Aix-en-Provence, France


Aix-en-Provence, France
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Leruez-Ville M.,University of Paris Descartes | Vauloup-Fellous C.,Service de Microbiologie Immunologie Biologique | Couderc S.,Center Hospitalier Intercommunal Of Poissy Saint Germain | Parat S.,Maternite | And 7 more authors.
Clinical Infectious Diseases | Year: 2011

Background:. Congenital cytomegalovirus (CMV) infection is a public health issue, and implementation of neonatal screening has been debated. Detection of CMV DNA by polymerase chain reaction (PCR) of dried blood spots (DBS) routinely collected for metabolic screening from all newborns has been proposed for congenital CMV infection screening. The goal of this study was to prospectively assess the performance of 2 CMV PCR assays of DBS for CMV neonatal screening in a selected population of neonates. Methods:. We studied prospective congenital CMV screening in a population of neonates either born with symptoms compatible with congenital CMV or born to mothers with a history of primary infection during pregnancy. For each neonate, 2 CMV PCR assays of DBS were blindly performed in parallel with a gold standard technique (ie, CMV PCR of a urine sample). Results:. Two hundred seventy-one neonates were studied, and CMV infection, defined by a positive urine sample in the first week of life, was confirmed in 64 (23.6%). Nineteen infected (29.7%) neonates were symptomatic, and 45 (70.3%) were asymptomatic. The ranges of sensitivity, specificity, positive predictive value, and negative predictive value for the 2 CMV PCR assays of DBS were 95.0%-100%; 98.1%-99.0%; 94.1%-96.9%, and 98.5%-100%, respectively. Conclusions:. The sensitivity and specificity of both CMV PCR assays of DBS to identify congenital CMV were very high in this population of neonates with a high risk of sequelae. These new data should be considered in the ongoing debate on the appropriateness of the use of DBS as a sample to screen for congenital CMV infection. © The Author 2011.

Tsatsaris V.,Groupe Hospitalier Cochin Saint Vincent Of Paul | Capitant C.,French Institute of Health and Medical Research | Schmitz T.,Maternite | Chazallon C.,French Institute of Health and Medical Research | And 9 more authors.
Annals of Internal Medicine | Year: 2011

Background: Pregnant women and infants who get influenza are at increased risk for severe illness. Objective: To evaluate the immunogenicity and transplacental antibody transfer of 2009 pandemic influenza A(H1N1) vaccine administered during pregnancy. Design: Prospective, multicenter, single-group clinical trial. (Clinical registration number: NCT01024400) Setting: Five level-3 perinatal centers in France. Patients: 107 pregnant women between 220/7 and 320/7 weeks of gestation. Intervention: An intramuscular dose of a nonadjuvanted H1N1 vaccine that contained 15 mcg of hemagglutinin. Measurements: Proportion of women with an influenza antibody titer of 1:40 or greater at days 21 and 42 after vaccination, delivery, and 3 months after delivery. Seroconversion rate, fold increase in the geometric mean titer 21 days after vaccination, and proportion of neonates with an antibody titer of 1:40 or greater at birth were also assessed. Results: At baseline, 19% of the women had an antibody titer of 1:40 or greater. At day 21, 98% of the women had an antibody titer of 1:40 or greater, the seroconversion rate was 93%, and the fold increase in geometric mean titer was 67.4. At day 42, delivery, and 3 months after delivery, 98%, 92%, and 90% of the women, respectively, had an antibody titer of 1:40 or greater. Ninety-five percent of the cord serum samples obtained from 88 neonates showed an antibody titer of 1:40 or greater. The median neonate- mother antibody titer ratio was 1.4. Limitations: Only healthy pregnant women were selected. Data on hemagglutination inhibition antibody titers of infants were reported only at birth. Conclusion: A single dose of a nonadjuvanted influenza A(H1N1) vaccine with 15 mcg of hemagglutinin triggered a strong immune response in pregnant women and a high rate of neonatal seroprotection. Primary Funding Source: French National Institute of Health and Medical Research. © 2011 American College of Physicians.

PubMed | University of Versailles, Maternite, Service de neonatologie, Institute hospitalier franco britannique and 2 more.
Type: Journal Article | Journal: Archives de pediatrie : organe officiel de la Societe francaise de pediatrie | Year: 2015

Early-onset neonatal infection remains a major cause of morbidity and mortality in neonates. Both universal vaginal screening for group-B streptococcus (GBS) and intrapartum antibiotic prophylaxis have decreased the incidence of early-onset GBS disease. Almost 12 years after the implementation of the French recommendations, we assessed the practices around screening, diagnosis, and treatment of early-onset neonatal infection in the le-de-France region.We conducted a prospective, multicenter, observational study in 14 volunteer maternity wards from 18 to 31 March 2013. All live newborn infants delivered at 35 gestational weeks or more were eligible. Maternal, obstetrical, and neonatal characteristics were collected, as well as the management of suspected early-onset neonatal infections.A total of 1194 mothers and 1217 neonates were included. Among the latter, 54% had bacteriological samplings at birth, with at least a gastric aspirate. Bacteriological samples were collected at birth in 85% of cases based on major or minor anamnestic infection criteria defined by the French National Authority for Health in 2002. In addition, 26% of neonates had at least one blood sample taken. Antibiotic treatment was administered in 4% of the infants with cefotaxime administered in two thirds of cases.An update of the French guidelines for the management of early-onset neonatal infections is required in order to improve targeting of newborn infants suspected of having an infection and to optimize the antibiotics administered. Moreover, the role of bacteriological sampling at birth needs to be clarified.

