BACKGROUND: Incontinence occurs frequently in the postpartum period. Several theoretical pathophysiological models may underlie the hypothesis that different types of management of the active phase of the second stage of labor have different effects on pelvic floor muscles and thus perhaps affect urinary and anal continence.OBJECTIVE: This study aimed to evaluate the impact of "moderate pushing" on the occurrence of urinary or anal incontinence compared with "intensive pushing," and to determine the factors associated with incon-tinence at 6 months postpartum.STUDY DESIGN: This was a planned analysis of secondary objectives of the PASST (Phase Active du Second STade) trial, a multicenter ran-domized controlled trial. PASST included nulliparous women with singleton term pregnancies and epidural analgesia, who were randomly assigned at 8 cm of dilatation to either the intervention group that used "moderate" pushing (pushing only twice during each contraction, resting regularly for 1 contraction in 5 without pushing, and no time limit on pushing) or the control group following the usual management of "intensive" pushing (pushing 3 times during each contraction, with no contractions without pushing, with an obstetrician called to discuss operative delivery after 30 minutes of pushing). Data about continence were collected with validated self-assessment questionnaires at 6 months postpartum. Urinary incon-tinence was defined by an ICIQ-UI SF (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form) score >1 and anal incontinence by a Wexner score >2. A separate analysis was also performed among the more severely affected women (ICIQ-UI SF >6 and Wexner >5). Factors associated with incontinence were assessed with univariate and multivariable analyses.RESULTS: Among 1618 women initially randomized, 890 (55%) returned the complete questionnaire at 6 months. The rate of urinary incontinence was 36.6% in the "moderate" pushing group vs 38.5% in the "intensive" pushing group (relative risk, 0.95; 95% confidence interval, 0.80-1.13), whereas the rate of anal incontinence was 32.2% vs 34.6% (relative risk, 0.93; 95% confidence interval, 0.77-1.12). None of the obstetrical factors studied related to the second stage of labor influenced the occurrence of urinary or anal incontinence, except operative vaginal delivery, which increased the risk of anal incontinence (adjusted odds ratio, 1.50; 95% confidence interval, 1.04-2. 15).CONCLUSION: The results of the PASST trial indicate that neither moderate nor intensive pushing efforts affect the risk of urinary or anal incontinence at 6 months postpartum among women who gave birth under epidural analgesia.

INTRODUCTION:This trial evaluates whether daily low-dose aspirin initiated before 16 weeks of gestation can reduce preeclampsia and fetal growth restriction in nulliparous women identified by first-trimester uterine artery Dopplers as at high risk of preeclampsia. METHODS:This randomized, blinded, placebo-controlled, parallel-group trial took place in 17 French obstetric departments providing antenatal care. Pregnant nulliparous women aged ≥ 18 years with a singleton pregnancy at a gestational age < 16 weeks of gestation with a lowest pulsatility index ≥ 1.7 or a bilateral protodiastolic notching for both uterine arteries on an ultrasound performed between 11+0 and 13+6 weeks by a certified sonographer were randomized at a 1:1 ratio to 160 mg of low-dose aspirin or to placebo to be taken daily from inclusion to their 34th week of gestation. The main outcome was preeclampsia or a birthweight ≤ 5th percentile. Other outcomes included preeclampsia, severe preeclampsia, preterm preeclampsia, preterm delivery before 34 weeks, mode of delivery, type of anesthesia, birthweight ≤ 5th percentile and perinatal death. RESULTS:The trial was interrupted due to recruiting difficulties. Between June 2012 and June 2016, 1104 women were randomized, two withdrew consent, and two had terminations of pregnancies. Preeclampsia or a birthweight ≤ 5th percentile occurred in 88 (16.0%) women in the low-dose aspirin group and in 79 (14.4%) in the placebo group (proportion difference 1.6 [-2.6; 5.9] p = 0.45). The two groups did not differ significantly for the secondary outcomes. CONCLUSION:Low-dose aspirin was not associated with a lower rate of either preeclampsia or birthweight ≤ 5th percentile in women identified by their first-trimester uterine artery Doppler as at high risk of preeclampsia. TRIAL REGISTRATION:(NCT0172946).

