  226-235

Link zur Publikation

Zusammenfassung:

Objective : To further examine the relationship between bedtime media use and sleep in adults by taking relevant covariates into account and testing hypothesised mediating and moderating pathways. Methods : Bedtime media use and sleep outcomes were examined by questionnaire in 4188 adults (59 % women, aged 19–94 years) from the Specchio cohort based in Geneva, Switzerland. We tested associations between bedtime media use and sleep (bedtimes, rise times, sleep latency, sleep duration, sleep quality, insomnia, and daytime sleepiness), adjusting for prior sleep, mental health, and health behaviours; whether bedtime media use mediates associations between individual susceptibility factors (age, chronotype, and mental health) and sleep; and whether individual susceptibility factors moderate associations between bedtime media use and sleep. Results Often using a screen in the 30 minutes before going to sleep at night was associated with a late bedtime (≥midnight; OR [95 % CI] = 1.90 [1.44,2.51], p < 0.001), a short sleep duration (<7 h; 1.21 [1.01,1.46], p < 0.05), and excessive daytime sleepiness (Epworth score >9; 1.47 [1.25,1.74], p < 0.001), adjusting for all covariates. Bedtime media use partly mediated the association between younger age and an evening chronotype and these sleep outcomes. Mental health moderated the association between bedtime media use and sleep quality/insomnia, such that the former was only associated with poorer sleep quality/insomnia among individuals with better mental health. Conclusions : Frequent bedtime media use was associated with various sleep outcomes, independently of relevant covariates. Limiting the use of screens at bedtime is important to promote sleep among adults. Individuals with poorer mental health likely require additional support to improve their sleep quality.

Tocolysis after preterm prelabor rupture of membranes and 5-year outcomes
Wissenschaftlicher Artikel
a population-based cohort study

Lorthe Elsa, L. Marchand-Martin, M. Letouzey, A. M. Aubert, V. Pierrat, V. Benhammou, P. Delorme, S. Marret, P. Y. Ancel, F. Goffinet, L. F. L'Helias, G. Kayem, Epipage-Obstetric Writing Group

American journal of obstetrics and gynecology, 2024 , vol.  230, no  5

Link zur Publikation

Zusammenfassung:

Background : The administration of tocolytics after preterm prelabor rupture of membranes remains a controversial practice. In theory, reducing uterine contractility should delay delivery and allow for optimal antenatal management, thereby reducing the risks for prematurity and adverse consequences over the life course. However, tocolysis may be associated with neonatal death or long-term adverse neurodevelopmental outcomes, mainly related to prolonged fetal exposure to intrauterine infection or inflammation. In a previous study, we showed that tocolysis administration was not associated with short-term benefits. There are currently no data available to evaluate the impact of tocolysis on neurodevelopmental outcomes in school-aged children born prematurely in this clinical setting.

Objective : This study aimed to investigate whether tocolysis administered after preterm prelabor rupture of membranes is associated with neurodevelopmental outcomes at 5.5 years of age.

Study Design : We used data from a prospective, population-based cohort study of preterm births recruited in 2011 (referred to as the EPIPAGE-2 study) and for whom the results of a comprehensive medical and neurodevelopmental assessment of the infant at age 5.5 years were available. We included pregnant individuals with preterm prelabor rupture of membranes at 24 to 32 weeks’ gestation in singleton pregnancies with a live fetus at the time of rupture, birth at 24 to 34 weeks’ gestation, and participation of the infant in an assessment at 5.5 years of age. Exposure was the administration of any tocolytic treatment after preterm prelabor rupture of membranes. The main outcome was survival without moderate to severe neurodevelopmental disabilities at 5.5 years of age. Secondary outcomes included survival without any neurodevelopmental disabilities, cerebral palsy, full-scale intelligence quotient, developmental coordination disorders, and behavioral difficulties. A propensity-score analysis was used to minimize the indication bias in the estimation of the treatment effect on outcomes.

Results : Overall, 596 of 803 pregnant individuals (73.4%) received tocolytics after preterm prelabor rupture of membranes. At the 5.5-year follow-up, 82.7% and 82.5% of the children in the tocolysis and no tocolysis groups, respectively, were alive without moderate to severe neurodevelopmental disabilities; 52.7% and 51.1%, respectively, were alive without any neurodevelopmental disabilities. After applying multiple imputations and inverse probability of treatment weighting, we found no association between the exposure to tocolytics and survival without moderate to severe neurodevelopmental disabilities (odds ratio, 0.93; 95% confidence interval, 0.55–1.60), survival without any neurodevelopmental disabilities (odds ratio, 1.02; 95% confidence interval, 0.65–1.61), or any of the other outcomes.

Conclusion : There was no difference in the neurodevelopmental outcomes at age 5.5 years among children with and without antenatal exposure to tocolysis after preterm prelabor rupture of membranes. To date, the health benefits of tocolytics remain unproven, both in the short- and long-term.

Clinical chorioamnionitis and neurodevelopment at 5 years of age in children born preterm
Wissenschaftlicher Artikel
the EPIPAGE-2 cohort study

F. Salmon, G. Kayem, E. Maisonneuve, L. Foix-L'Helias, V. Benhammou, M. Kaminski, L. Marchand-Martin, G. Kana, D. Subtil, Lorthe Elsa, P. Y. Ancel, M. Letouzey, Epipage- Infectious diseases working group

The journal of pediatrics, 2024 , vol.  267, no  article 113921

Link zur Publikation

Zusammenfassung:

Objective : To assess the association between clinical chorioamnionitis and neurodevelopmental disorders at 5 years of age in children born preterm.

Study design : EPIPAGE 2 is a national, population-based cohort study of children born before 35 weeks of gestation in France in 2011. We included infants born alive between 240/7 and 346/7 weeks after preterm labor or preterm premature rupture of membranes. Clinical chorioamnionitis was defined as maternal fever before labor (>37.8°C) with ≥2 of the following criteria: maternal tachycardia, hyperleukocytosis, uterine contractions, purulent amniotic fluid, or fetal tachycardia. The primary outcome was a composite, including cerebral palsy, coordination disorders, cognitive disorders, sensory disorders, or behavioral disorders. We also analyzed each of these disorders separately as secondary outcomes. We performed a multivariable analysis using logistic regression models. We accounted for the nonindependence of twins and missing data by generalized estimating equation models and multiple imputations, respectively.

Results : Among 2927 children alive at 5 years of age, 124 (3%) were born in a context of clinical chorioamnionitis. Overall, 8.2% and 9.6% of children exposed and unexposed, respectively, to clinical chorioamnionitis had moderate-to-severe neurodevelopmental disorders. After multiple imputations and multivariable analysis, clinical chorioamnionitis was not associated with the occurrence of moderate-to-severe neurodevelopmental disorders (aOR, 0.9; 95% CI, 0.5-1.8).

Conclusions : We did not find any association between clinical chorioamnionitis and neurodevelopmental disorders at 5 years of age in children born at <35 weeks of gestation after preterm labor or preterm premature rupture of membrane.

Obstetric interventions among native and migrant women
Wissenschaftlicher Artikel
the (Over)use of episiotomy in Portugal

Lorthe Elsa, M. Severo, S. Hamwi, T. Rodrigues, C. Teixeira, H. Barros

International journal of public health, 2024 , vol.  69, no  article 1606296

Link zur Publikation

Zusammenfassung:

Objective: Episiotomy, defined as the incision of the perineum to enlarge the vaginal opening during childbirth, is one of the most commonly performed surgical interventions in the world. We aimed to determine if migrant status is associated with episiotomy, and if individual characteristics mediate this association.

Methods: We analyzed data from the Bambino study, a national, prospective cohort of migrant and native women giving birth at a public hospital in mainland Portugal between 2017 and 2019. We included all women with vaginal delivery. The association between migrant status and episiotomy was assessed using multivariable multilevel random-effect logistic regression models. We used path analysis to quantify the direct, indirect and total effects of migrant status on episiotomy.

Results: Among 3,583 women with spontaneous delivery, migrant parturients had decreased odds of episiotomy, especially those born in Africa, compared to native Portuguese women. Conversely, with instrumental delivery, migrant women had higher odds of episiotomy. Disparities in episiotomy were largely explained by maternity units’ factors, and little by maternal and fetal characteristics.

Conclusion: Our results suggest non-medically justified differential episiotomy use during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use in a country with a high frequency of medical interventions during delivery.

2023

Factors associated with COVID-19 non-vaccination in Switzerland
Wissenschaftlicher Artikel
a nationwide study

S. Sabatini, M. Kaufmann, M. Fadda, S. Tancredi, N. Noor, B. W. A. Van Der Linden, S. Cullati, I. Frank, G. Michel, E. Harju, C. Luedi, A. Frei, T. Ballouz, D. Menges, J. Fehr, P. Kohler, C. R. Kahlert, V. Scheu, N. Ortega, P. Chocano-Bedoya, N. Rodondi, Lorthe Elsa, S. Stringhini

International journal of public health, 2023 , vol.  68

Link zur Publikation

Zusammenfassung:

Objectives: We compared socio-demographic characteristics, health-related variables, vaccination-related beliefs and attitudes, vaccination acceptance, and personality traits of individuals who vaccinated against COVID-19 and who did not vaccinate by December 2021.

Methods: This cross-sectional study used data of 10,642 adult participants from the Corona Immunitas eCohort, an age-stratified random sample of the population of several cantons in Switzerland. We used multivariable logistic regression models to explore associations of vaccination status with socio-demographic, health, and behavioral factors.

Results: Non-vaccinated individuals represented 12.4% of the sample. Compared to vaccinated individuals, non-vaccinated individuals were more likely to be younger, healthier, employed, have lower income, not worried about their health, have previously tested positive for SARS-CoV-2 infection, express lower vaccination acceptance, and/or report higher conscientiousness. Among non-vaccinated individuals, 19.9% and 21.3% had low confidence in the safety and effectiveness of SARS-CoV-2 vaccine, respectively. However, 29.1% and 26.7% of individuals with concerns about vaccine effectiveness and side effects at baseline, respectively vaccinated during the study period.

Conclusion: In addition to known socio-demographic and health-related factors, non-vaccination was associated with concerns regarding vaccine safety and effectiveness.

Socioeconomic inequalities in sport participation
Wissenschaftlicher Artikel
pattern per sport and time trends - a repeated cross-sectional study

V. Richard, G. Piumatti, N. Pullen, Lorthe Elsa, I. Guessous, N. Cantoreggi, S. Stringhini

BMC public health, 2023 , vol.  23, no  article 785

Link zur Publikation

Zusammenfassung:

Background : Sport participation is an important component of a healthy lifestyle and is known to be more common among privileged individuals. However, few studies examined socio-demographic patterns of participation by type of activity. This study aims at quantifying socio-economic inequalities in sport participation by sport type, and to analyse their trend over 15 years.

Methods : We used 2005–2019 data from the Bus Santé study, a yearly population-based cross-sectional survey of Geneva adults. Sport participation was defined as reporting at least one sporting activity over the previous week; educational level, household income and occupational position were used as indicators of socio-economic position. Socio-economic inequalities in sport participation, and their trend over time, were examined using the relative and slope indexes of inequality (RII/SII).

Results : Out of 7769 participants (50.8% women, mean age 46 years old), 60% participated in a sporting activity. Results showed that the higher the socioeconomic circumstances, the higher the sport participation (RII = 1.78; 95% Confidence Interval (CI): 1.64–1.92; SII = 0.33; 95%CI: 0.29–0.37 for education). Relative inequalities varied per sport e.g., 0.68 (95%CI: 0.44–1.07) for football and 4.25 (95%CI: 2.68–6.75) for tennis/badminton for education. Yearly absolute inequalities in sport participation tended to increase between 2005 and 2019 for household income, especially among women and older adults.

Conclusions : We observed strong socio-economic inequalities in sport participation in Geneva, with different magnitude depending on the sport type. These inequalities seemed to increase over the 2005–2019 period. Our results call for tailored measures to promote the participation of socially disadvantaged populations in sporting activities.

Chorionicity and neurodevelopmental outcomes at 5(1/2) years among twins born preterm
Wissenschaftlicher Artikel
the EPIPAGE2 cohort study

D. Hoarau, B. Tosello, J. Blanc, Lorthe Elsa, L. Foix-L'Helias, C. D'Ercole, N. Winer, D. Subtil, F. Goffinet, G. Kayem, N. Resseguier, C. Gire, Epipage Obstetric Writing Group

BJOG: an international journal of obstetrics & gynaecology, 2023 , vol.  130, no  9, pp.  1047-1058

Link zur Publikation

Zusammenfassung:

Objective : To compare the neurodevelopmental outcomes of preterm twins at 5½ years by chorionicity of pregnancy.

Design : Prospective nationwide population-based EPIPAGE2 (Etude Epidémiologique sur les Petits Âges Gestationnels) cohort study.

Setting : A total of 546 maternity units in France, between March and December 2011.

Population : A total of 1126 twins eligible for follow-up at 5½ years.

Methods : The association of chorionicity with outcomes was analysed using multivariate regression models.

Main outcome measures : Survival at 5½ years with or without neurodevelopmental disabilities (comprising cerebral palsy, visual, hearing, cognitive deficiency, behavioural difficulties or developmental coordination disorders) were described and compared by chorionicity.

Results : Among the 1126 twins eligible for follow-up at 5½ years, 926 (82.2%) could be evaluated: 228 monochorionic (MC) and 698 dichorionic (DC). Based on chronicity and gestational age of birth, we found no significant differences for severe neonatal morbidity. The rates of moderate/severe neurobehavioral disabilities were similar in infants from DC pregnancies versus infants from MC pregnancies (OR 1.22, 95% CI 0.65–2.28). By gestational age and without twin–twin transfusion syndrome (TTTS), no difference according to chorionicity was found for all neurodevelopmental outcome measures.

Conclusions : The neurodevelopmental outcomes among preterm twins at 5½ years is similar, irrespective of chorionicity.

Using digital tools to study the health of adults born preterm at a large scale
Wissenschaftlicher Artikel
e-Cohort pilot study

Lorthe Elsa, C. Santos, J. P. Ornelas, J. N. Doetsch, S. C. S. Marques, R. Teixeira, A. C. Santos, C. Rodrigues, G. Goncalves, P. Ferreira Sousa, J. Correia Lopes, A. Rocha, H. Barros

Journal of medical internet research, 2023 , vol.  25, no  e39854

Link zur Publikation

Zusammenfassung:

Background: Preterm birth is a global health concern. Its adverse consequences may persist throughout the life course, exerting a potentially heavy burden on families, health systems, and societies. In high-income countries, the first children who benefited from improved care are now adults entering middle age. However, there is a clear gap in the knowledge regarding the long-term outcomes of individuals born preterm.

Objective: This study aimed to assess the feasibility of recruiting and following up an e-cohort of adults born preterm worldwide and provide estimations of participation, characteristics of participants, the acceptability of questions, and the quality of data collected.

Methods: We implemented a prospective, open, observational, and international e-cohort pilot study (Health of Adult People Born Preterm—an e-Cohort Pilot Study [HAPP-e]). Inclusion criteria were being an adult (aged ≥18 years), born preterm (<37 weeks of gestation), having internet access and an email address, and understanding at least 1 of the available languages. A large, multifaceted, and multilingual communication strategy was established. Between December 2019 and June 2021, inclusion and repeated data collection were performed using a secured web platform. We provided descriptive statistics regarding participation in the e-cohort, namely, the number of persons who registered on the platform, signed the consent form, initiated and completed the baseline questionnaire, and initiated and completed the follow-up questionnaire. We also described the main characteristics of the HAPP-e participants and provided an assessment of the quality of the data and the acceptability of sensitive questions.

