PURPOSE:Hysterosalpingography (HSG) with iodinated contrast used during fertility work-up can transiently disrupt thyroid function during early neurodevelopment due to the Wolff-Chaikoff effect. We examined neurodevelopmental outcomes in school-aged children conceived after HSG. METHODS:69 children conceived within <6 months after HSG with oil-based (iodine content: 480mg/ml) or water-based contrast (iodine content: 250 mg/ml) within the H2Oil randomised clinical trial (NCT05168228) were compared with children of similar age, sex, and parental education conceived without fertility treatments (n=44) (NTR9574). Primary outcomes were intelligence quotient (IQ), behaviour, and academic performance. Secondary outcomes were neurocognitive domain scores. We used linear regression adjusted for age, sex, and parental education, applying false discovery rate correction. We examined timing subgroups (<4, 4-12, >12 weeks post-HSG) versus the control group using polynomial contrasts. RESULTS:Children conceived within 6 months after HSG had lower mean IQ (104.3 versus 113.1; adjusted estimate: -6.81; 95%CI -10.97 to -2.65; p=0.02) and lower information processing and attention control scores (-0.52 SD; 95%CI -0.84 to -0.19; p=0.02). IQ scores were lowest when conception occurred shortly after HSG, while children conceived >12 weeks after HSG did not differ from the control group. No differences were observed for behaviour or academic performance. Sensitivity analyses did not support confounding by prematurity, low birth weight, maternal smoking during pregnancy, or conception using assisted reproductive technologies. CONCLUSION:Replication in larger, adequately powered cohorts is needed to assess the potential long-term implications of HSG with iodinated contrast for neurodevelopmental outcomes of the offspring.
Health literacy refers to the capacities and resources that enable individuals to access, understand, appraise and use health information and services. Among people living with type2 diabetes (T2D) in France, the Entred 3 studyshows that certain aspects of health literacy, particularly engagement with healthcare professionnals and understanding of health information, are socially differentiated and associated with health status. Thejointanalysis of these aspects, complemented by active health management and the ability to navigate within the healthcare system, makes it possible to identify distinct profiles associated with contrasting social and clinical characteristics. Health literacy therefore appears to be a relevant lever for reducing T2D-related social inequalities.
Many epidemiological studies conducted in high-income countries have clearly established that type 2 diabetes disproportionately affects socially disadvantaged populations. In France, the latest epidemiological data confirm this trend and reveal that these inequalities are significant and have worsened overtime. Two population groups are particularly at risk: women and people living in overseas departments and regions. More than a phenomenon limited to the most vulnerable populations, these inequalities are part ofa continuous socioeconomic gradient, affecting all social categories. This observation highlights the importance of systematically adopting a strategy of proportionate universalism, combining universal interventions-accessible to all-but with a graduated intensity, adapted to the specific needs of each social category.
Epidemiological studies demonstrate since more than 20 years a clear link between socioeconomic deprivation and the occurrence of complications or death in people living with diabetes, although longitudinal studies remain rare and adjustments limited. In patients with type 2 diabetes, poverty is associated with an increased risk of microangiopathic and macroangiopathic complications (particularly retinopathy, nephropathy, and neuropathy), as well as increased mortality, particularly from cardiovascular disease and cancer. For type 1 diabetes, the relationship is similar: low socioeconomic status increases the likelihood of severe complications and premature mortality, with a gradient that tends to worsen. These inequalities can be explained by unfavorable health behaviors, individual factors, and structural barriers to accessing care. However, certain equitable healthcare teams or systems appear to mitigate this impact, demonstrating the importance of targeted and proactive public health policy in reducing socioeconomic disparities and their consequences on the health of diabetic patients.
French and international data show that social inequalities, low socioeducational level, and psychiatric disorders are associated with disruptions in care pathways, lack of access to healthcare, and an increased risk of severe diabetes-related complications, particularly in the context of diabetic foot disease. Conversely, coordinated, accessible, and territorially adapted multidisciplinary care, especially when based on proactive outreach ("going toward" approaches), is associated with improved prognosis, regardless of the presence of comorbidities. The quality of the relationship between healthcare professionals and the person receiving care appears to be a central lever for continuity of care. Care pathways may therefore act as a form of "medical compensation" for social deprivation and help reduce health inequalities
