Publications

Abstract

Objective: To estimate the incidence of eclampsia, characterise maternal and perinatal profiles, and document outcomes across seven countries within the International Obstetric Survey System and identify inter-country differences that may improve maternal and perinatal care.

Design: Multi-country analysis of population-based cohort data.

Setting: Six high-income countries (Belgium, France, Italy, the Netherlands, Norway, Slovakia) and one upper-middle-income country (Suriname).

Population: All women admitted with eclampsia in participating countries between 2012 and 2019.

Methods: Individual participant data meta-analysis.

Main outcome measures: Incidence of eclampsia, maternal demographics, pregnancy characteristics, clinical management, mode of delivery and maternal and perinatal outcomes.

Results: 615 cases of eclampsia were notified resulting in a pooled incidence of eclampsia of 2.2 per 10,000 deliveries in high-income countries and 36.6 per 10,000 deliveries in Suriname. About 42% of women were diagnosed with preeclampsia before seizure onset and one-third experienced their first seizure postpartum. Hypertension was the most reported clinical sign (91.1%). Most women were treated with magnesium sulphate (91.1%) and antihypertensive medications (89.8%). Caesarean section was performed in 72.7% of cases. About 53% of births was preterm with most of them linked to antepartum cases. Maternal and neonatal deaths were rare but more frequent in Suriname.

Conclusions: The declining incidence of eclampsia in Europe may be attributed to enhanced management, supported by ongoing audits and confidential enquiries; however, potential ascertainment bias limits causal interpretation. Global efforts remain crucial to promote awareness, timely prevention and implement standardised management guidelines for eclampsia across all settings.

Keywords: eclampsia; magnesium sulphate; maternal health; maternal mortality; perinatal care.

Abstract

Objective: Preterm birth is the leading cause of neonatal mortality and remains a major public health concern. Antenatal corticosteroids (ACS) significantly reduce the complications associated with prematurity, particularly when administered between 24h and 7 days before delivery. The objective of this study was to assess the proportion of women receiving ACS within the optimal window according to clinical indication, and to identify factors that may influence timing for each indication.

Material and methods: We conducted a retrospective, single center observational study at Armand Trousseau Hospital (APHP, Paris) throughout 2022. Singleton pregnancies at risk of preterm birth and treated with ACS were included. The primary outcome was delivery within the optimal ACS-to-birth interval (24h-7 days), adjusted for indication. The secondary outcome was the proportion of patients who delivered at term.

Results: Among the 185 women included, only 19% delivered within the optimal window. The mean ACS-to-delivery interval was 31.2 days. Optimal timing varied by indication: preeclampsia (40%), preterm premature rupture of membranes (31%), threatened preterm labor (6%), isolated fetal growth restriction (13%), and vaginal bleeding without cervical change (0%). No clinical factor was significantly associated with optimal timing, except for severe hypertension in the context of preeclampsia. Notably, 29% of patients delivered at term.

Conclusion: Most women received ACS outside the optimal therapeutic window. These findings highlight the need for predictive tools tailored to each indication to improve ACS targeting and reduce unnecessary exposure.

Keywords: Antenatal corticosteroids; Corticothérapie anténatale; Délai optimal; Naissance prématurée; Optimal timing; Preterm delivery.

Abstract

Aim: Children born very preterm require additional specialist care because of the health and developmental risks associated with preterm birth, but information on their health service use is sparse. We sought to describe the use of specialist services by children born very preterm in Europe.

Method: We analysed data from the multi-regional, population-based Effective Perinatal Intensive Care in Europe (EPICE) cohort of births before 32 weeks’ gestation in 11 European countries. Perinatal data were abstracted from medical records and parents completed a questionnaire at 2 years corrected age (4322 children; 2026 females, 2296 males; median gestational age 29wks, interquartile range [IQR] 27-31wks; median birthweight 1230g, IQR 970-1511g). We compared parent-reported use of specialist services by country, perinatal risk (based on gestational age, small for gestational age, and neonatal morbidities), maternal education, and birthplace.