Results: As of December 31, 2020, a total of 1004 persons had registered on the platform, leading to 527 accounts with a confirmed email and 333 signed consent forms. A total of 333 participants initiated the baseline questionnaire. All participants were invited to follow-up, and 35.7% (119/333) consented to participate, of whom 97.5% (116/119) initiated the follow-up questionnaire. Completion rates were very high both at baseline (296/333, 88.9%) and at follow-up (112/116, 96.6%). This sample of adults born preterm in 34 countries covered a wide range of sociodemographic and health characteristics. The gestational age at birth ranged from 23+6 to 36+6 weeks (median 32, IQR 29-35 weeks). Only 2.1% (7/333) of the participants had previously participated in a cohort of individuals born preterm. Women (252/333, 75.7%) and highly educated participants (235/327, 71.9%) were also overrepresented. Good quality data were collected thanks to validation controls implemented on the web platform. The acceptability of potentially sensitive questions was excellent, as very few participants chose the “I prefer not to say” option when available.

Conclusions: Although we identified room for improvement in specific procedures, this pilot study confirmed the great potential for recruiting a large and diverse sample of adults born preterm worldwide, thereby advancing research on adults born preterm.

Parental willingness to have children vaccinated against COVID-19 in Geneva, Switzerland
Wissenschaftlicher Artikel
a cross-sectional population-based study

H. Baysson, N. Pullen, C. De Mestral, C. Semaani, F. Pennacchio, M. E. Zaballa, A. G. L'Huillier, Lorthe Elsa, I. Guessous, S. Stringhini, Covid study group Specchio

Swiss medical weekly, 2023 , vol.  153, no  4

Link zur Publikation

Zusammenfassung:

OBJECTIVE: We aimed to examine factors associated with parental willingness to vaccinate their children against COVID-19.

METHODS: We surveyed adults included in a digital longitudinal cohort study composed of participants in previous SARS-CoV-2 serosurveys conducted in Geneva, Switzerland. In February 2022, an online questionnaire collected information on COVID-19 vaccination acceptance, parental willingness to vaccinate their children aged ≥5 years and reasons for vaccination preference. We used multivariable logistic regression to assess the demographic, socioeconomic and health-related factors associated with being vaccinated and with parental intention to vaccinate their children.

RESULTS: We included 1,383 participants (56.8% women; 69.3% aged 35–49 years). Parental willingness to vaccinate their children increased markedly with the child’s age: 84.0%, 60.9% and 21.2%, respectively, for parents of adolescents aged 16–17 years, 12–15 years and 5–12 years. For all child age groups, unvaccinated parents more frequently indicated not intending to vaccinate their children than vaccinated parents. Refusal to vaccine children was associated with having a secondary education (1.73; 1.18–2.47) relative to a tertiary education and with middle (1.75; 1.18–2.60) and low (1.96; 1.20–3.22) household income relative to high income. Refusal to vaccine their children was also associated with only having children aged 12–15 years (3.08; 1.61–5.91), aged 5–11 years (19.77; 10.27–38.05), or in multiple age groups (6.05; 3.22–11.37), relative to only having children aged 16–17 years.

CONCLUSION: Willingness to vaccinate children was high for parents of adolescents aged 16–17 years but decreased significantly with decreasing child age. Unvaccinated, socioeconomically disadvantaged parents and those with younger children were less likely to be willing to vaccinate their children. These results are important for vaccination programs and developing communication strategies to reach vaccine-hesitant groups, both in the context of COVID-19 and in the prevention of other diseases and future pandemics.

Seroprevalence trends of anti-SARS-CoV-2 antibodies and associated risk factors
Wissenschaftlicher Artikel
a population-based study

S. Tancredi, A. Chiolero, C. Wagner, M. L. Haller, P. Chocano-Bedoya, N. Ortega, N. Rodondi, L. Kaufmann, Lorthe Elsa, H. Baysson, S. Stringhini, G. Michel, C. Ludi, E. Harju, I. Frank, M. Imboden, M. Witzig, D. Keidel, N. Probst-Hensch, R. Amati, E. Albanese, L. Corna, L. Crivelli, J. Vincentini, S. Gonseth Nussle, M. Bochud, V. D'Acremont, P. Kohler, C. R. Kahlert, A. Cusini, A. Frei, M. A. Puhan, M. Geigges, M. Kaufmann, J. Fehr, S. Cullati, Group Corona Immunitas Research

Infection, 2023 , vol.  51, no  5, pp.  1453-1465

Link zur Publikation

Zusammenfassung:

Purpose : We aimed to assess the seroprevalence trends of SARS-CoV-2 antibodies in several Swiss cantons between May 2020 and September 2021 and investigate risk factors for seropositivity and their changes over time.

Methods : We conducted repeated population-based serological studies in different Swiss regions using a common methodology. We defined three study periods: May–October 2020 (period 1, prior to vaccination), November 2020–mid-May 2021 (period 2, first months of the vaccination campaign), and mid-May–September 2021 (period 3, a large share of the population vaccinated). We measured anti-spike IgG. Participants provided information on sociodemographic and socioeconomic characteristics, health status, and adherence to preventive measures. We estimated seroprevalence with a Bayesian logistic regression model and the association between risk factors and seropositivity with Poisson models.

Results : We included 13,291 participants aged 20 and older from 11 Swiss cantons. Seroprevalence was 3.7% (95% CI 2.1–4.9) in period 1, 16.2% (95% CI 14.4–17.5) in period 2, and 72.0% (95% CI 70.3–73.8) in period 3, with regional variations. In period 1, younger age (20–64) was the only factor associated with higher seropositivity. In period 3, being aged ≥ 65 years, with a high income, retired, overweight or obese or with other comorbidities, was associated with higher seropositivity. These associations disappeared after adjusting for vaccination status. Seropositivity was lower in participants with lower adherence to preventive measures, due to a lower vaccination uptake.

Conclusions : Seroprevalence sharply increased over time, also thanks to vaccination, with some regional variations. After the vaccination campaign, no differences between subgroups were observed.

Migrant and native women's perceptions of prenatal care communication quality
Wissenschaftlicher Artikel
the role of host-country language proficiency

S. Hamwi, Lorthe Elsa, M. Severo, H. Barros

BMC public health, 2023 , vol.  23, no  article 295

Link zur Publikation

Zusammenfassung:

Background : Despite the potentially significant impact of women-prenatal care provider communication quality (WPCQ) on women’s perinatal health, evidence on the determinants of those perceptions is still lacking, particularly among migrant women. Methods : We aimed to examine the effect of women’s host-country language proficiency on their perceived WPCQ. We analyzed the data of 1210 migrant and 1400 native women who gave birth at Portuguese public hospitals between 2017 and 2019 and participated in the baMBINO cohort study. Migrants’ language proficiency was self-rated. Perceived WPCQ was measured as a composite score of 9 different aspects of self-reported communication quality and ranged from 0 (optimal) to 27. Results : A high percentage of women (29%) rated communication quality as “optimal”. Zero-inflated regression models were fitted to estimate the association between language proficiency and perceived WPCQ. Women with full (aIRR 1.35; 95% CI 1.22,1.50), intermediate (aIRR 1.41; 95% CI 1.23,1.61), and limited (aIRR 1.72; 95% CI 1.45,2.05) language proficiencies were increasingly more likely to have lower WPCQ when compared to natives. Conclusions : Facilitating communication with migrant women experiencing language barriers in prenatal care could provide an important contribution to improving prenatal care quality and addressing potential subsequent disparities in perinatal health outcomes.

Changes in socioeconomic resources and mental health after the second COVID-19 wave (2020-2021)
Wissenschaftlicher Artikel
a longitudinal study in Switzerland

S. Tancredi, A. Ulyte, C. Wagner, D. Keidel, M. Witzig, M. Imboden, N. Probst-Hensch, R. Amati, E. Albanese, S. Levati, L. Crivelli, P. Kohler, A. Cusini, C. Kahlert, E. Harju, G. Michel, C. Ludi, N. Ortega, S. Baggio, P. Chocano-Bedoya, N. Rodondi, T. Ballouz, A. Frei, M. Kaufmann, V. Von Wyl, Lorthe Elsa, H. Baysson, S. Stringhini, V. Schneider, L. Kaufmann, F. Wieber, T. Volken, A. Zysset, J. Dratva, S. Cullati, Group Corona Immunitas Research

International journal for equity in health, 2023 , vol.  22, no  article 51

Link zur Publikation

Zusammenfassung:

Background : During the 2020/2021 winter, the labour market was under the impact of the COVID-19 pandemic. Changes in socioeconomic resources during this period could have influenced individual mental health. This association may have been mitigated or exacerbated by subjective risk perceptions, such as perceived risk of getting infected with SARS-CoV-2 or perception of the national economic situation. Therefore, we aimed to determine if changes in financial resources and employment situation during and after the second COVID-19 wave were prospectively associated with depression, anxiety and stress, and whether perceptions of the national economic situation and of the risk of getting infected modified this association. Methods : One thousand seven hundred fifty nine participants from a nation-wide population-based eCohort in Switzerland were followed between November 2020 and September 2021. Financial resources and employment status were assessed twice (Nov2020–Mar2021, May–Jul 2021). Mental health was assessed after the second measurement of financial resources and employment status, using the Depression, Anxiety and Stress Scale (DASS-21). We modelled DASS-21 scores with linear regression, adjusting for demographics, health status, social relationships and changes in workload, and tested interactions with subjective risk perceptions. Results : We observed scores above thresholds for normal levels for 16% (95%CI = 15–18) of participants for depression, 8% (95%CI = 7–10) for anxiety, and 10% (95%CI = 9–12) for stress. Compared to continuously comfortable or sufficient financial resources, continuously precarious or insufficient resources were associated with worse scores for all outcomes. Increased financial resources were associated with higher anxiety. In the working-age group, shifting from full to part-time employment was associated with higher stress and anxiety. Perceiving the Swiss economic situation as worrisome was associated with higher anxiety in participants who lost financial resources or had continuously precarious or insufficient resources. Conclusion : This study confirms the association of economic stressors and mental health during the COVID-19 pandemic and highlights the exacerbating role of subjective risk perception on this association.

Second-trimester amniotic fluid proteins changes in subsequent spontaneous preterm birth
Wissenschaftlicher Artikel

L. Marcellin, F. Batteux, S. Chouzenoux, T. Schmitz, Lorthe Elsa, C. Mehats, F. Goffinet, G. Kayem

Acta obstetricia et gynecologica scandinavica, 2023 , vol.  102, no  5, pp.  597-604

Link zur Publikation

Zusammenfassung:

Introduction : The global sequence of the pathogenesis of preterm labor remains unclear. This study aimed to compare amniotic fluid concentrations of extracellular matrix-related proteins (procollagen, osteopontin and IL-33), and of cytokines (IL-19, IL-6, IL-20, TNFα, TGFβ, and IL-1β) in asymptomatic women with and without subsequent spontaneous preterm delivery. Material and methods : We used amniotic fluid samples of singleton pregnancy, collected by amniocentesis between 16 and 20 weeks' gestation, without stigmata of infection (i.e., all amniotic fluid samples were tested with broad-range 16 S rDNA PCR to distinguish samples with evidence of past bacterial infection from sterile ones), during a randomized, double-blind, placebo-controlled trial to perform a nested case–control laboratory study. Cases were women with a spontaneous delivery before 37 weeks of gestation (preterm group). Controls were women who gave birth at or after 39 weeks (full term group). Amniotic fluid concentrations of the extracellular matrix-related proteins and cytokines measured by immunoassays were compared for two study groups. ClinicalTrials.gov: NCT00718705. Results : Between July 2008 and July 2011, in 12 maternal-fetal medicine centers in France, 166 women with available PCR-negative amniotic fluid samples were retained for the analysis. Concentrations of procollagen, osteopontin, IL-19, IL-6, IL-20, IL-33, TNFα, TGFβ, and IL-1β were compared between the 37 who gave birth preterm and the 129 women with full-term delivery. Amniotic fluid levels of procollagen, osteopontin, IL-19, IL-33, and TNFα were significantly higher in the preterm than the full-term group. IL-6, IL-20, TGFβ, and IL-1β levels did not differ between the groups. Conclusions : In amniotic fluid 16 S rDNA PCR negative samples obtained during second-trimester amniocentesis, extracellular matrix-related protein concentrations (procollagen, osteopontin and IL-33), together with IL-19 and TNFα, were observed higher at this time in cases of later spontaneous preterm birth.

Women's occupational status during pregnancy and preventive behaviour and health outcomes between 1998 and 2016 in France
Wissenschaftlicher Artikel

S. Vigoureux, Lorthe Elsa, B. Blondel, V. Ringa, M. J. Saurel-Cubizolles

Journal of gynecology obstetrics and human reproduction, 2023 , vol.  52, no  3 ; article 102545

Link zur Publikation

Zusammenfassung:

Background : Despite an improvement in preventive care and perinatal health in previous decades, social inequalities persist, particularly to the disadvantage of isolated or unemployed women.

The objective was to analyse the evolution between 1998 and 2016 of the association between women's occupational status and perinatal outcomes.

Methods : Data came from four national surveys performed in 1998, 2003, 2010 and 2016. Occupational status was defined by maternal employment status and type of occupation during pregnancy. Preventive behaviours (initiation of antenatal care, antenatal classes, breast feeding) and health outcomes (hospitalization, preterm birth, birth weight below the 10th percentile) were analysed by occupational status adjusted for other maternal characteristics, for each study year.

Results : The studied sample included 12,497 women in 1998, 13,290 in 2003, 13,209 in 2010 and 11,179 in 2016. The proportion of employed women increased from 66% to 75% between 1998 and 2016, and that of housewives decreased from 22% to 12%. The proportion of preterm births globally increased between 1998 and 2016, especially for housewives. The proportion of low birthweight for gestational age (LBWGA) remained similar over the years. From 1998 to 2016, the differences between occupational groups persisted for preterm births and LBWGA.

Conclusions : Occupational groups exhibited strong social differences in preventive care over the entire study period and persisted in the recent data. As a major social indicator, women's occupational status during pregnancy has to be considered as a risk factor of poor preventive behaviour and unfavourable perinatal outcomes.

Seroprevalence of anti-SARS-CoV-2 antibodies and cross-variant neutralization capacity after the Omicron BA.2 wave in Geneva, Switzerland
Wissenschaftlicher Artikel
a population-based study

M. E. Zaballa, J. Perez-Saez, C. de Mestral, N. Pullen, J. Lamour, P. Turelli, C. Raclot, H. Baysson, F. Pennacchio, J. Villers, J. Duc, V. Richard, R. Dumont, C. Semaani, A. J. Loizeau, C. Graindorge, Lorthe Elsa, J. F. Balavoine, D. Pittet, M. Schibler, N. Vuilleumier, F. Chappuis, O. Kherad, A. S. Azman, K. M. Posfay-Barbe, L. Kaiser, D. Trono, S. Stringhini, I. Guessous, Specchio Covid study group

The Lancet regional health - Europe, 2023 , vol.  24, no  article 100547

Link zur Publikation

Zusammenfassung:

Background: More than two years into the COVID-19 pandemic, most of the population has developed anti-SARS-CoV-2 antibodies from infection and/or vaccination. However, public health decision-making is hindered by the lack of up-to-date and precise characterization of the immune landscape in the population. Here, we estimated anti-SARS-CoV-2 antibodies seroprevalence and cross-variant neutralization capacity after Omicron became dominant in Geneva, Switzerland.