There is no consensus on an optimal strategy to facilitate expulsive efforts. Intensive pushing could reduce pushing duration, but also increase abnormal FHR due to cord compression resulting from the combination of uterine contractions and maternal expulsive forces. It may therefore increase the risk of neonatal acidosis and the need for operative delivery. Our objective was to assess the impact of a "moderate pushing" management on neonatal morbidity, in comparison with "intensive pushing" We performed a multicenter randomized controlled trial including nulliparas in the 2nd stage, with a singleton cephalic fetus at term and a normal FHR. Two groups were defined 1/the "moderate pushing" group in which women had no time limit on pushing, pushed only twice during each contraction and observed regular periods without pushing, 2/the "intensive pushing" group in which women pushed three times during each contraction, and an ObGyn was called after 30 minutes of pushing to discuss operative delivery (standard care). The primary outcome was a composite neonatal morbidity criterion including umbilical arterial pH <7.15, base excess>10, lactates>6, 5min Apgar <7 and severe neonatal trauma. Secondary outcomes were mode of delivery, episiotomy, OASIS, PPH and maternal satisfaction The trial was stopped prematurely due to feasibility. Among the 3380 women initially planned, 1710 were included. The rate of neonatal morbidity was 19.1% in the "moderate pushing" group and 20.8 % in the "intensive pushing" group (p=0.39). Pushing duration was longer in the "moderate pushing" group (38.8 min+/-26.4 vs 28.6+/-17.0,p < 0.001). The rate of instrumental delivery was 21.1% in the "moderate pushing group and 24.8 % among the "intensive pushing" (p=0.08). The rate of episiotomy was significantly lower in the "moderate pushing" group (13.5% vs 17.8%,p=0.02). We found no significant differences for OASIS, PPH and maternal satisfaction Our trial failed to demonstrate any impact on neonatal morbidity of moderate pushing, but it may have benefit, as it was associated with a lower rate of episiotomy

To demonstrate the noninferiority of half compared to full antenatal betamethasone dose regimen to prevent severe respiratory distress syndrome in preterm neonates. In this multicenter double-blinded, randomized controlled, noninferiority trial, women with a singleton fetus at risk of preterm delivery before 32 gestational weeks, already treated with the first 11.4 mg betamethasone injection were randomly assigned to receive 24 hours later either placebo (half dose group) or the second 11.4 mg betamethasone injection (full dose group). The primary outcome was severe respiratory distress syndrome, defined as the need for exogenous intra-tracheal surfactant within 48 hours of life. The noninferiority was tested with a margin of 4 percentage points. Among the 3244 women enrolled between January 2017 and October 2019 in 37 French level-3 perinatal centers, 46 women retrieved consent, 29 had stillborn fetuses and 17 were lost to follow-up, leaving 3150 newborns for analysis. For the intention-to-treat (ITT) analysis, the primary outcome occurred in 317/1574 (20.1%) neonates in the half dose group and in 279/1576 (17.7%) neonates in the full dose group. The between-group difference was 2.4 percentage points (upper boundary of one side 97.5% Confidence Interval 5.4%), which was above the noninferiority margin. Per protocol analysis for the primary outcome performed in 2992 neonates was consistent with ITT analysis. Rates of neonatal death, intraventricular hemorrhage grade 3-4, necrotizing enterocolitis stage ≥2, retinopathy of prematurity requiring anti-VEGF or laser, and neonatal survival without any of these complications did not differ between groups. Half dose did not show noninferiority to full antenatal betamethasone dose regimen to prevent severe respiratory distress syndrome in preterm neonates. However, neonatal survival and complications did not differ between the two groups (ClinicalTrials.gov;NCT02897076)View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Objective: To describe the course over time of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in French women from the beginning of the pandemic until mid-April, the risk profile of women with respiratory complications, and short-term pregnancy outcomes. Methods: We collected a case series of pregnant women with COVID-19 in a research network of 33 French maternity units between March 1 and April 14, 2020. All cases of SARS-CoV-2 infection confirmed by a positive result on real-time reverse transcriptase polymerase chain reaction tests of a nasal sample and/or diagnosed by a computed tomography chest scan were included and analyzed. The primary outcome measures were COVID-19 requiring oxygen (oxygen therapy or noninvasive ventilation) and critical COVID-19 (requiring invasive mechanical ventilation or extracorporeal membrane oxygenation, ECMO). Demographic data, baseline comorbidities, and pregnancy outcomes were also collected. Results: Active cases of COVID-19 increased exponentially during March 1-31, 2020; the numbers fell during April 1-14, after lockdown was imposed on March 17. The shape of the curve of active critical COVID-19 mirrored that of all active cases. By April 14, among the 617 pregnant women with COVID-19, 93 women (15.1 %; 95 %Cl 12.3-18.1) had required oxygen therapy and 35 others (5.7 %; 95 %CI 4.0-7.8) had had a critical form of COVID-19. The severity of the disease was associated with age older than 35 years and obesity, as well as preexisting diabetes, previous preeclampsia, and gestational hypertension or preeclampsia. One woman with critical COVID-19 died (0.2 %; 95 %CI 0-0.9). Among the women who gave birth, rates of preterm birth in women with non-severe, oxygen-requiring, and critical COVID-19 were 13/123 (10.6 %),14/29 (48.3 %), and 23/29 (79.3 %) before 37 weeks and 3/123 (2.4 %), 4/29 (13.8 %), and 14/29 (48.3 %) before 32 weeks, respectively. One neonate (0.5 %; 95 %CI 0.01-2.9) in the critical group died from prematurity. Conclusion: COVID-19 can be responsible for significant rates of severe acute, potentially deadly, respiratory distress syndromes. The most vulnerable pregnant women, those with comorbidities, may benefit particularly from prevention measures such as a lockdown. (C) 2020 Elsevier Masson SAS. All rights reserved.