Results: Seventy-six per cent of the children had consulted at least one specialist, ranging across countries from 53.7% to 100%. Ophthalmologists (53.4%) and physiotherapists (48.0%) were most frequently consulted, but individual specialists varied greatly by country. Perinatal risk was associated with specialist use, but the gradient differed across countries. Children with more educated mothers had higher proportions of specialist use in three countries.

Interpretation: Large variations in the use of specialist services across Europe were not explained by perinatal risk and raise questions about the strengths and limits of existing models of care.

What this paper adds: Use of specialist services by children born very preterm varied across Europe. This variation was observed for types and number of specialists consulted. Perinatal risk was associated with specialist care, but did not explain country-level differences. In some countries, mothers’ educational level affected use of specialist services.

No abstract available

Abstract

Numerous mood and behavior disorders have developmental origins resulting from genetic and environmental interactions. Maternal tryptophan hydroxylase 1 (TPH-1)-dependent serotonin (5-HT) depletion alters embryonic brain development, but its long-term impact on adult progeny has never been investigated. Here we demonstrate that adult WT male offspring born to hyposerotonergic Tph1^+/- dams ( ~ 60% deficit) display hyperlocomotion, impaired self-care and an increased anxiety relative to those from WT dams. Concomitantly, norepinephrine (NE) levels and dopamine (DA) turnover are significantly reduced in the mesencephalon and brainstem, whereas monoaminergic cell density is not affected. In the frontal cortex of the offspring, maternal hyposerotonergic status results in significant reduction in DA, NE and 5-HT levels, accompanied by transcriptomic changes, notably in monoaminergic system signaling, synaptic function and plasticity, methylation processes and myelination. Myelination is also impaired as revealed by a reduced thickness of the corpus callosum. Maternal hyposerotonemia thus appears sufficient to affect the phenotype of the adult WT progeny. TPH-1-dependent 5-HT deficit during pregnancy could be considered as a risk factor for neurodevelopmental disorders in the offspring.

Abstract

Introduction: Preeclampsia is a hypertensive disorder of pregnancy associated with placental dysfunction. Optoacoustic imaging enables non-invasive, real-time assessment of placental oxygen saturation. This study aimed to evaluate placental oxygenation and its response to hypoxia in the STOX1A mouse model of preeclampsia.

Methods: Two groups were studied: STOX1A pregnancies (wild-type females crossed with transgenic STOX1A males) and controls (wild-type crosses). Blood pressure and urinary albumin-to-creatinine ratio were monitored during gestation. Placental oxygen saturation was assessed by multispectral optoacoustic imaging between embryonic days 15.5 and 17.5 under normoxia and hypoxia. Delta oxygen saturation and desaturation kinetics were analyzed using sigmoid curve fitting.

Results: Thirty-one placentas from seventeen control pregnancies and twenty-nine placentas from twenty STOX1A pregnancies were analyzed. The STOX1A group showed increased blood pressure and albuminuria compared to controls (mean systolic blood pressure change at embryonic day 17.5: +21.2 ± 11 mmHg versus -8.4 ± 3.7 mmHg, p = 0.006; albumin-to-creatinine ratio fold-change: 3.91 [2.52-17.14] versus 0.86 [0.43-2.49], p = 0.033). Placental baseline oxygen saturation was similar between groups (70.1 ± 5.3 percent versus 70.0 ± 6.9 percent, p = 0.96). No significant differences were observed in delta oxygen saturation (17.0 ± 6.9 percent versus 16.1 ± 7.1 percent, p = 0.61) or desaturation rate (8.6 ± 6.0 versus 7.9 ± 6.1, p = 0.43) during hypoxia.

Discussion: Despite a confirmed preeclamptic phenotype, placental oxygenation and adaptation to maternal hypoxia were preserved in the STOX1A model, suggesting maintained placental resilience in late gestation.

Keywords: Mouse model; Optoacoustic imaging; Placental oxygenation; Preeclampsia.