Methods : We conducted a population-based serosurvey between April 29 and June 9, 2022, recruiting children and adults of all ages from age-stratified random samples of the general population of Geneva, Switzerland. We tested for anti-SARS-CoV-2 antibodies using commercial immunoassays targeting either the spike (S) or nucleocapsid (N) protein, and for antibody neutralization capacity against different SARS-CoV-2 variants using a cell-free Spike trimer-ACE2 binding-based surrogate neutralization assay. We estimated seroprevalence and neutralization capacity using a Bayesian modeling framework accounting for the demographics, vaccination, and infection statuses of the Geneva population.

Findings : Among the 2521 individuals included in the analysis, the estimated total antibodies seroprevalence was 93.8% (95% CrI 93.1–94.5), including 72.4% (70.0–74.7) for infection-induced antibodies. Estimates of neutralizing antibodies in a representative subsample (N = 1160) ranged from 79.5% (77.1–81.8) against the Alpha variant to 46.7% (43.0–50.4) against the Omicron BA.4/BA.5 subvariants. Despite having high seroprevalence of infection-induced antibodies (76.7% [69.7–83.0] for ages 0–5 years, 90.5% [86.5–94.1] for ages 6–11 years), children aged <12 years had substantially lower neutralizing activity than older participants, particularly against Omicron subvariants. Overall, vaccination was associated with higher neutralizing activity against pre-Omicron variants. Vaccine booster alongside recent infection was associated with higher neutralizing activity against Omicron subvariants.

Interpretation : While most of the Geneva population has developed anti-SARS-CoV-2 antibodies through vaccination and/or infection, less than half has neutralizing activity against the currently circulating Omicron BA.5 subvariant. Hybrid immunity obtained through booster vaccination and infection confers the greatest neutralization capacity, including against Omicron.

Migrant-native disparities in obstetric neuraxial analgesia use
Wissenschaftlicher Artikel
the role of host-country language proficiency

S. Hamwi, H. Barros, Lorthe Elsa

Anesthesia & analgesia, 2023 , vol.  137, no  4, pp.  870-881

Link zur Publikation

Zusammenfassung:

Background: Neuraxial analgesia (NA) is the most effective modality in managing labor pain with widespread availability in high-income countries. Previous research has reported a differential obstetric NA use among migrant and native women, but the contribution of language barriers is not well understood. We aimed to investigate whether host-country language proficiency among migrant women influences NA use and satisfaction with pain management during labor, when compared to natives.

Methods: We conducted a secondary analysis of data collected from 1024 native and 1111 migrant women who had singleton vaginal deliveries between 2017 and 2019 and were enrolled in the nationwide Portuguese baMBINO prospective cohort study. Obstetric NA use, satisfaction with labor pain management, and migrants’ Portuguese language proficiency were self-reported. Data were analyzed using robust multilevel Poisson regression, adjusted for maternal region of birth (characterized by the Human Development Index), age, and education.

Results: Overall, 84.4% of native women gave birth with NA, compared to 81.6%, 71.3%, and 56.9% of migrant women with full, intermediate, and limited language proficiency, respectively. Compared to native women, migrants with intermediate (adjusted risk ratio [aRR] = 0.91 [95% confidence interval {CI}, 0.82–0.99]) and limited (aRR = 0.73 [95% CI, 0.56–0.94]) proficiency were less likely to receive NA. However, no significant differences were observed in pain management satisfaction by language proficiency level.

Conclusions  : Compared to native women, we observed a differential obstetric NA use across migrant women with different host-country language proficiency levels in Portugal, without affecting satisfaction with labor pain management. Although defining the mechanisms underlying NA use discrepancies requires further research, our findings support systematically evaluating pregnant migrant women’s linguistic skills and ensuring their access to adequate obstetric analgesia-related information and interpretation services.

Impact of the COVID-19 pandemic on children and adolescents
Wissenschaftlicher Artikel
determinants and association with quality of life and mental health-a cross-sectional study

V. Richard, R. Dumont, Lorthe Elsa, A. Loizeau, H. Baysson, M. E. Zaballa, F. Pennacchio, R. P. Barbe, K. M. Posfay-Barbe, I. Guessous, S. Stringhini, SEROCoV-KIDS Study Group

Child and adolescent psychiatry and mental health, 2023 , vol.  17, no  article 17

Link zur Publikation

Zusammenfassung:

Background : The medium-term impact of the COVID-19 pandemic on the wellbeing of children and adolescents remains unclear. More than 2 years into the pandemic, we aimed to quantify the frequency and determinants of having been severely impacted by the COVID-19 pandemic and estimate its impact on health-related quality of life (HRQoL) and mental health.

Methods : Data was drawn from a population-based cohort of children and adolescents, recruited between December 2021 and June 2022, in Geneva, Switzerland. The Coronavirus impact scale was used to assess the multidimensional impact of the pandemic on children through parent’s report. A score higher than one standard deviation above the mean was deemed a severe impact. Parents additionally reported about their offspring HRQoL and mental health with validated scales. Determinants of having been severely impacted were assessed with logistic models, as were the associations between having experienced a severe impact and poor HRQoL or mental health.

Results : Out of 2101 participants aged 2–17, 12.7% had experienced a severe pandemic impact. Having a lasting health condition, a pandemic-related worsening of lifestyle habits or an unfavorable family environment were associated with having been severely impacted by the pandemic, while a previous anti-SARS-CoV-2 infection was not. Participants who had experienced a severe pandemic impact were more likely to present poor HRQoL (aOR = 3.1; 95% CI 2.3–4.4) and poor mental health (aOR = 3.9; 95% CI 2.5–6.2).

Conclusion : The COVID-19 pandemic may have persistent consequences on the wellbeing of children and adolescents, especially among those with health and family vulnerabilities.

Socioeconomic conditions and children's mental health and quality of life during the COVID-19 pandemic
Wissenschaftlicher Artikel
an intersectional analysis

Lorthe Elsa, V. Richard, R. Dumont, A. Loizeau, J. Perez-Saez, H. Baysson, M. E. Zaballa, J. Lamour, N. Pullen, S. Schrempft, R. P. Barbe, K. M. Posfay-Barbe, I. Guessous, S. Stringhini, SEROCoV-KIDS study group

SSM - population health, 2023 , vol.  23, no  article 101472

Link zur Publikation

Zusammenfassung:

Background : Children and adolescents are highly vulnerable to the impact of sustained stressors during developmentally sensitive times. We investigated how demographic characteristics intersect with socioeconomic dimensions to shape the social patterning of quality of life and mental health in children and adolescents, two years into the COVID-19 pandemic.

Methods : We used data from the prospective SEROCoV-KIDS cohort study of children and adolescents living in Geneva (Switzerland, 2022). We conducted an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy by nesting participants within 48 social strata defined by intersecting sex, age, immigrant background, parental education and financial hardship in Bayesian multilevel logistic models for poor health-related quality of life (HRQoL, measured with PedsQL) and mental health difficulties (measured with the Strengths and Difficulties Questionnaire).

Results : Among participants aged 2–17 years, 240/2096 (11.5%, 95%CI 10.1–12.9) had poor HRQoL and 105/2135 (4.9%, 95%CI 4.0–5.9) had mental health difficulties. The predicted proportion of poor HRQoL ranged from 3.4% for 6–11 years old Swiss girls with highly educated parents and no financial hardship to 34.6% for 12–17 years old non-Swiss girls with highly educated parents and financial hardship. Intersectional strata involving adolescents and financial hardship showed substantially worse HRQoL than their counterparts. Between-stratum variations in the predicted frequency of mental health difficulties were limited (range 4.4%–6.5%).

Conclusions : We found considerable differences in adverse outcomes across social strata. Our results suggest that, post-pandemic, interventions to address social inequities in HRQoL should focus on specific intersectional strata involving adolescents and families experiencing financial hardship, while those aiming to improve mental health should target all children and adolescents.

Circumstances, causes and timing of death in extremely preterm infants admitted to NICU
Wissenschaftlicher Artikel
the EPIPAGE-2 study

P. Boileau, M. Letouzey, A. S. Morgan, Lorthe Elsa, M. Kaminski, A. Coquelin, E. Azria, L. Caeymaex, F. Rouget, C. Diguisto, O. Claris, B. Tosello, P. Truffert, P. Betremieux, V. Benhammou, L. Marchand-Martin, F. Goffinet, P. Y. Ancel, L. Foix-L'Helias

Acta paediatrica, 2023 , vol.  112, no  10, pp.  2066-2074

Link zur Publikation

Zusammenfassung:

Aim : To describe the circumstances, causes and timing of death in extremely preterm infants.

Methods : We included from the EPIPAGE-2 study infants born at 24–26 weeks in 2011 admitted to neonatal intensive care units (NICU). Vital status and circumstances of death were used to define three groups of infants: alive at discharge, death with or without withholding or withdrawing life-sustaining treatment (WWLST). The main cause of death was classified as respiratory disease, necrotizing enterocolitis, infection, central nervous system (CNS) injury, other or unknown.

Results: Among 768 infants admitted to NICU, 224 died among which 89 died without WWLST and 135 with WWLST. The main causes of death were respiratory disease (38%), CNS injury (30%) and infection (12%). Among the infants who died with WWLST, CNS injury was the main cause of death (47%), whereas respiratory disease (56%) and infection (20%) were the main causes in case of death without WWLST. Half (51%) of all deaths occurred within the first 7 days of life, and 35% occurred within 8 and 28 days.

Conclusion : The death of extremely preterm infants in NICU is a complex phenomenon in which the circumstances and causes of death are intertwined.

2022

Persistent symptoms after SARS-CoV-2 infection in children
Wissenschaftlicher Artikel
a cross-sectional population-based serological study

R. Dumont, M. Nehme, Lorthe Elsa, C. De Mestral, V. Richard, H. Baysson, F. Pennacchio, J. Lamour, C. Semaani, M. E. Zaballa, N. Pullen, A. Perrin, A. G. L'Huillier, K. M. Posfay-Barbe, I. Guessous, S. Stringhini, Covid study group Specchio

BMJ open, 2022 , vol.  12, no  11

Link zur Publikation

Zusammenfassung:

Objectives To estimate the prevalence of children and adolescents reporting persistent symptoms after SARS-CoV-2 infection.

Design A random sample of children and adolescents participated with their family members to a serological survey including a blood drawing for detecting antibodies targeting the SARS-CoV-2 nucleocapsid (N) protein and a questionnaire on COVID-19-related symptoms experienced since the beginning of the pandemic.

Setting The study took place in the canton of Geneva, Switzerland, between June and July 2021.

Participant 660 children aged between 2 and 17 years old.

Primary and secondary outcome The primary outcome was the persistence of symptoms beyond 4 weeks comparing seropositive and seronegative participants. The type of declared symptoms were also studied as well as associated risk factors.

Results Among seropositive children, the sex-adjusted and age-adjusted prevalence of symptoms lasting longer than 2 weeks was 18.3%, compared with 11.1% among seronegatives (adjusted prevalence difference (ΔaPrev)=7.2%, 95% CI: 1.5% to 13.0%). Among adolescents aged 12–17 years, we estimated the prevalence of experiencing symptoms lasting over 4 weeks to be 4.4% (ΔaPrev,95% CI: −3.8% to 13.6%), whereas no seropositive child aged 2–11 reported symptoms of this duration. The most frequently declared symptoms were fatigue, headache and loss of smell.

Conclusions We estimated the prevalence of experiencing persistent symptoms lasting over 4 weeks to be around 4% among adolescents, which represents a large absolute number, and should raise awareness and concern. We did not observe meaningful differences of persistent symptoms between seropositive and seronegative younger children, suggesting that they may be less affected than their older counterparts.

Time trends in episiotomy and severe perineal tears in Portugal
Wissenschaftlicher Artikel
a nationwide register-based study

C. Teixeira, Lorthe Elsa, H. Barros

BMC pregnancy childbirth, 2022 , vol.  22, no  article 976

Link zur Publikation

Zusammenfassung:

Introduction : Rates of episiotomy and severe perineal tears (SPT) are indicators of the quality of obstetric care. Time-trends in the reported occurrence of episiotomy and SPT can contribute to understand both, changes in care and in the frequency of risk factors. Therefore, we aimed to estimate time trends in the frequency of SPT in Portugal and its relationship with episiotomy.

Methods : We conducted a nationwide register-based study using data from the national inpatient database of all Portuguese public hospitals between 2000 and 2015. Time-trend analysis using joinpoint regression models was performed to identify trends (joinpoints) and compare time changes in the prevalence of SPT and risk factors expressed as annual percentage changes (APC) with 95% Confidence Intervals (95% CI). Poisson regression models were fitted to estimate whether time-trends in SPT rates were explained by changes in risk factors and to assess the association between episiotomy and SPT. Adjusted relative risk (aRR) and their respective 95% CI were obtained.

Results : From 908,999 singleton vaginal deliveries, 20.6% were instrumental deliveries, 76.7% with episiotomy and 0.56% were complicated by SPT. Among women with non-instrumental deliveries and no episiotomy SPT decreased from 2009 onwards (1.3% to 0.7%), whereas SPT kept increasing in women with episiotomy for both non-instrumental (0.1% in 2000 to 0.4% in 2015) and instrumental deliveries (0.7% in 2005 to 2.3% in 2015). Time-trends in potential risk factors did not explain the observed increase in SPT. Episiotomy was associated with a decrease in SPT with adjusted RR varying between 2000 and 2015 from 0.18 (95%CI:0.13–0.25) to 0.59 (95%CI:0.44–0.79) for non-instrumental deliveries and from 0.45 (95%CI:0.25–0.81) to 0.50 (95%CI:0.40–0.72) for instrumental deliveries.

Conclusions : Our findings suggest that episiotomy rate could safely further decrease as the main factor driving SPT rates seems to be an increase in awareness and reporting of SPT particularly among women who underwent an episiotomy.

Host-country language proficiency and migrant-native disparities in prenatal care utilization
Wissenschaftlicher Artikel
a nationwide study in Portugal

S. Hamwi, Lorthe Elsa, H. Barros

Birth, 2022 , vol.  49, no  3, pp.  474-485

Link zur Publikation

Zusammenfassung:

Background : Migrant-native disparities in perinatal health and care utilization are well-established, yet most evidence comes from countries without universal health coverage. Migrant-specific factors potentially contributing to such disparities are seldom examined. We investigated the association between migration and host-country language proficiency and inadequate utilization of prenatal care (PNC) in Portugal.

Methods : We used robust Poisson regression to analyze data from 1419 migrant and 2477 native women enrolled in the Portuguese Bambino cohort study who had given birth at a Portuguese public hospital between 2017 and 2019. Migrant women's language proficiency was self-rated for understanding, speaking, reading, and writing skills. PNC utilization inadequacy was assessed using three dimensions: initiation, number of visits, and the modified Adequacy of Prenatal Care Utilization (mAPNCU) Index score.

Results : Migrant women were overall more likely to initiate PNC late and have inadequate/intermediate mAPNCU scores than natives. Migrant-native disparities in the number of PNC visits were only observed among recent migrants (≤5 years in Portugal). Full, intermediate, and limited Portuguese skills were associated with increasingly higher risks of late PNC initiation (aRR 1.34 [95%CI 1.20-1.50]); (aRR 1.52 [95%CI 1.28-1.80]); (aRR 1.91 [95%CI 1.52-2.40]), inadequate number of PNC visits (aRR 1.06 [95%CI 0.93-1.22]); (aRR 1.14 [95%CI 0.97-1.34]); (aRR 1.57 [95%CI 1.19-2.07]), and inadequate/intermediate mAPNCU scores (aRR 1.18 [95%CI 1.07-1.32]); (aRR 1.30 [95%CI 1.11-1.53]); (aRR 1.69 [95%CI 1.38-2.07]) compared with native Portuguese skills, respectively.

