Association between inadequate antenatal care utilisation and severe perinatal and maternal morbidity: an analysis in the Pre<scp>CARE</scp> cohort

Linard, Morgane; Blondel, Béatrice; Estellat, Candice; Deneux‐Tharaux, Catherine; Luton, Dominique; Oury, J.-F.; Schmitz, Thomas; Mandelbrot, Laurent; Azria, Élie

doi:10.1111/1471-0528.14794

Cited by 60 publications

(57 citation statements)

References 37 publications

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“…Two sensitivity analyses were performed. The first revised the path analysis mediation model to include an additional adjustment for prenatal care utilization during the pregnancy which was coded in two categories (prenatal care visits as a proportion of what is routinely recommended by gestational age at delivery either <50% or > =50% 33,34 ). We conducted this sensitivity analysis to ascertain if treating prenatal care utilization as a confounder as opposed to an intermediate variable changed the obesity-mediated association between maternal place of birth and severe pre-eclampsia significantly.…”

Section: Study Proceduresmentioning

confidence: 99%

Maternal obesity and severe pre-eclampsia among immigrant women: a mediation analysis

Siddiqui

Deneux‐Tharaux

Luton

et al. 2020

Sci Rep

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We investigated the extent to which pre-pregnancy obesity mediates the association between maternal place of birth and severe pre-eclampsia in the precARe cohort of pregnant women in paris (n = 9,579). Adjusted path analysis logistic regression models were used to assess the role of pre-pregnancy obesity as a mediator in the association between maternal place of birth and the development of severe pre-eclampsia. We calculated 1. adjusted odds ratios and 95% confidence intervals for the total exposure-outcome association and for the direct and indirect/obesity-mediated components 2. the indirect/obesity-mediated effect. Ninety-five (0.99%) women developed severe pre-eclampsia, 47.6% were non-European immigrants, 16.3% were born in Sub-Saharan Africa, and 12.6% were obese (BMI > = 30 kg/m 2 ). Women experiencing severe pre-eclampsia were more likely to be from Sub-Saharan Africa (p = 0.023) and be obese (p = 0.048). Mothers from Sub-Saharan Africa had an increased risk of severe pre-eclampsia compared to European-born mothers (aOR 2.53, 95% CI 1.39-4.58) and the obesity-mediated indirect effect was 18% of the total risk (aOR 1.18, 95%CI 1.03-1.35). In conclusion, Sub-Saharan African immigrant women have a two-fold higher risk of developing severe pre-eclampsia as compared to European-born women, one-fifth of which is mediated by pre-pregnancy obesity. Our results quantify the potential benefit of decreasing obesity among at-risk women.Pre-eclampsia, a disorder of pregnancy characterized by hypertension and proteinuria, affects 3-5% of pregnancies globally 1-3 and is one of the leading causes of maternal and neonatal mortality and morbidity in developed countries 2,4-7 . Severe pre-eclampsia is characterized by higher blood pressures and more profound organ dysfunction than mild pre-eclampsia 8 and constitutes the largest attributable fraction of severe morbidity due to hypertensive disorders in pregnancy 5 . Overall, the prevalence of pre-eclampsia has been declining in some European countries and Australia but continues to rise in the United States 5,9,10 . The increase in pre-eclampsia in the United States is driven specifically by higher rates of severe disease: while mild pre-eclampsia declined between 1980 and 2010, from 3.1% to 2.5%, severe pre-eclampsia increased from 0.3% to 1.4% 11 .There are known social and medical factors associated with a differential risk of developing pre-eclampsia. Maternal origin has been linked to disparities in rates of pre-eclampsia in various settings. In Europe, immigrant our understanding of the complex relationships between maternal origin, obesity, and severe pre-eclampsia, they also highlight the need to better understand other drivers of severe maternal outcomes among immigrant women. Future investigations should focus on better elucidating the role of other modifiable mediators, such as those pertaining to quality of care and the health care system factors in an effort to improve Data availabilityDue to ethical restrictions, data will be made available on request to A. S...