No abstract available

No abstract available

Abstract

Aim: Neonatal resuscitation follows national or regional guidelines, but uptake varies in clinical practice. This study aimed to examine variations in reported delivery room practices for infants < 29 weeks’ gestation across neonatal units in 12 networks of the International Network for Evaluating Outcomes in Neonates.

Methods: An online pre-piloted survey was sent to 608 neonatal units across 12 networks. Responses, based on 2022-2023 practices, were categorized as very frequent (90%-100%), often (50%-89%), sometimes (10%-49%), rarely (1%-9%), and never, and summarized as frequency of units per network.

Results: Overall, 382 units (63%) responded (37%-100% within network). Active resuscitation at 22, 23 and 24 weeks was reported as ‘very frequent/often’ by 22%, 53% and 76% of units, with variation. Delayed cord clamping, cord milking, and resuscitation with intact cord were ‘very frequent/often’ in 47%, 27% and 7% of units. Japan reported 75% cord milking. For initial respiratory support, 86% reported oxygen concentration < 40%. Intubation at birth for infants 27-28 weeks was uncommon except in Japan. Surfactant delivery room use was reported by 24% of units.

Conclusions: Delivery room management of very preterm infants varies across networks. Future studies should analyse the impact of reported delivery room practices on neonatal outcomes.

Keywords: delivery room; infant; intensive care units; neonatal premature; questionnaires; resuscitation; surveys.

Abstract

The objective of this study is to evaluate whether non-emergency red blood cell transfusions (RBCT) is associated with neurologic outcomes in preterm infants born at 27-31 weeks of gestation. This analysis used data from the Etude Epidémiologique sur les Petits Ages Gestationnels (EPIPAGE-2), a French nationwide prospective cohort. Infants born at 27-31 weeks and surviving to 5½ years were included, excluding those with emergency RBCT indications. Neurologic outcomes, defined as moderate or severe disabilities, a composite of motor, neurosensory, and cognitive disabilities, were assessed at 5½ years with standardized scales. Behavioral difficulties were evaluated using parental questionnaires. Transfused and non-transfused infants were matched 1:1 using propensity scores. Statistical analyses included odds ratios (ORs) and mean differences. Of the 2182 infants included (656 transfused, 1526 non-transfused), 1062 were matched (531 per group). In the unmatched cohort, RBCT exposure was significantly associated with the composite outcome of moderate to severe neurological disabilities (OR, 1.40; 95%CI, 1.04-1.87). Cognitive impairment and developmental coordination disorders were significantly increased with RBCT (OR, 1.40; 95%CI, 1.07-1.81 and OR, 1.44; 95%CI, 1.06-1.96), respectively. After adjustment using the propensity score, RBCTs were not significantly associated with any individual outcome: cerebral palsy, overall cognitive deficiency, coordination disorders, behavioral difficulties, or moderate-to-severe neurological disabilities. Only the association with cognitive performance relating to working memory persisted (mean difference, – 2.3; 95%CI, – 4.2 to – 0.5).

Conclusion: After controlling for potential confounders, non-emergency RBCTs in preterm infants born at 27-31 weeks were not significantly associated with long-term neurologic outcomes but reduced working memory warrants further investigation.

Trial registration: NCT03078439.

What is known: • Red blood cell transfusions (RBCTs) are frequently administered to preterm infants and have been associated with adverse neonatal outcomes in observational studies. • The long-term neurodevelopmental consequences of RBCT exposure remain uncertain because transfused infants are generally sicker and more immature, making confounding difficult to address.

What is new: • In a large nationwide cohort of preterm infants born at 27-31 weeks’ gestation, non-emergency RBCT exposure was associated with poorer neurodevelopmental outcomes in unadjusted analyses but not after propensity score matching.A modest reduction in working memory performance persisted after adjustment, suggesting a potential domain-specific effect that warrants further investigation.

Keywords: Disabilities; Infants; Red blood cell transfusion; neurological outcome.