Conclusions : Migrant-native disparities in PNC utilization are present in Portugal, despite universal health coverage. Recent migrants and women with limited language competence are the most vulnerable to inadequate PNC use.

Specchio-COVID19 cohort study
Wissenschaftlicher Artikel
a longitudinal follow-up of SARS-CoV-2 serosurvey participants in the canton of Geneva, Switzerland

H. Baysson, F. Pennachio, A. Wisniak, M. E. Zabella, N. Pullen, P. Collombet, Lorthe Elsa, S. Joost, J. F. Balavoine, D. Bachmann, A. Azman, D. Pittet, F. Chappuis, O. Kherad, L. Kaiser, I. Guessous, S. Stringhini, Specchio Covid study group

BMJ open, 2022 , vol.  12, no  article e055515

Link zur Publikation

Zusammenfassung:

Introduction The COVID-19 pandemic has affected billions of people around the world both directly through the infection itself and indirectly through its economic, social and sanitary impact. Collecting data over time is essential for the understanding of the disease spread, the incidence of COVID-19-like symptoms, the level and dynamics of immunity, as well as the long-term impact of the pandemic. The objective of the study was to set up a longitudinal follow-up of adult participants of serosurveys carried out in the canton of Geneva, Switzerland, during the COVID-19 pandemic. This follow-up aims at monitoring COVID-19 related symptoms and SARS-CoV-2 seroconversion, as well as the overall impact of the pandemic on several dimensions of health and on socioeconomic factors over a period of at least 2 years.

Methods and analysis Serosurvey participants were invited to create an account on the dedicated digital platform Specchio-COVID19 (https://www.specchio-covid19.ch/). On registration, an initial questionnaire assessed sociodemographic and lifestyle characteristics (including housing conditions, physical activity, diet, alcohol and tobacco consumption), anthropometry, general health and experience related to COVID-19 (symptoms, COVID-19 test results, quarantines, hospitalisations). Weekly, participants were invited to fill in a short questionnaire with updates on self-reported COVID-19-compatible symptoms, SARS-CoV-2 infection testing and vaccination. A more detailed questionnaire about mental health, well-being, risk perception and changes in working conditions was proposed monthly. Supplementary questionnaires were proposed at regular intervals to assess more in depth the impact of the pandemic on physical and mental health, vaccination adherence, healthcare consumption and changes in health behaviours. At baseline, serology testing allowed to assess the spread of SARS-CoV-2 infection among the general population and subgroups of workers. Additionally, seropositive participants and a sample of randomly selected participants were invited for serologic testing at regular intervals in order to monitor both the seropersistance of anti-SARS-CoV-2 antibodies and the seroprevalence of anti-SARS-CoV-2 antibodies in the population of the canton of Geneva.

Survey of data collection methods and retention strategies in European birth cohorts of children and adults born very preterm
Wissenschaftlicher Artikel

R. Teixeira, J. Doetsch, A. I. Freitas, Lorthe Elsa, A. C. Santos, H. Barros, RECAP-preterm consortium

Paediatric and perinatal epidemiology, 2022 , vol.  36, no  5, pp.  706-714

Link zur Publikation

Zusammenfassung:

Background : The long-term follow-up of very preterm and very low birthweight cohorts contributes to valuable evidence to understand life-course outcomes in these vulnerable populations. However, attrition is a major challenge in long-term outcome studies. Examining the techniques used by existing cohorts may help to reveal practices that enhance willingness to continue participation over time.

Objectives : To evaluate the effect of data collection methods and retention strategies on overall retention in European birth cohorts of individuals born very preterm and very low birthweight.

Methods : A survey of European cohorts integrated in the RECAP-preterm Consortium provided data on study characteristics, retention at the most recent follow-up, data collection methods and retention strategies. Cohorts were classified according to participants’ age at most recent follow-up as child (<18) or adult cohorts (≥18 years old).

Results : Data were obtained for 17 (81%) cohorts (7 adult and 10 child) in 12 countries. Considering the baseline, at the most recent follow-up, overall retention ranged from 10% to 99%. Child cohorts presented higher median retention (68% versus 38% or 52% for adult cohorts with ≤5 or >5 follow-ups) and used relatively more retention strategies. For contact and invitation, cohorts mostly resorted to invitation letters, and to face-to-face interviews for assessments. Study duration was negatively correlated with retention and positively associated with the number of follow-up evaluation. We identified 109 retention strategies, with a median of 6 per cohort; bond-building (n = 41; 38%) was the most utilised, followed by barrier-reduction (n = 36; 33%) and reminders (n = 32; 29%). Retention was not influenced by category or number of strategies.

Conclusions : Regular contact with cohort participants favour retention whilst neither the number nor the categories of retention strategies used seemed to have an influence, suggesting that tailored strategies focussed on participants at higher risk of dropout might be a more effective approach.

High maternal pre-pregnancy BMI is associated with increased offspring peer-relationship problems at 5 years
Wissenschaftlicher Artikel

C. Dow, Lorthe Elsa, C. Galera, M. Tafflet, L. Marchand-Martin, P. Y. Ancel, M. A. Charles, B. Heude

Frontiers in child and adolescent psychiatry, 2022 , vol.  1

Link zur Publikation

Zusammenfassung:

Background: Peer relationships are an important aspect of child development that are often overlooked. Maternal pre-pregnancy body mass index (BMI) may influence peer relationships through intrauterine mechanisms affecting fetal neurodevelopment or through postnatal mechanisms including social discrimination of the obese mother/child. This study aimed to determine the relationship between maternal pre-pregnancy BMI and child peer-relationship problems around 5 years old, including preterm and term-born children.

Methods and findings: Maternal BMI and offspring peer-relationship problems were assessed in participants of three French birth cohorts: EDEN (n = 1,184 children born at term), ELFE (n = 10,889 children born ≥33 weeks of gestation) and EPIPAGE-2 (n = 2,646 children born 23–34 weeks of gestation). Reported or measured pre-pregnancy weight (kg) and height (m) were collected from mothers and used to calculate BMI (kg/m2). Offspring peer-relationship problems were assessed using the Strengths and Difficulties Questionnaire at 5.5 years. Logistic regression was used to estimate odds ratios (OR) of a high peer-relationship problem score (≥3) in EDEN and ELFE, and generalized estimated equations were used in EPIPAGE-2 to account for the large number of multiple births. Paternal BMI was used as a negative control in sensitivity analyses. Maternal pre-pregnancy obesity was associated with increased odds of a high peer-relationship problem score in all three cohorts, independent of confounding factors [adjusted OR 2.27 (1.32, 3.88); 1.52 (1.29, 1.78); 1.44 (1.04, 1.99); for EDEN, ELFE and EPIPAGE-2, respectively]. Additional analysis based on negative controls (i.e., adjusting for paternal BMI) showed the same pattern of associations.

Conclusion: High maternal pre-pregnancy BMI is associated with greater likelihood of a high peer-relationship trouble score in offspring around 5 years of age in both children born preterm and at term.

Antibiotic prophylaxis in preterm premature rupture of membranes at 24-31 weeks' gestation
Wissenschaftlicher Artikel
perinatal and 2-year outcomes in the EPIPAGE-2 cohort

Lorthe Elsa, M. Letouzey, H. Torchin, L. Foix L'Helias, C. Gras-Le Guen, V. Benhammou, P. Boileau, C. Charlier, G. Kayem, Epipage- Obstetric Writing Group

BJOG : an international journal of obstetrics & gynaecology, 2022 , vol.  129, no  9, pp.  1560-1573

Link zur Publikation

Zusammenfassung:

Objective : To compare different antibiotic prophylaxis administered after preterm premature rupture of membranes to determine whether any were associated with differences in obstetric and/or neonatal outcomes and/or neurodevelopmental outcomes at 2 years of corrected age.

Design : Prospective, nationwide, population-based EPIPAGE-2 cohort study of preterm infants.

Setting : France, 2011.

Sample : We included 492 women with a singleton pregnancy and a diagnosis of preterm premature rupture of membranes at 24–31 weeks. Exclusion criteria were contraindication to expectant management or indication for antibiotic therapy other than preterm premature rupture of membranes. Antibiotic prophylaxis was categorised as amoxicillin (n = 345), macrolide (n = 30), third-generation cephalosporin (n = 45) or any combinations covering Streptococcus agalactiae and >90% of Escherichia coli (n = 72), initiated within 24 hours after preterm premature rupture of membranes.

Methods : Population-averaged robust Poisson models.

Main Outcome Measures : Survival at discharge without severe neonatal morbidity, 2-year neurodevelopment.

Results : With amoxicillin, macrolide, third-generation cephalosporin and combinations, 78.5%, 83.9%, 93.6% and 86.0% of neonates were discharged alive without severe morbidity. The administration of third-generation cephalosporin or any E. coli-targeting combinations was associated with improved survival without severe morbidity (adjusted risk ratio 1.25 [95% confidence interval 1.08–1.45] and 1.10 [95 % confidence interval 1.01–1.20], respectively) compared with amoxicillin. We evidenced no increase in neonatal sepsis related to third-generation cephalosporin-resistant pathogen.

Conclusion : In preterm premature rupture of membranes at 24–31 weeks, antibiotic prophylaxis based on third-generation cephalosporin may be associated with improved survival without severe neonatal morbidity when compared with amoxicillin, with no evidence of increase in neonatal sepsis related to third-generation cephalosporin-resistant pathogen.

Tweetable Abstract : Antibiotic prophylaxis after PPROM at 24–31 weeks: 3rd-generation cephalosporins associated with improved neonatal outcomes.

A population-based serological study of post-COVID syndrome prevalence and risk factors in children and adolescents
Wissenschaftlicher Artikel

R. Dumont, V. Richard, Lorthe Elsa, A. Loizeau, F. Pennacchio, M. E. Zaballa, H. Baysson, M. Nehme, A. Perrin, A. G. L'Huillier, L. Kaiser, R. P. Barbe, K. M. Posfay-Barbe, S. Stringhini, SEROCoV-KIDS study group, I. Guessous

Nature communications, 2022 , vol.  13, no  article 7086

Link zur Publikation

Zusammenfassung:

Post-COVID syndrome remains poorly studied in children and adolescents. Here, we aimed to investigate the prevalence and risk factors of pediatric post-COVID in a population-based sample, stratifying by serological status. Children from the SEROCoV-KIDS cohort study (State of Geneva, Switzerland), aged 6 months to 17 years, were tested for anti-SARS-CoV-2 N antibodies (December 2021-February 2022) and parents filled in a questionnaire on persistent symptoms in their children (lasting over 12 weeks) compatible with post-COVID. Of 1034 children tested, 570 (55.1%) were seropositive. The sex- and age-adjusted prevalence of persistent symptoms among seropositive children was 9.1% (95%CI: 6.7;11.8) and 5.0% (95%CI: 3.0;7.1) among seronegatives, with an adjusted prevalence difference (ΔaPrev) of 4.1% (95%CI: 1.1;7.3). Stratifying per age group, only adolescents displayed a substantial risk of having post-COVID symptoms (ΔaPrev = 8.3%, 95%CI: 3.5;13.5). Identified risk factors for post-COVID syndrome were older age, having a lower socioeconomic status and suffering from chronic health conditions, especially asthma. Our findings show that a significant proportion of seropositive children, particularly adolescents, experienced persistent COVID symptoms. While there is a need for further investigations, growing evidence of pediatric post-COVID urges early screening and primary care management.

Maternal pre-pregnancy obesity and offspring hyperactivity-inattention symptoms at 5 years in preterm and term children
Wissenschaftlicher Artikel
a multi-cohort analysis

C. Dow, Lorthe Elsa, L. Marchand-Martin, C. Galera, M. Tafflet, P. Y. Ancel, M. A. Charles, B. Heude

Scientific reports, 2022 , vol.  12, no  article 18190

Link zur Publikation

Zusammenfassung:

The objective of this study was to determine the relationship between maternal pre-pregnancy body mass index (BMI) and child hyperactivity-inattention symptoms (HIS) at 5 years, including preterm and term-born children, and to determine whether this association varied with gestational age. Maternal pre-pregnancy BMI and offspring HIS were assessed in 10,898 participants born ≥ 33 weeks of gestation from the ELFE cohort and 2646 children born between 23 and 34 weeks from the EPIPAGE 2 cohort. Reported pre-pregnancy weight (kg) and measured height (m) were collected from mothers at inclusion and used to classify BMI (kg/m2). Child HIS were evaluated using the Strengths and Difficulties Questionnaire around 5 years of age. Logistic regression estimated odds ratios (OR) of a high HIS score (≥ 90th percentile) in the ELFE cohort and generalized estimated equations were used in EPIPAGE 2 to account for non-independence of multiple births. As a negative control, paternal BMI was also considered as an exposure of interest in sensitivity analyses. Maternal pre-pregnancy obesity and overweight were associated with child HIS at 5 years in ELFE (adjusted OR [aOR] for obesity 1.27 [1.06, 1.53]; overweight aOR 1.16 [1.00, 1.36]) and pre-pregnancy obesity was associated with high HIS scores in preterm infants of EPIPAGE 2 (aOR 1.48 [1.06, 2.08]). In ELFE, the magnitude of the association increased with decreasing gestational age (interaction p = 0.02). High maternal pre-pregnancy BMI is associated with greater likelihood of high HIS scores in both at-term and preterm children at 5 years of age.

Early antibiotic exposure and adverse outcomes in very preterm infants at low risk of early-onset sepsis
Wissenschaftlicher Artikel
the EPIPAGE-2 cohort study

M. Letouzey, Lorthe Elsa, L. Marchand-Martin, G. Kayem, C. Charlier, M. Butin, A. Mitha, M. Kaminski, V. Benhammou, P. Y. Ancel, P. Boileau, L. Foix-L'Helias, Epipage- Infectious Diseases Working Group

The journal of pediatrics, 2022 , vol.  243, pp.  91-98

Zusammenfassung:

Objective : To assess the association between early empirical antibiotics and neonatal adverse outcomes in very preterm infants without risk factors for early-onset sepsis (EOS).

Study design : This is a secondary analysis of the EPIPAGE-2 study, a prospective national population-based cohort that included all liveborn infants at 22-31 completed weeks of gestation in France in 2011. Infants at high risk of EOS (ie, born after preterm labor or preterm premature rupture of membranes or from a mother who had clinical chorioamnionitis or had received antibiotics during the last 72 hours) were excluded. Early antibiotic exposure was defined as antibiotic therapy started at day 0 or day 1 of life, irrespective of the duration and type of antibiotics. We compared treated and untreated patients using inverse probability of treatment weighting based on estimated propensity scores.

Results : Among 648 very preterm infants at low risk of EOS, 173 (26.2%) had received early antibiotic treatment. Early antibiotic exposure was not associated with death or late-onset sepsis or necrotizing enterocolitis (OR, 1.04; 95% CI, 0.72-1.50); however, it was associated with higher odds of severe cerebral lesions (OR, 2.71; 95% CI, 1.25-5.86) and moderate-severe bronchopulmonary dysplasia (BPD) (OR, 2.30; 95% CI, 1.21-4.38).

Conclusions : Early empirical antibiotic therapy administrated in very preterm infants at low risk of EOS was associated with a higher risk of severe cerebral lesions and moderate-severe BPD.