Lubin V.,Maternite | Shojai R.,Maternite | Darmon P.,Aix - Marseille University | Cosson E.,Paris Nord University | Cosson E.,French Institute of Health and Medical Research
Diabetes and Metabolism | Year: 2016

Aim: This study assessed whether myoinositol might be a first-line medical treatment for gestational diabetes mellitus (GDM). Methods: For 12 months, women with GDM not controlled by diet (n = 32) were prospectively treated with myoinositol 1200. mg and folic acid 400. μg/day, while consecutive women (n = 28) with insulin-requiring GDM treated during the previous year at our centre constituted the control group. Baseline characteristics and care were similar in both groups. Results: Insulin was required in eight women (25%) in the myoinositol group who, compared with the 24 who did not need insulin, were older (37. ±. 5 vs. 32. ±. 5 years, respectively; P = 0.018) and had a larger percentage of high self-monitored glucose values (45. ±. 8% vs. 32. ±. 14%; P <. 0.0001) during the week prior to the introduction of myoinositol treatment. All of the women had similar pregnancy outcomes regardless of their GDM management, although less labour induction was required in the myoinositol group (OR: 0.22 [0.07-0.65]), which had no side effects. Conclusion: This pilot study suggests that myoinositol may be a safe first-line medical treatment for uncontrolled GDM. © 2016 Elsevier Masson SAS.

Monnot S.,University of Paris Descartes | Gigarel N.,University of Paris Descartes | Samuels D.C.,Vanderbilt University | Burlet P.,University of Paris Descartes | And 11 more authors.
Human Mutation | Year: 2011

Mitochondrial DNA (mtDNA) mutations cause a wide range of serious diseases with high transmission risk and maternal inheritance. Tissue heterogeneity of the heteroplasmy rate ("mutant load") accounts for the wide phenotypic spectrum observed in carriers. Owing to the absence of therapy, couples at risk to transmit such disorders commonly ask for prenatal (PND) or preimplantation diagnosis (PGD). The lack of data regarding heteroplasmy distribution throughout intrauterine development, however, hampers the implementation of such procedures. We tracked the segregation of the m.3243A>G mutation (MT-TL1 gene) responsible for the MELAS syndrome in the developing embryo/fetus, using tissues and cells from eight carrier females, their 38 embryos and 12 fetuses. Mutant mtDNA segregation was found to be governed by random genetic drift, during oogenesis and somatic tissue development. The size of the bottleneck operating for m.3243A>G during oogenesis was shown to be individual-dependent. Comparison with data we achieved for the m.8993T>G mutation (MT-ATP6 gene), responsible for the NARP/Leigh syndrome, indicates that these mutations differentially influence mtDNA segregation during oogenesis, while their impact is similar in developing somatic tissues. These data have major consequences for PND and PGD procedures in mtDNA inherited disorders. © 2010 Wiley-Liss, Inc.

Costa J.-M.,Laboratoire Cerba | Benachi A.,Maternite
Medecine Therapeutique Medecine de la Reproduction, Gynecologie et Endocrinologie | Year: 2010

In its conventional approach, prenatal diagnosis is based on the analysis of fetal material obtained by invasive procedures such as chorionic villus sampling, amniocentesis or fetal blood sampling. In most cases, prenatal diagnosis is performed to establish fetal karyotype in order to determine if the fetus carries chromosomal abnormalities. However, amniocentesis, the main worldwide invasive procedure, is at risk for fetal miscarriage, this risk being estimated to be around 1 %. Therefore, many laboratories have attempted to develop non-invasive prenatal diagnostic procedures to avoid such fetal loss. Analysis of fetal cells circulating in the maternal blood is still unresolved for routine use because of several technical problems. On the contrary, cell-free fetal DNA circulating in maternal plasma/ serum has rapidly become a useful tool for prenatal diagnosis. Today this approach is limited to fetal sex determination and rhesus D genotyping but large investigations are currently in progress in order to develop non invasive prenatal diagnosis for other genetics conditions and fetal chromosomal abnormalities such as trisomy 21 based on circulating fetal nucleic acids.

