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ANAES' co-ordinated initiative to acquaint a hard core of French public hospitals with CQI proved successful. Identification of the factors for success and of potential hurdles helped pave the way for the national hospital accreditation procedure currently underway.

The issue of health benefits coverage—and its relation to health technology assessment (HTA)—has gained increasing attention in recent years. Economic constraints on health care, as well as the rapid pace of technological change, have forced European countries to face difficult choices in providing such care. The active use of coverage decision making has been proposed as a tool to help rationalize health care, and HTA has been advocated as a necessary activity to improve coverage decisions.

Introduction The objective was to evaluate the quality of life of pregnant women with a full‐term birth from the first trimester to the 9th month using the EQ5D‐3L questionnaire, comparing physiological, simple pathological, or complex pathological pregnancies. Material and methods A prospective cohort of 500 pregnant women over the age of 18 was monitored between 2015 and 2017 at the Toulouse University Hospital (France). The data were collected monthly with an online report. Given that the decrease in quality of life was not linear during pregnancy, unadjusted and adjusted piecewise linear regression models were performed, considering 3 periods of time during pregnancy: 3‐4, 4‐8, and 8‐9 months. The 5 dimensions of the EQ5D‐Index and perceived health status were also analyzed. Results In total, 1847 questionnaires were collected. Between the 4th and 8th months, the quality of life was lower for pathological pregnancies (P < 0.001) than for physiological ones and decreased over time for each type of pregnancy (physiological: −0.08 points per month, P < 0.001; simple pathological: −0.12 points per month, P < 0.001; complex pathological: −0.11 points per month, P < 0.001). Interestingly, the perceived health status was lower at the 9th month than at the 3rd month of pregnancy, for physiological pregnancies (mean difference = −10.5 points, P < 0.001), pathological pregnancies (mean difference = −10.0 points, P < 0.002), and for complex pathological pregnancies (mean difference = −7.8 points, P = 0.058). Conclusions In our population, the quality of life decreased between the 4th and 8th months, and decreased to a greater degree in a pathological pregnancy.

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