A SARS-CoV-2 omicron (B.1.1.529) variant outbreak in a primary school in Geneva, Switzerland
Wissenschaftlicher Artikel

Lorthe Elsa, M. Bellon, J. Berthelot, G. Michielin, A. G. L'Huillier, K. M. Posfay-Barbe, A. S. Azman, I. Guessous, S. J. Maerkl, I. Eckerle, S. Stringhini, SEROCoV-Schools Study Group

The Lancet infectious diseases, 2022 , vol.  22, no  6, pp.  767-768

Link zur Publikation

Determinants of adolescents' Health-Related Quality of Life and psychological distress during the COVID-19 pandemic
Wissenschaftlicher Artikel

R. Dumont, V. Richard, H. Baysson, Lorthe Elsa, G. Piumatti, S. Schrempft, A. Wisniak, R. P. Barbe, K. M. Posfay-Barbe, I. Guessous, S. Stringhini, Specchio-Covid study group

PLoS one, 2022 , vol.  17, no  8 - article e0272925

Link zur Publikation

Zusammenfassung:

Background : We examined the determinants of adolescents’ Health-Related Quality of Life (HRQoL) and psychological distress (self-reported and parent-reported) during the COVID-19 pandemic, using a random sample of the population of Geneva, Switzerland.

Methods : Data was drawn from participants aged 14–17 years, who participated with their families to a serosurvey conducted in November and December 2020. Adolescents’ HRQoL was evaluated using the validated adolescent-reported KIDSCREEN-10 and parent-reported KINDL® scales. Psychological distress was assessed with self-reported sadness and loneliness, and using the KINDL® emotional well-being scale. Using generalized estimating equations, we examined the role of socio-demographic, family and behavioural characteristics in influencing adolescents’ mental health status and wellbeing.

Results : Among 240 adolescents, 11% had a low HRQoL, 35% reported sadness and 23% reported loneliness. Based on parents’ perception, 12% of the adolescents had a low HRQoL and 16% a low emotional well-being. Being a girl (aOR = 3.20; 95%CI: 1.67–6.16), increased time on social media (aOR = 2.07; 95%CI: 1.08–3.97), parents’ average to poor mood (aOR = 2.62; 95%CI: 1.10–6.23) and average to poor household financial situation (aOR = 2.31; IC95%: 1.01–6.10) were associated with an increased risk of sadness. Mismatches between adolescents’ and their parents’ perception of HRQoL were more likely for girls (aOR = 2.88; 95%CI: 1.54–5.41) and in households with lower family well-being (aOR = 0.91; 95%CI: 0.86–0.96).

Conclusions : A meaningful proportion of adolescents experienced low well-being during the second wave of COVID-19, and average well-being was lower than pre-pandemic estimates. Adolescents living in underprivileged or distressed families seemed particularly affected. Monitoring is necessary to evaluate the long-term effects of the pandemic on adolescents.

Reply
Wissenschaftlicher Artikel

M. Letouzey, L. Foix-L'Helias, Lorthe Elsa

The journal of pediatrics, 2022 , vol.  248, pp.  133-134

Link zur Publikation

Epidemiological, virological and serological investigation of a SARS-CoV-2 outbreak (Alpha variant) in a primary school
Wissenschaftlicher Artikel
a prospective longitudinal study

Lorthe Elsa, M. Bellon, G. Michielin, J. Berthelot, M. E. Zaballa, F. Pennacchio, M. Bekliz, F. Laubscher, F. Arefi, J. Perez-Saez, A. S. Azman, A. G. L'Huillier, K. M. Posfay-Barbe, L. Kaiser, I. Guessous, S. J. Maerkl, I. Eckerle, S. Stringhini, SEROCoV-Schools Study Group

PLoS one, 2022 , vol.  17, no  8 - article e0272663

Link zur Publikation

Zusammenfassung:

Objectives : To report a prospective epidemiological, virological and serological investigation of a SARS-CoV-2 outbreak in a primary school.

Methods : As part of a longitudinal, prospective, school-based surveillance study, this investigation involved repeated testing of 73 pupils, 9 teachers, 13 non-teaching staff and 26 household members of participants who tested positive, with rapid antigen tests and/or RT-PCR (Day 0–2 and Day 5–7), serologies on dried capillary blood samples (Day 0–2 and Day 30), contact tracing interviews and SARS-CoV-2 whole genome sequencing.

Results : We identified 20 children (aged 4 to 6 years from 4 school classes), 2 teachers and a total of 4 household members who were infected by the Alpha variant during this outbreak. Infection attack rates were between 11.8 and 62.0% among pupils from the 4 school classes, 22.2% among teachers and 0% among non-teaching staff. Secondary attack rate among household members was 15.4%. Symptoms were reported by 63% of infected children, 100% of teachers and 50% of household members. All analysed sequences but one showed 100% identity. Serological tests detected 8 seroconversions unidentified by SARS-CoV-2 virological tests.

Conclusions : This study confirmed child-to-child and child-to-adult SARS-CoV-2 transmission and introduction into households. Effective measures to limit transmission in schools have the potential to reduce the overall community circulation.

Lifestyle behaviours of children and adolescents during the first two waves of the COVID-19 pandemic in Switzerland and their relation to well-being
Wissenschaftlicher Artikel
an observational study

G. P. Peralta, A. L. Camerini, S. R. Haile, C. R. Kahlert, Lorthe Elsa, L. Marciano, A. Nussbaumer, T. Radtke, A. Ulyte, M. A. Puhan, S. Kriemler

International journal of public health, 2022 , vol.  67, no  article 1604978

Link zur Publikation

Zusammenfassung:

Objectives: To describe changes in adherence to recommendations for physical activity (PA), screen time (ST), and sleep duration over the first two waves of the pandemic in Switzerland, and to assess the associations of these lifestyle behaviours with life satisfaction and overall health as well-being indicators.

Methods: In this observational study, we included 2,534 participants (5–16 years) from four Swiss cantons. Participants, or their parents, completed repeated questionnaires and reported on their (child’s) lifestyle and well-being, between June 2020 and April 2021. We used linear and logistic regression models to assess the associations between lifestyle and well-being.

Results: The percentage of children meeting the recommendations for PA and ST decreased from the pre-pandemic period to the first wave, with a slight recovery during the second wave. Participants meeting all three recommendations during the second wave were more likely to report excellent health (OR: 1.65 [95% CI: 1.00–2.76]) and higher life satisfaction (β: 0.46 [0.16–0.77]) in early 2021 than participants not meeting any recommendation.

Conclusion: We showed a substantial impact of the COVID-19 pandemic on children’s and adolescents’ lifestyle, and a positive association between meeting lifestyle recommendations and well-being.

Socio-economic determinants of SARS-CoV-2 infection
Wissenschaftlicher Artikel
results from a population-based cross-sectional serosurvey in Geneva, Switzerland

H. A. Santa-Ramirez, A. Wisniak, N. Pullen, M. E. Zaballa, F. Pennacchio, Lorthe Elsa, R. Dumont, H. Baysson, I. Guessous, S. Stringhini

Frontiers in public health, 2022 , vol.  10, no  article 874252

Link zur Publikation

Zusammenfassung:

Background: SARS-CoV-2 infection and its health consequences have disproportionally affected disadvantaged socio-economic groups globally. This study aimed to analyze the association between socio-economic conditions and having developed antibodies for-SARS-CoV-2 in a population-based sample in the canton of Geneva, Switzerland.

Methods: Data was obtained from a population-based serosurvey of adults in Geneva and their household members, between November and December, 2020, toward the end of the second pandemic wave in the canton. Participants were tested for antibodies for-SARS-CoV-2. Socio-economic conditions representing different dimensions were self-reported. Mixed effects logistic regressions were conducted for each predictor to test its association with seropositive status as the main outcome.

Results: Two thousand eight hundred and eighty-nine adults completed the study questionnaire and were included in the final analysis. Retired participants and those living in suburban areas had lower odds of a seropositive result when compared to employed participants (OR: 0.42, 95% CI: 0.20–0.87) and those living in urban areas (OR: 0.67, 95% CI: 0.46–0.97), respectively. People facing financial hardship for less than a year had higher odds of a seropositive result compared to those who had never faced them (OR: 2.23, 95% CI: 1.01–4.95). Educational level, occupational position, and household income were not associated with being seropositive, nor were ethnicity or country of birth.

Discussion: While conventional measures of socio-economic position did not seem to be related to the risk of being infected in this sample, this study sheds lights on the importance of examining the broader social determinants of health when evaluating the differential impact of the pandemic within the population.

The Corona immunitas digital follow-up eCohort to monitor impacts of the SARS-CoV-2 pandemic in Switzerland
Wissenschaftlicher Artikel
study protocol and first results

A. Speierer, P. O. Chocano-Bedoya, D. Anker, A. Schmid, D. Keidel, T. Vermes, M. Imboden, S. Levati, G. Franscella, Lorthe Elsa

International journal of public health, 2022 , vol.  67, no  article 1604506

Link zur Publikation

Zusammenfassung:

Objectives: To describe the rationale, organization, and procedures of the Corona Immunitas Digital Follow-Up (CI-DFU) eCohort and to characterize participants at baseline.

Methods: Participants of Corona Immunitas, a population-based nationwide SARS-CoV-2 seroprevalence study in Switzerland, were invited to join the CI-DFU eCohort in 11 study centres. Weekly online questonnaires cover health status changes, prevention measures adherence, and social impacts. Monthly questionnaires cover additional prevention adherence, contact tracing apps use, vaccination and vaccine hesitancy, and socio-economic changes.

Results: We report data from the 5 centres that enrolled in the CI-DFU between June and October 2020 (covering Basel City/Land, Fribourg, Neuchâtel, Ticino, Zurich). As of February 2021, 4636 participants were enrolled and 85,693 weekly and 27,817 monthly questionnaires were collected. Design-based oversampling led to overrepresentation of individuals aged 65+ years. People with higher education and income were more likely to enroll and be retained.

Conclusion: Broad enrolment and robust retention of participants enables scientifically sound monitoring of pandemic impacts, prevention, and vaccination progress. The CI-DFU eCohort demonstrates proof-of-principle for large-scale, federated eCohort study designs based on jointly agreed principles and transparent governance.

COVID-19-related school disruptions and well-being of children and adolescents in Geneva
Wissenschaftlicher Artikel

V. Richard, R. Dumont, Lorthe Elsa, H. Baysson, M. E. Zaballa, R. P. Barbe, K. M. Posfay-Barbe, I. Guessous, S. Stringhini, Specchio-Covid19 Group

Journal of paediatrics and child health, 2022 , vol.  58, no  5, pp.  937-939

Link zur Publikation

2021

Overcoming spectrum bias for accurate SARS-CoV-2 seroprevalence estimates
Wissenschaftlicher Artikel

M.A. Puhan, A. Chiolero, J. Fehr, S. Cullati, Group Corona Immunitas Research, Lorthe Elsa

BMJ open, 2021 , vol.  373, no  article n917

Link zur Publikation

Language proficiency and migrant-native disparities in postpartum depressive symptoms
Wissenschaftlicher Artikel

S. Hamwi, Lorthe Elsa, H. Barros

International journal of environmental research and public health, 2021 , vol.  18, no  9

Link zur Publikation

Zusammenfassung:

Migrant women have a higher risk of developing postpartum depressive symptoms (PPDS) than do native women. This study aimed to investigate the role of host-country language proficiency in this disparity. We analysed the data of 1475 migrant and 1415 native women who gave birth at a Portuguese public hospital between 2017 and 2019 and were participants in the baMBINO cohort study. Migrants’ language proficiency was self-rated and comprised understanding, speaking, reading, and writing skills. PPDS were assessed using the Edinburgh Postnatal Depression Scale with a cut-off score of ≥10. Multivariable logistic regression models were fitted to estimate the association between language proficiency and PPDS. PPDS were experienced by 7.2% of native women and 12.4% among migrants (p < 0.001). Increasing proportions of PPDS were observed among decreasing Portuguese proficiency levels; 11% among full, 13% among intermediate, and 18% among limited proficiency women (ptrend < 0.001). Full (aOR 1.63 (95% CI 1.21–2.19)), intermediate (aOR 1.68 (95% CI 1.16–2.42)), and limited (aOR 2.55 (95% CI 1.64–3.99)) language proficiencies were associated with increasingly higher odds of PPDS among migrant women, compared to native proficiency. Prevention measures should target migrant women at high risk of PPDS, namely those with limited language skills, and promote awareness, early detection, and help-seeking, in addition to facilitating communication in their perinatal healthcare encounters.

Seroprevalence of anti-SARS-CoV-2 antibodies 6 months into the vaccination campaign in Geneva, Switzerland, 1 June to 7 July 2021
Wissenschaftlicher Artikel

S. Stringhini, M. E. Zaballa, N. Pullen, J. Perez-Saez, C. de Mestral, A. J. Loizeau, J. Lamour, F. Pennacchio, A. Wisniak, R. Dumont, H. Baysson, V. Richard, Lorthe Elsa, C. Semaani, J. F. Balavoine, D. Pittet, N. Vuilleumier, F. Chappuis, O. Kherad, A. S. Azman, K. Posfay-Barbe, L. Kaiser, I. Guessous, Specchio Covid study group

Eurosurveillance, 2021 , vol.  26, no  43

Link zur Publikation

Zusammenfassung:

Background: Up-to-date seroprevalence estimates are critical to describe the SARS-CoV-2 immune landscape and to guide public health decisions.

Aim : We estimate seroprevalence of anti-SARS-CoV-2 antibodies 15 months into the COVID-19 pandemic and 6 months into the vaccination campaign.

Methods : We conducted a population-based cross-sectional serosurvey between 1 June and 7 July 2021, recruiting participants from age- and sex-stratified random samples of the general population. We tested participants for anti-SARS-CoV-2 antibodies targeting the spike (S) or nucleocapsid (N) proteins using the Roche Elecsys immunoassays. We estimated the anti-SARS-CoV-2 antibodies seroprevalence following vaccination and/or infection (anti-S antibodies), or infection only (anti-N antibodies).

Results : Among 3,355 individuals (54.1% women; 20.8% aged < 18 years and 13.4% aged ≥ 65 years), 2,161 (64.4%) had anti-S antibodies and 906 (27.0%) had anti-N antibodies. The total seroprevalence was 66.1% (95% credible interval (CrI): 64.1–68.0). We estimated that 29.9% (95% Crl: 28.0–31.9) of the population developed antibodies after infection; the rest having developed antibodies via vaccination. Seroprevalence estimates differed markedly across age groups, being lowest among children aged 0–5 years (20.8%; 95% Crl: 15.5–26.7) and highest among older adults aged ≥ 75 years (93.1%; 95% Crl: 89.6–96.0). Seroprevalence of antibodies developed via infection and/or vaccination was higher among participants with higher educational level.

Conclusion : Most of the population has developed anti-SARS-CoV-2 antibodies, despite most teenagers and children remaining vulnerable to infection. As the SARS-CoV-2 Delta variant spreads and vaccination rates stagnate, efforts are needed to address vaccine hesitancy, particularly among younger individuals and to minimise spread among children.

The impact of chorionicity on pregnancy outcome and neurodevelopment at 2 years old among twins born preterm
Wissenschaftlicher Artikel
the EPIPAGE-2 cohort study

B. Tosello, A. Garbi, J. Blanc, Lorthe Elsa, L. Foix-L'Helias, C. D'Ercole, N. Winer, D. Subtil, F. Goffinet, G. Kayem, N. Resseguier, C. Gire, Epipage- Obstetric Writing Group

BJOG : an International Journal of Obstetrics & Gynaecology, 2021 , vol.  128, no  2, pp.  281-291

Link zur Publikation

Zusammenfassung:

Objective : To compare the short- and mid-term outcomes of preterm twins by chorionicity of pregnancy.