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Section: Study Proceduresmentioning

confidence: 99%

Maternal obesity and severe pre-eclampsia among immigrant women: a mediation analysis

Siddiqui

Deneux‐Tharaux

Luton

et al. 2020

Sci Rep

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“…The PreCARE prospective multicenter cohort study took place between 2010 and 2012 in four maternity units in university hospitals in northern Paris (France) [22]. This study, whose primary goal was to assess the association between social deprivation and maternal and perinatal morbidity, was conducted in a geographical area characterized by its high prevalence of social deprivation and a wide multiculturalism.…”

Section: Methodsmentioning

confidence: 99%

“…High medical risk level at the beginning of pregnancy, social deprivation and adequacy of prenatal care were defined as proposed in Linard et al [22]. Complications during pregnancy was a binary variable defined as the occurrence of one or more of the following: gestational diabetes, diabetic ketoacidosis, pre-eclampsia, eclampsia, placenta abruption, HELLP syndrome, venous thrombosis, pulmonary embolism, severe sepsis, convulsions, coagulation disorder, cholestasis of pregnancy and complications due to uterine fibroids.…”

Section: Available Datamentioning

confidence: 99%

Differential rates of cesarean delivery by maternal geographical origin: a cohort study in France

Linard¹,

Deneux‐Tharaux²,

Luton³

et al. 2019

BMC Pregnancy Childbirth

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Background: In many Western countries, higher rates of cesarean have been described among migrant women compared to natives of receiving countries. We aimed to estimate this difference comparing women originating from France and Sub-Saharan Africa (SSA), identify the clinical situations explaining most of this difference and assess whether maternal origin was independently associated with cesarean risk. Methods: The PreCARE prospective multicenter cohort study was conducted in 2010-2012 in the north Paris area. Our sample was restricted to 1500 women originating from Sub-Saharan Africa and 2206 from France. Profiles of cesarean section by maternal origin were described by the Robson classification. Independent associations between maternal origin and 1) cesarean before labor versus trial of labor, then 2) intrapartum cesarean versus vaginal delivery were assessed by logistic regression models to adjust for other maternal and pregnancy characteristics. Results: Rates of cesarean for women originating from France and SSA were 17 and 31%. The Robson 5A category "unique uterine scar, single cephalic ≥37 weeks" was the main contributor to this difference. Within this category, SSA origin was associated with cesarean before labor after adjustment for medical risk factors (adjusted odds ratio [aOR] = 2.30 [1.12-4.71]) but no more significant when adjusting on social deprivation (aOR = 1.45 [0.63-3.31]). SSA origin was associated with cesarean during labor after adjustment for both medical and social factors (aOR = 2.95 [1.35-6.44]). Conclusions: The wide difference in cesarean rates between SSA and French native women is mainly explained by the Robson 5A category. Within this group, medical factors alone do not explain the increased risk of cesarean in SSA women.

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“…We thank Pandey et al . for their comment on our article ‘Association between inadequate antenatal care utilisation and severe perinatal and maternal morbidity: an analysis in the PreCARE cohort’ . They highlight the existence of wide variations in maternal morbidity and mortality among ethnic groups in Europe.…”

mentioning

confidence: 93%

Authors’ reply re: Association between inadequate antenatal care utilisation and severe perinatal and maternal morbidity: an analysis in the PreCARE cohort

Linard

Deneux‐Tharaux

Azria

2017

BJOG

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Association between inadequate antenatal care utilisation and severe perinatal and maternal morbidity: an analysis in the PreCARE cohort

Abstract: Inadequate antenatal care utilisation is associated with severe maternal and perinatal morbidity.

Cited by 60 publications

References 37 publications

Maternal obesity and severe pre-eclampsia among immigrant women: a mediation analysis

Maternal obesity and severe pre-eclampsia among immigrant women: a mediation analysis

Differential rates of cesarean delivery by maternal geographical origin: a cohort study in France

Authors’ reply re: Association between inadequate antenatal care utilisation and severe perinatal and maternal morbidity: an analysis in the PreCARE cohort

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