PubMed | Reseau << Securite Naissance des Pays de la Loire >>, Maternite, Angers University Hospital Center and Nantes University Hospital Center
Type: Journal Article | Journal: Journal de gynecologie, obstetrique et biologie de la reproduction | Year: 2016

Guidelines for screening for gestational diabetes mellitus (GDM) were published in 2010. An audit of the maternity units of the Pays de la Loire network sought to determine the adherence rate and to study the factors affecting it in order to propose corrective measures to improve it.The perinatal network in Pays de la Loire provided obstetricians of the 23 participating maternity units with a set of criteria to be collected from the files of women giving birth. The methodology of the audit was designed to enable calculation of the adherence rate overall and according to indications (risk factors, hyperglycemia, and macrosomia): adherence, non-adherence, and over-adherence (screening in the absence of an indication). To obtain around 900 pregnancies, the audit was planned to cover a week of deliveries in June 2014.The analysis included 848 pregnancies and 872 newborns. Risk factors were found for 46.6% of the women (43.2 to 49.9): 13.2% for maternal age35years and 30.8% for BMI25kg/mThis audit showed that adherence to the guidelines was insufficient in the Pays de la Loire network. The reasons for this are numerous: ignorance of the guidelines, in part due to their relative recency, the change in the blood sugar levels defining GDM (perceived as too low), and the absence of strong evidence about these thresholds from publications and practices in other countries, the need to select women for risk factors, and sometimes the late onset of prenatal care at the maternity unit.In view of this audit, the Perinatal Network of Pays de la Loire must work to improve the knowledge and screening practices for GDM among its professionals, by the repeated dissemination of these guidelines and chart review sessions.

Pertussis is a potentially serious illness in very young infants. The growing number of cases encountered in the past few years is partly explained by the loss of immunity, either natural or post vaccinal. To prevent the occurrence of pertussis in newborns and very young infants, it is mandatory to ensure compliance with vaccination recommendations regarding the general population (vaccination of young adults likely to have a child, of fathers and siblings during pregnancies, of mothers soon after birth), as well as professionals in contact with infants too young to have received their three doses of primary vaccination (diphtheria-tetanus-polio-pertussis booster may be performed as soon as the latest is more than two years). Obstetricians, midwives and pediatricians are directly concerned by this vaccinal strategy, owing to their prominent place in both informing couples during pregnancy and after delivery, and performing maternal vaccines soon after birth. © 2011 Elsevier Masson SAS.

Dudkiewicz-Sibony C.,Maternite | Dudkiewicz-Sibony C.,Center Dtude Et Of Conservation Des Oeufs Et Du Sperme
Medecine Therapeutique Medecine de la Reproduction, Gynecologie et Endocrinologie | Year: 2011

We have just gone through a great period of turbulence with the questioning of the principle of anonymity in gamete donation. The violence of the debate between proponents of maintaining the anonymity and those of his emergence, was surprising. It has obviously led the CECOS to question their principles: anonymity, free, volunteer. The voices that have affected us are those of some children born with a donation of sperm and claiming to know the identity of their donor.

Kivilevitch Z.,Womens Medical Center | Salomon L.J.,Center Hospitalier Intercommunal Of Poissy St Germain | Benoit B.,Maternite | Achiron R.,Chaim Sheba Medical Center | Achiron R.,Tel Aviv University
Ultrasound in Obstetrics and Gynecology | Year: 2010

Objectives: The aims of this study were to establish normal ranges of values for interlens distance (ILD) during gestation, and to assess the correlation between ILD and growth of the orbits and other fetal biometric parameters. Methods: A cross-sectional study of morphologically normal, singleton fetuses was carried out in low-risk pregnant women. We measured the distance between the centers of the fetal lenses from 12 to 37 completed weeks of gestation. An oblique anterior coronal section was used to measure the ILD. The biorbital diameter (BOD) was measured in the same plane. We analyzed the correlation between the ILD and gestational age (GA), BOD, biparietal diameter (BPD), head circumference (HC), femur length (FL) and abdominal circumference (AC). Fetal gender was assessed to evaluate possible significant differences. Results: Four hundred and fifty normal fetuses were recruited for the study. In 427 fetuses appropriate ILD measurements were obtained, and complete evaluation of all parameters was accomplished in 377 of these. ILD demonstrated a high positive correlation with GA (r2 = 0.969), BPD (r2 = 0.959), HC (r2 = 0.962), AC (r2 = 0.949) and FL (r 2 = 0.956) as pregnancy advanced. The mean BOD: ILD ratio was 1.50 ± 0.08, remaining constant throughout pregnancy (linear regression r 2 = 0.006). No statistically significant differences were found between genders for mean ILD and GA of the study population (P = 0.604 and 0.595, respectively). Conclusions: The Results: of this study confirm previous hypotheses regarding the close relationship between eyeball growth and growth of the surrounding bony structures. Measurement of fetal ILD, which can be used interchangeably with BOD measurement in either the axial or coronal plane, can be taken to reflect the expected development of the fetal orbits whilst simultaneously providing valuable information on eyeball development. It is likely that ILD could be used as a complementary tool in the elaboration of various severe abnormalities, mainly related to craniofacial and nervous system malformations. Copyright © 2010 ISUOG.

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