Design : Prospective nationwide population-based EPIPAGE-2 cohort study.

Setting : 546 maternity units in France, between March and December 2011.

Population : A total of 1700 twin neonates born between 24 and 34 weeks of gestation.

Methods : The association of chorionicity with outcomes was analysed using multivariate regression models.

Main outcome measures : First, survival at 2-year corrected age with or without neurosensory impairment, and second, perinatal, short-, and mid-term outcomes (survival at discharge, survival at discharge without severe morbidity) were described and compared by chorionicity.

Results : In the EPIPAGE 2 cohort, 1700 preterm births were included (850 twin pregnancies). In all, 1220 (71.8%) were from dichorionic (DC) pregnancies and 480 from monochorionic (MC) pregnancies. MC pregnancies had three times more medical terminations than DC pregnancies (1.67 versus 0.51%, P < 0.001), whereas there were three times more stillbirths in MC than in DC pregnancies (10.09 versus 3.78%, P < 0.001). Both twins were alive at birth in 86.6% of DC pregnancies compared with 80.0% among MC pregnancies (P = 0.008). No significant difference according to chorionicity was found regarding neonatal deaths and morbidities. Likewise, for children born earlier than 32 weeks, the 2-year follow-up neurodevelopmental results were not significantly different between DC and MC twins.

Conclusions : This study confirms that MC pregnancies have a higher risk of adverse outcomes. However, the outcomes among preterm twins admitted to neonatal intensive care units are similar irrespective of chorionicity.

Tweetable abstract : Monochorionicity is associated with adverse perinatal outcomes, but outcomes for preterm twins are comparable irrespective of their chorionicity.

Association between extremely preterm caesarean delivery and maternal depressive and anxious symptoms
Wissenschaftlicher Artikel
a national population-based cohort study

J. Blanc, N. Resseguier, Lorthe Elsa, F. Goffinet, L. Sentilhes, P. Auquier, B. Tosello, C. d'Ercole

BJOG, 2021 , vol.  128, no  3, pp.  594-602

Link zur Publikation

Zusammenfassung:

Objective : To evaluate whether caesarean delivery before 26 weeks of gestation was associated with symptoms of depression and anxiety in mothers in comparison with deliveries between 26 and 34 weeks.

Design : Prospective national population-based EPIPAGE-2 cohort study.

Setting : 268 neonatology departments in France, March to December 2011.

Population : Mothers who delivered between 22 and 34 weeks and whose self-reported symptoms of depression (Center for Epidemiologic Studies Depression Scale: CES-D) and anxiety (State-Trait Anxiety Inventory: STAI) were assessed at the moment of neonatal discharge.

Methods : The association of caesarean delivery before 26 weeks with severe symptoms of depression (CES-D ≥16) and anxiety (STAI ≥45) was assessed by weighted and design-based log-linear regression model.

Main outcome measures : Severe symptoms of depression and anxiety in mothers of preterm infants.

Results : Among the 2270 women completing CES-D and STAI questionnaires at the time of neonatal discharge, severe symptoms of depression occurred in 25 (65.8%) women having a caesarean before 26 weeks versus in 748 (50.6%) women having a caesarean after 26 weeks. Caesarean delivery before 26 weeks was associated with severe symptoms of depression compared with caesarean delivery after 26 weeks (adjusted relative risk [aRR] 1.42, 95% CI 1.12–1.81) adjusted to neonatal birthweight and severe neonatal morbidity among other factors. There was no evidence of an association between mode of delivery and symptoms of anxiety.

Conclusions : Mothers having a caesarean delivery before 26 weeks’ gestation are at high risk of symptoms of depression and may benefit from specific preventive care.

Tweetable abstract : Mothers having caesarean delivery before 26 weeks’ gestation are at high risk of symptoms of depression.

Accuracy of the combination of commercially available biomarkers and cervical length measurement to predict preterm birth in symptomatic women
Wissenschaftlicher Artikel
a systematic review

I. Dehaene, Lorthe Elsa, L. Gurney, P. Turtiainen, A. Schwickert, M. Svenvik, A. Care, L. Bergman, International Spontaneous Preterm birth Young investigators (I-SPY) group

European Journal of obstetrics & gynecology and reproductive biology, 2021 , vol.  258, pp.  198-207

Link zur Publikation

Zusammenfassung:

An accurate prognostic method for preterm birth (PTB) could avoid unnecessary treatment(s) with potentially negative effects. The objective was to explore the prognostic accuracy of commercially available bedside cervicovaginal biomarker tests in combination with cervical length (CL) compared to CL measurement alone and/or a biomarker test alone, for PTB within 7 days after testing symptomatic women at 22–34 weeks. The MEDLINE, Cochrane, Embase and Web of Science databases were searched from inception to August 28th, 2019. Seven hundred and eight articles were identified and screened using Rayyan. Studies reporting on the predictive accuracy of combined tests compared to CL or biomarker alone for the prediction of PTB within 7 days of testing in symptomatic women with intact membranes were included. A piloted data extraction form was used. Direct comparisons of the prognostic accuracy of the combination test with CL measurement or a biomarker alone were done, as well as comparisons of prognostic accuracy of the included combination tests (indirect comparisons). Twelve articles were included (seven on fetal fibronectin, four on phosphorylated insulin-like growth factor binding protein-1, one comparing both). A variety of CL cut-offs was reported. The results could not demonstrate superiority of a combination method compared to single methods. Due to data scarcity and quality, the superiority of either predictive test for PTB, either combination or single, cannot be demonstrated with this systematic review. We recommend further research to compare available biomarkers.

Cause of preterm birth and late-onset sepsis in very preterm infants
Wissenschaftlicher Artikel
the EPIPAGE-2 cohort study

M. Letouzey, L. Foix-L'Helias, H. Torchin, A. Mitha, A. S. Morgan, J. Zeitlin, G. Kayem, E. Maisonneuve, P. Delorme, B. Khoshnood, M. Kaminski, P. Y. Ancel, P. Boileau, Lorthe Elsa, Epipage- Working Group on Infections

Pediatric research, 2021 , vol.  90, pp.  584-592

Link zur Publikation

Zusammenfassung:

Background : The pathogenesis of late-onset sepsis (LOS) in preterm infants is poorly understood and knowledge about risk factors, especially prenatal risk factors, is limited. This study aimed to assess the association between the cause of preterm birth and LOS in very preterm infants.

Methods : 2052 very preterm singletons from a national population-based cohort study alive at 72 h of life were included. Survival without LOS was compared by cause of preterm birth using survival analysis and Cox regression models.

Results : 437 (20.1%) had at least one episode of LOS. The frequency of LOS varied by cause of preterm birth: 17.1% for infants born after preterm labor, 17.9% after preterm premature rupture of membranes, 20.3% after a placental abruption, 20.3% after isolated hypertensive disorders, 27.5% after hypertensive disorders with fetal growth restriction (FGR), and 29.4% after isolated FGR. In multivariate analysis, when compared to infants born after preterm labor, the risk remained higher for infants born after hypertensive disorders (hazard ratio HR = 1.7, 95% CI = 1.2–2.5), hypertensive disorders with FGR (HR = 2.6, 95% CI = 1.9–3.6) and isolated FGR (HR = 2.9, 95% CI = 1.9–4.4).

Conclusion : Very preterm infants born after hypertensive disorders or born after FGR had an increased risk of LOS compared to those born after preterm labor.

Completeness of retention data and determinants of attrition in birth cohorts of very preterm infants
Wissenschaftlicher Artikel
a systematic review

R. Teixeira, A. C. Queiroga, A. I. Freitas, Lorthe Elsa, A. C. Santos, C. Moreira, H. Barros

Frontiers in pediatrics, 2021 , vol.  9, no  article 529733

Link zur Publikation

Zusammenfassung:

Background: Birth cohorts provided essential knowledge for clinical and public health decision-making. However, little is known about retention and determinants of attrition in these specific longitudinal studies, although characterizing predictors of attrition sets the path to mitigate its occurrence and to promote valid inferences. We systematically reviewed retention in follow-ups of birth cohorts of very preterm or very low birth weight infants and the determinants of attrition. PROSPERO registration number: CRD42017082672.

Methods: Publications were identified through PubMed®, Scopus, Web of Science, and Cochrane Library databases from inception to December 2017. Studies were included when reporting at least one of the following: retention at follow-ups, reasons for attrition, or characteristics of non-participants. Quality assessment was conducted using the completeness of the report of participation features in the articles. Non-participant's characteristics were presented using descriptive statistics. Local polynomial regression was used to describe overall retention trends over years of follow-up.

Results: We identified 57 eligible publications, reporting on 39 birth cohorts and describing 83 follow-up evaluations. The overall median retention was 87% (p25–p75:75.8–93.6), ranging from 14.6 to 100%. Overall, retention showed a downward trend with increasing child age. Completeness of retention report was considered “enough” in only 36.8% of publications. Considering the 33 (57.9%) publications providing information on participants and non-participants, and although no formal meta-analysis was performed, it was evident that participants lost to follow-up were more often male, had foreign-born, multiparous, and younger mothers, and with a lower socioeconomic status.

Conclusion: This systematic review evidenced a lack of detailed data on retention, which may threaten the potential use of evidence derived from cohort studies of very preterm infants for clinical and public health purpose. It supports the requirement for a standardized presentation of retention features responding to current guidelines.

Cohort profile
Wissenschaftlicher Artikel
the etude Epidemiologique sur les Petits Ages Gestationnels-2 (EPIPAGE-2) preterm birth cohort

Lorthe Elsa, V. Benhammou, L. Marchand-Martin, V. Pierrat, C. Lebeaux, M. Durox, F. Goffinet, M. Kaminski, P.-Y. Ancel, Epipage- Study group

International journal of epidmediology, 2021 , vol.  50, no  5, pp.  1428-1429

Link zur Publikation

Tocolysis in the management of preterm prelabor rupture of membranes at 22-33 weeks of gestation
Wissenschaftlicher Artikel
study protocol for a multicenter, double-blind, randomized controlled trial comparing nifedipine with placebo (TOCOPROM)

Lorthe Elsa, G. Kayem, Tocoprom Study Group the Grog

BMC pregnancy childbirth, 2021 , vol.  21, no  article 614

Link zur Publikation

Zusammenfassung:

Background : Preterm prelabor rupture of membranes (PPROM) before 34 weeks of gestation complicates 1% of pregnancies and accounts for one-third of preterm births. International guidelines recommend expectant management, along with antenatal steroids before 34 weeks and antibiotics. Up-to-date evidence about the risks and benefits of administering tocolysis after PPROM, however, is lacking. In theory, reducing uterine contractility could delay delivery and reduce the risks of prematurity and its adverse short- and long-term consequences, but it might also prolong fetal exposure to inflammation, infection, and acute obstetric complications, potentially associated with neonatal death or long-term sequelae. The primary objective of this study is to assess whether short-term (48 h) tocolysis reduces perinatal mortality/morbidity in PPROM at 22 to 33 completed weeks of gestation.

Methods : A randomized, double-blind, placebo-controlled, superiority trial will be performed in 29 French maternity units. Women with PPROM between 220/7 and 336/7 weeks of gestation, a singleton pregnancy, and no condition contraindicating expectant management will be randomized to receive a 48-hour oral treatment by either nifedipine or placebo (1:1 ratio). The primary outcome will be the occurrence of perinatal mortality/morbidity, a composite outcome including fetal death, neonatal death, or severe neonatal morbidity before discharge. If we assume an alpha-risk of 0.05 and beta-risk of 0.20 (i.e., a statistical power of 80%), 702 women (351 per arm) are required to show a reduction of the primary endpoint from 35% (placebo group) to 25% (nifedipine group). We plan to increase the required number of subjects by 20%, to replace any patients who leave the study early. The total number of subjects required is thus 850. Data will be analyzed by the intention-to-treat principle.

Discussion : This trial will inform practices and policies worldwide. Optimized prenatal management to improve the prognosis of infants born preterm could benefit about 50,000 women in the European Union and 40,000 in the United States each year.

Preterm and term prelabour rupture of membranes
Wissenschaftlicher Artikel
a review of timing and methods of labour induction

P. Delorme, Lorthe Elsa, J. Sibiude, G. Kayem

Best practice & research clinical obstetrics & gynaecology, 2021 , vol.  77, pp.  27-41

Link zur Publikation

Zusammenfassung:

Prelabour rupture of membranes (PROM) exposes both foetuses and mothers to the risk of infection. Induction of labour has been proposed to reduce this risk, but its neonatal and maternal risks and benefits must be balanced against those of expectant management (EM). Recent randomized studies of preterm PROM show that EM until 37 weeks of gestation is associated with lower overall neonatal morbidity. In term PROM, active management is associated with a shorter birth interval but not with lower rates of neonatal infection. Similar maternal and neonatal outcomes are reported regardless of whether induction uses oxytocin, PGE2, or oral misoprostol.

2020

Neurodevelopment at 2 years and umbilical artery Doppler in cases of very preterm birth after prenatal hypertensive disorder or suspected fetal growth restriction
Wissenschaftlicher Artikel
EPIPAGE-2 prospective population-based cohort study

P. Delorme, G. Kayem, Lorthe Elsa, L. Sentilhes, J. Zeitlin, D. Subtil, J. C. Roze, C. Vayssiere, M. Durox, P. Y. Ancel, V. Pierrat, F. Goffinet, Epipage-Obstetric Writing Group

Ultrasound in obstetrics & gynecology, 2020 , vol.  56, no  4, pp.  557-565

Link zur Publikation

Zusammenfassung:

Objective : To investigate the association between absent or reversed end-diastolic flow (ARED) on umbilical artery Doppler ultrasound and poor neurological outcome at 2 years of age after very preterm birth associated with suspected fetal growth restriction (FGR) or maternal hypertensive disorders.

Methods : The study population comprised all very preterm (22–31 completed weeks) singleton pregnancies delivered because of suspected FGR and/or maternal hypertensive disorders that had umbilical artery Doppler and 2-year follow-up available included in EPIPAGE-2, a prospective, nationwide, population-based cohort of preterm births in France in 2011. Univariate and two-level multivariable logistic regression analyses were used to assess the association of ARED in the umbilical artery, as compared with normal or reduced end-diastolic flow, with severe or moderate neuromotor and/or sensory disability and with an Ages and Stages Questionnaire (ASQ) score below a threshold. This was defined as a score more than 2 SD below the mean in any of the five domains, at age 2, adjusting for gestational age at delivery. ASQ is used to identify children at risk of developmental delay requiring reinforced follow-up and further evaluation. Descriptive statistics and bivariate tests were weighted according to the duration of the inclusion periods.

Results : The analysis included 484 children followed up at 2 years of age, for whom prenatal umbilical artery Doppler ultrasound was available. Among them, 8/484 (1.6%) had severe or moderate neuromotor and/or sensory disability, and 156/342 (45.4%) had an ASQ score below the threshold. Compared with normal or reduced end-diastolic flow in the umbilical artery (n = 305), ARED (n = 179) was associated with severe or moderate neuromotor and/or sensory disability (adjusted odds ratio (OR), 11.3; 95% CI, 1.4–93.2) but not with an ASQ score below the threshold (adjusted OR, 1.2; 95% CI, 0.8–1.9).

Conclusion : Among children delivered before 32 weeks of gestation due to suspected FGR and/or maternal hypertensive disorder who survived until 2 years of age, prenatal ARED in the umbilical artery was associated with a higher incidence of severe or moderate neuromotor and/or sensory disability. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Unit policies regarding tocolysis after preterm premature rupture of membranes
Wissenschaftlicher Artikel
association with latency, neonatal and 2-year outcomes (EPICE cohort)

Lorthe Elsa, C. Moreira, T. Weber, L. D. Huusom, S. Schmidt, R. F. Maier, P. H. Jarreau, M. Cuttini, E.S. Draper, J. Zeitlin, H. Barros, Epice research group

Scientific reports, 2020 , vol.  10, no  1

Link zur Publikation

Zusammenfassung:

After preterm premature rupture of membranes (PPROM), antibiotics and antenatal steroids are effective evidence-based interventions, but the use of tocolysis is controversial. We investigated whether a unit policy of tocolysis use after PPROM is associated with prolonged gestation and improved outcomes for very preterm infants in units that systematically use these other evidence-based treatments. From the prospective, observational, population-based EPICE cohort study (all very preterm births in 19 regions from 11 European countries, 2011–2012), we included 607 women with a singleton pregnancy and PPROM at 24–29 weeks’ gestation, of whom 101, 195 and 311 were respectively managed in 17, 32 and 45 units with no-use, restricted and liberal tocolysis policies for PPROM. The association between unit policies and outcomes (early-onset sepsis, survival at discharge, survival at discharge without severe morbidity and survival at two years without gross motor impairment) was investigated using three-level random-intercept logistic regression models, showing no differences in neonatal or two-year outcomes by unit policy. Moreover, there was no association between unit policies and prolongation of gestation in a multilevel survival analysis. Compared to a unit policy of no-use of tocolysis after PPROM, a liberal or restricted policy is not associated with improved obstetric, neonatal or two-year outcomes.

Association of chorioamnionitis with cerebral palsy at two years after spontaneous very preterm birth
Wissenschaftlicher Artikel
the EPIPAGE-2 cohort study

E. Maisonneuve, Lorthe Elsa, H. Torchin, P. Delorme, L. Devisme, L. H. L'Helias, S. Marret, D. Subtil, F. Bodeau-Livinec, V. Pierrat, L. Sentilhes, F. Goffinet, P. Y. Ancel, G. Kayem, EPIPAGE-2 Obstetric writing group

The journal of pediatrics, 2020 , vol.  222, pp.  71-78

Link zur Publikation

Zusammenfassung:

Objective : To assess whether chorioamnionitis is associated with cerebral palsy (CP) or death at 2 years' corrected age in infants born before 32 weeks of gestation after spontaneous birth.

Study design : EPIPAGE-2 is a national, prospective, population-based cohort study of children born preterm in France in 2011; recruitment periods varied by gestational age. This analysis includes infants born alive after preterm labor or preterm premature rupture of membranes from 240/7 to 316/7 weeks of gestation. We compared the outcomes of CP, death at 2 years' corrected age, and “CP or death at age 2” according to the presence of either clinical chorioamnionitis or histologic chorioamnionitis. All percentages were weighted by the duration of the recruitment period.

Results : Among 2252 infants born alive spontaneously before 32 weeks of gestation, 116 (5.2%) were exposed to clinical chorioamnionitis. Among 1470 with placental examination data available, 639 (43.5%) had histologic chorioamnionitis. In total, 346 infants died before 2 years and 1586 (83.2% of the survivors) were evaluated for CP at age 2 years. CP rates were 11.1% with and 5.0% without clinical chorioamnionitis (P = .03) and 6.1% with and 5.3% without histologic chorioamnionitis (P = .49). After adjustment for confounding factors, CP risk rose with clinical chorioamnionitis (aOR 2.13, 95% CI 1.12-4.05) but not histologic chorioamnionitis (aOR 1.21, 95% 0.75-1.93). Neither form was associated with the composite outcome “CP or death at age 2.”

Conclusions : Among infants very preterm born spontaneously, the risk of CP at a corrected age of 2 years was associated with exposure to clinical chorioamnionitis but not histologic chorioamnionitis.

Planned delivery route and outcomes of cephalic singletons born spontaneously at 24-31 weeks' gestation
Wissenschaftlicher Artikel
the EPIPAGE-2 cohort study

A. Gaudineau, Lorthe Elsa, M. Quere, F. Goffinet, B. Langer, I. Le Ray, D. Subtil

Acta obstetricia et gynecologica scandinavica, 2020 , vol.  99, no  12, pp.  1682-1690

Link zur Publikation

Zusammenfassung:

Introduction : The objective of this study was to investigate the association between planned mode of delivery and neonatal outcomes with spontaneous very preterm birth among singletons in cephalic presentation.

Material and methods : Etude Epidémiologique sur les Petits Ages Gestationnels 2 is a French national, prospective, population-based cohort study of preterm infants. For this study, we included women with a singleton cephalic pregnancy and spontaneous preterm labor or preterm premature rupture of membranes at 24-31 weeks’ gestation. The main exposure was the planned mode of delivery (ie planned vaginal delivery or planned cesarean delivery at the initiation of labor). The primary outcome was survival at discharge and secondary outcome survival at discharge without severe morbidity. Propensity scores were used to minimize indication bias in estimating the association.

Results : The study population consisted of 1008 women: 206 (20.4%) had planned cesarean delivery and 802 (79.6%) planned vaginal delivery. In all, 723 (90.2%) finally had a vaginal delivery. Overall, 187 (92.0%) and 681 (87.0%) neonates in the planned cesarean delivery and planned vaginal delivery groups were discharged alive, and 156 (77.6%) and 590 (76.3%) were discharged alive without severe morbidity. After matching on propensity score, planned cesarean delivery was not associated with survival (adjusted odds ratio [aOR] 1.05, 95% confidence interval [CI] 0.48-2.28) or survival without severe morbidity (aOR 0.64, 95% CI 0.36-1.16).

Conclusions : Planned cesarean delivery for cephalic presentation at 24-31 weeks’ gestation after preterm labor or preterm premature rupture of membranes does not improve neonatal outcomes.

2019

Early extubation is not associated with severe intraventricular hemorrhage in preterm infants born before 29 weeks of gestation
Wissenschaftlicher Artikel
results of an EPIPAGE-2 cohort study

M. Chevallier, P. Y. Ancel, H. Torchin, L. Marchand-Martin, Lorthe Elsa, P. Truffert, P. H. Jarreau, J. C. Roze, V. Pierrat, S. Marret, O. Baud, V. Benhammou, A. Ego, T. Debillon

PLoS One, 2019 , vol.  14, no  4

Link zur Publikation

Zusammenfassung:

Objective : To determine whether there is an association between severe intraventricular hemorrhage and early extubation in preterm infants born before 29 weeks of gestational age and intubated at birth.

Methods :This study included 1587 preterm infants from a nationwide French population cohort (EPIPAGE-2). Secondary data on intubated preterm infants were analyzed. After gestational age and propensity score matching (1:1) we built two comparable groups: an early extubation group and a delayed extubation group. Each neonate in one group was paired with a neonate in the other group having the same propensity score and gestational age. Early extubation was defined as extubation within 48 hours of life. Severe intraventricular hemorrhages were defined as grade III or IV hemorrhages according to the Papile classification.

Results : After matching, there were 398 neonates in each group. Using a generalized estimating equation model, we found that intraventricular hemorrhage was not associated with early extubation (adjusted OR 0.9, 95%CI 0.6–1.4). This result was supported by sensitivity analyses.

Conclusion : The practice of early extubation was not associated with an increased proportion of intraventricular hemorrhages. To complete these results, the long-term neurologic outcomes of these infants need to be assessed.

Planned delivery route of preterm breech singletons, and neonatal and 2-year outcomes
Wissenschaftlicher Artikel
a population-based cohort study

Lorthe Elsa, P.J. Steer

BJOG : an International Journal of Obstetrics & Gynaecology, 2019 , vol.  126, no  1, pp.  73-82

Link zur Publikation

Planned mode of delivery of preterm twins and neonatal and 2-year outcomes
Wissenschaftlicher Artikel

L. Sentilhes, Lorthe Elsa, L. Marchand-Martin, S. Marret, P. Y. Ancel, P. Delorme, F. Goffinet, M. Quere, G. Kayem, Group Etude Epidemiologique sur les Petits Ages Gestationnels 2 Obstetric Writing

Obstetrics & gynecology, 2019 , vol.  133, no  1, pp.  71-80

Link zur Publikation

Zusammenfassung:

OBJECTIVE: To assess neonatal and 2-year outcomes for preterm twins born after planned vaginal delivery compared with planned cesarean delivery.

METHODS: Women with preterm cephalic first twins delivered after preterm labor or preterm prelabor rupture of membranes from 24 0/7 to 34 6/7 weeks of gestation, with both fetuses alive at the beginning of labor, were identified from the national prospective population-based Etude Epidémiologique sur les Petits Ages Gestationnels 2 cohort study. Planned vaginal delivery was defined as vaginal delivery or cesarean delivery performed during labor. Planned cesarean delivery was considered if performed during labor for the indication of preterm twins or before labor whatever the indication. A propensity score analysis was used to compare planned vaginal delivery and planned cesarean delivery. Outcomes analyzed separately for the first and second twins were survival at discharge, survival at discharge without severe morbidity, and survival at 2 years of corrected age without neurosensory impairment.

RESULTS: Among the 932 women with a twin pregnancy, 549 were excluded mainly as a result of the first twin in noncephalic presentation, cause of delivery other than preterm labor or preterm prelabor rupture of membranes, at least one twin died before labor, and gestational age at delivery less than 24 weeks of gestation. The planned vaginal delivery group included 276 women and the planned cesarean delivery group 107. For first and second twins, survival at discharge (97.7% vs 98.3% and 95.6% vs 97.1%, respectively), survival at discharge without severe morbidity (91.6% vs 88.8% and 90.3% vs 84.5%, respectively), and survival at 2 years of corrected age without neurosensory impairment (96.0% vs 95.4% and 92.9% vs 90.8%, respectively) did not differ significantly between the planned vaginal delivery and planned cesarean delivery groups. Propensity score analysis showed that planned cesarean delivery was not associated with improved outcomes with the caveat that the infrequency of death and disability limited the statistical power of the study to detect potentially clinically meaningful differences between planned modes of delivery.

CONCLUSION: Planned cesarean delivery for women in preterm labor or with preterm prelabor rupture of membranes was not associated with improved neonatal outcomes or 2-year outcomes.

Association between gestational age and severe maternal morbidity and mortality of preterm cesarean delivery
Wissenschaftlicher Artikel
a population-based cohort study

J. Blanc, N. Resseguier, F. Goffinet, Lorthe Elsa, G. Kayem, P. Delorme, C. Vayssiere, P. Auquier, C. D'Ercole

American journal of obstetrics and gynecology, 2019 , vol.  220, no  4

Link zur Publikation

Zusammenfassung:

Background : Cesarean delivery rates at extreme prematurity have regularly increased over the past years, and few previous studies have investigated severe maternal morbidity associated with extreme preterm cesarean delivery.

Objective : The aim of this study was to evaluate whether gestational age <26 weeks of gestation (weeks) was associated with severe maternal morbidity and mortality (SMMM) of preterm cesarean deliveries in comparison with cesarean deliveries between 26 and 34 weeks.

Materials and Methods : The Etude Epidémiologique sur les petits âges gestationnels (EPIPAGE) 2 is a national prospective population-based cohort study of preterm births in 2011. We included mothers with cesarean deliveries between 22 and 34 weeks, excluding those who had a cesarean delivery for the second twin only and those with pregnancy terminations. SMMM was analyzed as a composite endpoint defined as the occurrence of at least 1 of the following complications: severe postpartum hemorrhage defined by the use of a blood transfusion, intensive care unit admission, or death. To assess the association of gestational age <26 weeks and SMMM, we used multivariate logistic regression and a propensity score−matching approach.

Results : Among 2525 women having preterm cesarean deliveries, 116 before 26 weeks and 2409 between 26 and 34 weeks, 407 (14.4%) presented with SMMM. The SMMM occurred in 31 mothers (26.7%) who were at gestational age <26 weeks vs 376 (14.2%) between 26 and 34 weeks (P < .001). Cluster multivariate logistic regression showed significant association of gestational age <26 weeks and SMMM (adjusted odds ratio [aOR], 2.50; 95% confidence interval [CI], 1.42–4.40) and propensity score−matching analysis was consistent with these results (aOR, 2.27; 95% CI, 1.31–3.93).

Conclusion : Obstetricians should know about the higher SMMM associated with cesarean deliveries before 26 weeks, integrate this knowledge into decisions regarding cesarean delivery, and be prepared to manage the associated complications.

2018

Preterm premature rupture of membranes at 22-25 weeks' gestation
Wissenschaftlicher Artikel
perinatal and 2-year outcomes within a national population-based study (EPIPAGE-2)

Lorthe Elsa, H. Torchin, P. Delorme, P. Y. Ancel, L. Marchand-Martin, L. Foix-L'Helias, V. Benhammou, C. Gire, C. d'Ercole, N. Winer, L. Sentilhes, D. Subtil, F. Goffinet, G. Kayem

American journal of obstetrics and gynecology, 2018 , vol.  219, no  3

Link zur Publikation

Zusammenfassung:

Background: Most clinical guidelines state that with early preterm premature rupture of membranes, obstetric and pediatric teams must share a realistic and individualized appraisal of neonatal outcomes with parents and consider their wishes for all decisions. However, we currently lack reliable and relevant data, according to gestational age at rupture of membranes, to adequately counsel parents during pregnancy and to reflect on our policies of care at these extreme gestational ages.

Objective: We sought to describe both perinatal and 2-year outcomes of preterm infants born after preterm premature rupture of membranes at 22–25 weeks’ gestation.

Study Design : EPIPAGE-2 is a French national prospective population-based cohort of preterm infants born in 546 maternity units in 2011. Inclusion criteria in this analysis were women diagnosed with preterm premature rupture of membranes at 22–25 weeks’ gestation and singleton or twin gestations with fetus(es) alive at rupture of membranes. Latency duration, antenatal management, and outcomes (survival at discharge, survival at discharge without severe morbidity, and survival at 2 years’ corrected age without cerebral palsy) were described and compared by gestational age at preterm premature rupture of membranes.

Results: Among the 1435 women with a diagnosis of preterm premature rupture of membranes, 379 were at 22–25 weeks’ gestation, with 427 fetuses (331 singletons and 96 twins). Median gestational age at preterm premature rupture of membranes and at birth were 24 (interquartile range 23–25) and 25 (24–27) weeks, respectively. For each gestational age at preterm premature rupture of membranes, nearly half of the fetuses were born within the week after the rupture of membranes. Among the 427 fetuses, 51.7% were survivors at discharge (14.1%, 39.5%, 66.8%, and 75.8% with preterm premature rupture of membranes at 22, 23, 24, and 25 weeks, respectively), 38.8% were survivors at discharge without severe morbidity, and 46.4% were survivors at 2 years without cerebral palsy, with wide variations by gestational age at preterm premature rupture of membranes. Survival at 2 years without cerebral palsy was low with preterm premature rupture of membranes at 22 and 23 weeks but reached approximately 60% and 70% with preterm premature rupture of membranes at 24 and 25 weeks.

Conclusion: Preterm premature rupture of membranes at 22–25 weeks is associated with high incidence of mortality and morbidity, with wide variations by gestational age at preterm premature rupture of membranes. However, a nonnegligible proportion of children survive without severe morbidity both at discharge and at 2 years’ corrected age.

Association of intraventricular hemorrhage and death with tocolytic exposure in preterm infants
Wissenschaftlicher Artikel

G. Pinto Cardoso, E. Houivet, L. Marchand-Martin, G. Kayem, L. Sentilhes, P. Y. Ancel, Lorthe Elsa, S. Marret, Epipage- Working Group

JAMA network open, 2018 , vol.  1, no  5

Link zur Publikation

Zusammenfassung:

Importance  No trials to date have demonstrated the benefits of tocolysis on death and/or neonatal morbidity in preterm infants; tocolytics may affect the fetal blood-brain barrier.

Objectives  To assess the risks associated with tocolysis in women delivering prematurely as measured by death and/or intraventricular hemorrhage (IVH) in preterm infants and to compare the association of calcium channel blockers (CCBs) nifedipine and nicardipine hydrochloride vs atosiban used for tocolysis with death and/or IVH.

Design, Settings, and Participants  The French 2011 EPIPAGE-2 (Enquête Épidémiologique sur les Petits Âges Gestationnels) cohort was limited to mothers admitted for preterm labor without fever, who delivered from 24 to 31 weeks of gestation from April 1 through December 31, 2011. Groups of preterm infants with vs without tocolytic exposure and groups with atosiban vs CCB exposure were compared. Data analysis was performed from June 7, 2014, through September 3, 2017.

Exposures  Tocolytics.

Main Outcomes and Measures  The primary outcome was a composite of death and/or IVH in preterm infants. Secondary outcomes included death, IVH, and a composite of death and/or grades III to IV IVH.

Results  A total of 1127 mothers (mean [SD] age, 25.5 [6.0] years) experienced preterm labor and gave birth to 1343 preterm infants with a male to female ratio of 1.23 and mean (SD) gestational age of 27 (2.5) weeks. Of these, 789 mothers (70.0%) received tocolytics; 314 (39.8%) received only atosiban, and 118 (15.0%) received only a CCB. In the first analysis, the primary outcome (death and/or IVH) was not significantly different in preterm infants with vs without tocolytic exposure (183 of 363 [50.4%] vs 207 of 363 [57.0%]; relative risk [RR], 0.88; 95% CI, 0.77-1.01; P = .07). The secondary outcome (death and/or grades III-IV IVH) was significantly lower in preterm infants with vs without tocolytic exposure (92 of 363 [25.3%] vs 118 of 363 [32.5%]; RR, 0.78; 95% CI, 0.62-0.98; P = .03). Other outcomes did not differ significantly. In the secondary analysis, death and/or IVH was not significantly different in preterm infants with atosiban vs CCB exposure (96 of 214 [44.9%] vs 62 of 121 [51.2%]; RR, 0.88; 95% CI, 0.70-1.10; P = .26), nor was IVH (77 of 197 [39.1%] vs 48 of 106 [45.3%]; RR, 0.86; 95% CI, 0.66-1.13; P = .29).

Conclusions and Relevance  In this population-based study, findings suggest that tocolytics were associated with a reduction of death and severe IVH. Other studies are necessary to compare perinatal outcomes after use of atosiban vs CCBs.

2017

Impact of latency duration on the prognosis of preterm infants after preterm premature rupture of membranes at 24 to 32 weeks' gestation
Wissenschaftlicher Artikel
a national population-based cohort study

Lorthe Elsa, P. Y. Ancel, H. Torchin, M. Kaminski, B. Langer, D. Subtil, L. Sentilhes, C. Arnaud, B. Carbonne, T. Debillon, P. Delorme, C. D'Ercole, M. Dreyfus, C. Lebeaux, J. E. Galimard, C. Vayssiere, N. Winer, L. F. L'Helias, F. Goffinet, G. Kayem

The journal of pediatrics, 2017 , vol.  182

Link zur Publikation

Zusammenfassung:

Objective : To assess the impact of latency duration on survival, survival without severe morbidity, and early-onset sepsis in infants born after preterm premature rupture of membranes (PPROM) at 24-32 weeks' gestation.

Study design : This study was based on the prospective national population-based Etude Épidémiologique sur les Petits ?ges Gestationnels 2 cohort of preterm births and included 702 singletons delivered in France after PPROM at 24-32 weeks' gestation. Latency duration was defined as the time from spontaneous rupture of membranes to delivery, divided into 4 periods (12 hours to 2 days [reference], 3-7 days, 8-14 days, and >14 days). Multivariable logistic regression was used to assess the relationship between latency duration and survival, survival without severe morbidity at discharge, or early-onset sepsis.

Results : Latency duration ranged from 12 hours to 2 days (18%), 3-7 days (38%), 8-14 days (24%), and >14 days (20%). Rates of survival, survival without severe morbidity, and early-onset sepsis were 93.5% (95% CI 91.8-94.8), 85.4% (82.4-87.9), and 3.4% (2.0-5.7), respectively. A crude association found between prolonged latency duration and improved survival disappeared on adjusting for gestational age at birth (aOR 1.0 [reference], 1.6 [95% CI 0.8-3.2], 1.2 [0.5-2.9], and 1.0 [0.3-3.2] for latency durations from 12 hours to 2 days, 3-7 days, 8-14 days, and >14 days, respectively). Prolonged latency duration was not associated with survival without severe morbidity or early-onset sepsis.

Conclusion : For a given gestational age at birth, prolonged latency duration after PPROM does not worsen neonatal prognosis.

Incidence and risk factors of caesarean section in preterm breech births
Wissenschaftlicher Artikel
a population-based cohort study

Lorthe Elsa, M. Quere, L. Sentilhes, P. Delorme, G. Kayem

European journal of obstetrics & gynecology and reproductive biology, 2017 , vol.  212, pp.  37-43

Link zur Publikation

Zusammenfassung:

Objectives : To describe the incidence of breech presentation at 22–34 weeks’ gestation, estimate the incidence of cesarean section delivery by cause of prematurity, and assess the factors associated with caesarean delivery in preterm breech births with preterm labor or preterm premature rupture of membranes.

Study design : EPIPAGE 2 is a French national prospective population-based cohort study of preterm births that occurred in 546 maternity units in 2011. We estimated the overall incidence of breech presentation and the incidence of cesarean delivery by cause of prematurity. Among the 579 singletons with breech presentation born at 22–34 weeks in a context of spontaneous preterm labor or membrane rupture, multivariable logistic regression was used to assess the association between individual and institutional characteristics and caesarean delivery.

Results : Among the 3660 singletons born at 22–34 weeks’ gestation in the EPIPAGE 2 study, 20.1% (n = 911) were breech presentation. Among these births, the rate of cesarean section was 99.6% with vascular pathologies, intrauterine growth retardation or placental abruption as compared with 60.1% with spontaneous preterm labor or membrane rupture. The main indication for caesarean delivery was gestational age associated with breech presentation (61.0%). Delivery mode varied by region of birth. Other characteristics associated with caesarean delivery were hospital status (public teaching, public non-teaching or private), clinical chorioamniotitis, hospital admission after labor onset, and gestational age.

Conclusion : Breech presentation is common in preterm infants and is associated with widespread use of cesarean delivery with significant regional disparities that could reflect the lack of consensus and recommendations on the preferential mode of delivery. Other factors associated with caesarean delivery are the status of the maternity unit, clinical chorioamniotitis, admission after labor onset and gestational age.

Tocolysis after preterm premature rupture of membranes and neonatal outcome
Wissenschaftlicher Artikel
a propensity-score analysis

Lorthe Elsa, F. Goffinet, S. Marret, C. Vayssiere, C. Flamant, M. Quere, V. Benhammou, P. Y. Ancel, G. Kayem

American journal of obstetrics and gynecology, 2017 , vol.  217, no  2

Link zur Publikation

Zusammenfassung:

Background : There are conflicting results regarding tocolysis in cases of preterm premature rupture of membranes. Delaying delivery may reduce neonatal morbidity because of prematurity and allow for prenatal corticosteroids and, if necessary, in utero transfer. However, that may increase the risks of maternofetal infection and its adverse consequences.

Objective : The objective of the study was to investigate whether tocolytic therapy in cases of preterm premature rupture of membranes is associated with improved neonatal or obstetric outcomes.

Study Design : Etude Epidémiologique sur les Petits Ages Gestationnels 2 is a French national prospective, population-based cohort study of preterm births that occurred in 546 maternity units in 2011. Inclusion criteria in this analysis were women with preterm premature rupture of membranes at 24–32 weeks’ gestation and singleton gestations. Outcomes were survival to discharge without severe morbidity, latency prolonged by ≥48 hours and histological chorioamnionitis. Uterine contractions at admission, individual and obstetric characteristics, and neonatal outcomes were compared by tocolytic treatment or not. Propensity scores and inverse probability of treatment weighting for each woman were used to minimize indication bias in estimating the association of tocolytic therapy with outcomes.

Results : The study population consisted of 803 women; 596 (73.4%) received tocolysis. Women with and without tocolysis did not differ in neonatal survival without severe morbidity (86.7% vs 83.9%, P = .39), latency prolonged by ≥48 hours (75.1% vs 77.4%, P = .59), or histological chorioamnionitis (50.0% vs 47.6%, P = .73). After applying propensity scores and assigning inverse probability of treatment weighting, tocolysis was not associated with improved survival without severe morbidity as compared with no tocolysis (odds ratio, 1.01 [95% confidence interval, 0.94–1.09], latency prolonged by ≥48 hours (1.03 [95% confidence interval, 0.95–1.11]), or histological chorioamnionitis (1.03 [95% confidence interval, 0.92–1.17]). There was no association between the initial tocolytic drug used (oxytocin receptor antagonists or calcium-channel blockers vs no tocolysis) and the 3 outcomes. Sensitivity analyses of women with preterm premature rupture of membranes at 26–31 weeks’ gestation, women who delivered at least 12 hours after rupture of membranes, women with direct admission after the rupture of membranes and the presence or absence of contractions gave similar results.

Conclusion : Tocolysis in cases of preterm premature rupture of membranes is not associated with improved obstetric or neonatal outcomes; its clinical benefit remains unproven.

Histologic chorioamnionitis and bronchopulmonary dysplasia in preterm infants
Wissenschaftlicher Artikel
the epidemiologic study on low gestational ages 2 cohort

H. Torchin, Lorthe Elsa, F. Goffinet, G. Kayem, D. Subtil, P. Truffert, L. Devisme, V. Benhammou, P. H. Jarreau, P. Y. Ancel

The journal of pediatrics, 2017 , vol.  187

Link zur Publikation

Zusammenfassung:

Objective : To investigate the association between histologic chorioamnionitis (HCA) and bronchopulmonary dysplasia (BPD) in very preterm infants, both in a general population and for those born after spontaneous preterm labor and after preterm premature rupture of membranes (pPROM).

Study design : This study included 2513 live born singletons delivered at 24-31 weeks of gestation from a national prospective population-based cohort of preterm births; 1731 placenta reports were available. HCA was defined as neutrophil infiltrates in the amnion, chorion of the membranes, or chorionic plate, associated or not with funisitis. The main outcome measure was moderate or severe BPD. Analyses involved logistic regressions and multiple imputation for missing data.

Results : The incidence of HCA was 28.4% overall: 38% in cases of preterm labor, 64% in cases of pPROM, and less than 5% in cases of vascular disorders. Overall, the risk of BPD after adjustment for gestational age, sex, and antenatal steroids was reduced for infants with HCA (HCA alone: aOR 0.6 [95% CI 0.4-0.9]; associated with funisitis: aOR 0.5 [95% CI 0.3-0.8]). This finding was explained by the high rate of BPD and low rate of chorioamnionitis among children with fetal growth restriction. HCA was not associated with BPD in the preterm labor (13.4% vs 8.5%; aOR 0.9; 95% CI 0.5-1.8) or in the pPROM group (12.9% vs 12.1%; aOR 0.6; 95% CI 0.3-1.3).

Conclusion : In homogeneous groups of infants born after preterm labor or pPROM, HCA is not associated with BPD.

Providing active antenatal care depends on the place of birth for extremely preterm births
Wissenschaftlicher Artikel
the EPIPAGE 2 cohort study

C. Diguisto, F. Goffinet, Lorthe Elsa, G. Kayem, J. C. Roze, P. Boileau, B. Khoshnood, V. Benhammou, B. Langer, L. Sentilhes, D. Subtil, E. Azria, M. Kaminski, P. Y. Ancel, L. Foix-L'Helias

Archives of disease in childhood : fetal & neonatal, 2017 , vol.  102, no  6

Link zur Publikation

Zusammenfassung:

Survival rates of infants born before 25 weeks of gestation are low in France and have not improved over the past decade. Active perinatal care increases these infants’ likelihood of survival.

Objective Our aim was to identify factors associated with active antenatal care, which is the first step of proactive perinatal care in extremely preterm births.

Methods The population included 1020 singleton births between 220/6 and 260/6 weeks of gestation enrolled in the Etude Epidémiologique sur les Petits Ages Gestationnels 2 study, a French national population-based cohort of very preterm infants born in 2011. The main outcome was ‘active antenatal care’ defined as the administration of either corticosteroids or magnesium sulfate or delivery by caesarean section for fetal rescue. A multivariable analysis was performed using a two-level multilevel model taking into account the maternity unit of delivery to estimate the adjusted ORs (aORs) of receiving active antenatal care associated with maternal, obstetric and place of birth characteristics.

Results Among the population of extremely preterm births, 42% received active antenatal care. After standardisation for gestational age, regional rates of active antenatal care varied between 22% (95% CI 5% to 38%) and 61% (95% CI 44% to 78%). Despite adjustment for individual and organisational characteristics, active antenatal care varied significantly between maternity units (p=0.03). Rates of active antenatal care increased with gestational age with an aOR of 6.46 (95% CI 3.40 to 12.27) and 10.09 (95% CI 5.26 to 19.36) for infants born at 25 and 26 weeks’ gestation compared with those born at 24 weeks. No other individual characteristic was associated with active antenatal care.

Conclusion Even after standardisation for gestational age, active antenatal care in France for extremely preterm births varies widely with place of birth. The dependence of life and death decisions on place of birth raises serious ethical questions.

Maintaining and repeating tocolysi
Wissenschaftlicher Artikel
a reflection on evidence

I. Dehaene, L. Bergman, P. Turtiainen, A. Ridout, B. W. Mol, Lorthe Elsa, Group from the International Spontaneous Preterm birth Young Investigators

Seminars in perinatology, 2017 , vol.  41, no  8, pp.  468-476

Link zur Publikation

Zusammenfassung:

It is inherent to human logic that both doctors and patients want to suppress uterine contractions when a woman presents in threatened preterm labor. Tocolysis is widely applied in women with threatened preterm labor with a variety of drugs. According to literature, tocolysis is indicated to enable transfer to a tertiary center as well as to ensure the administration of corticosteroids for fetal maturation. There is international discrepancy in the content and the implementation of guidelines on preterm labor. Tocolysis is often maintained or repeated. Nevertheless, the benefit of prolonging pregnancy has not yet been proven, and it is not impossible that prolongation of the pregnancy in a potential hostile environment could harm the fetus. Here we reflect on the use of tocolysis, focusing on maintenance and repeated tocolysis, and compare international guidelines and practices to available evidence. Finally, we propose strategies to improve the evaluation and use of tocolytics, with potential implications for future research.

Errungenschaften

Medien und Kommunikation
Kontaktieren Sie uns
Folgen Sie der HES-SO
linkedin instagram facebook twitter youtube rss
univ-unita.eu www.eua.be swissuniversities.ch
Rechtliche Hinweise
© 2021 - HES-SO.

HES-SO Rectorat