Summary Background Children born to mothers with IBD may be exposed to anti‐TNFα agents antenatally. Current European guidelines recommend postponing live vaccines until after 6 months of life in this population. Data on the safety of live vaccines administration in the first year of life of these children are sparse with one reported fatality following bacillus Calmette‐Guerin (BCG) administration. Aims To describe the use and safety of vaccines administered in children born to mothers with IBD and exposed antenatally to anti‐TNFα agents Methods Data from children born to mothers with IBD between 2013 and 2014 were collected retrospectively from the French Health Insurance Database. Vaccines recommended before or at 1 year of age were considered. Results Among 4741 children, 670 (14.1%) were exposed to anti‐TNFα agents antenatally, with concomitant thiopurines in 16.0% (n = 107) and steroids in 19.3% (n = 214). Among these 670 children, 315 (47%) were exposed up to delivery. Exposed children were less likely than non‐exposed to receive BCG (88/670, 13.1% vs 780/4071, 19.2% respectively, P < .05) and received it later in life (months, mean ± SD, 4.3 ± 3.9 and 2.4 ± 2.9 respectively, P < .001). In exposed children, 64/88 (73%) received BCG vaccination before 6 months of age, but with no BCG‐related severe adverse event observed during the first year. Uptake of other vaccines recommended before 6 months was above 85% in both groups. Conclusion In children exposed antenatally to anti‐TNFα agents, vaccinations are often not postponed in keeping with the recommendations, but no BCG‐related severe adverse events were reported in children vaccinated before 6 months of life.

Ningún tocolítico se asocia a una disminución de la mortalidad y la morbilidad neonatales en relación con el placebo. Los betamiméticos reducen los partos entre 48 horas y 7 días, pero se asocian a efectos adversos maternos en ocasiones graves (edema agudo de pulmón [EAP]), infartos, fallecimiento), lo que justifica su no prescripción para la tocólisis. El atosiban, antagonista de la oxitocina, y el nifedipino, antagonista del calcio, presentan una eficacia equivalente para prolongar el embarazo más allá de 48 horas y más de 7 días, pero en caso de amenaza de parto prematuro sin ruptura prematura de membranas, el nifedipino reduce el riesgo de parto antes de las 37 semanas de amenorrea (SA) y se asocia a una prolongación mayor del embarazo, y además con un beneficio neonatal demostrado. Los efectos adversos cardiovasculares aumentan moderadamente con el nifedipino en comparación con el atosiban, pero las tasas de suspensión del tratamiento son similares. Otros fármacos no han demostrado eficacia en la prolongación del embarazo o en el pronóstico neonatal y no deben emplearse con objetivo tocolítico: los liberadores de óxido nítrico (NO), el sulfato de magnesio, la progesterona, el fluoroglucinol. Los datos relacionados con los antinflamatorios no esteroideos son contradictorios y requieren más estudios. Teniendo en cuenta su beneficio en la progresión del embarazo y su buena tolerabilidad materna, el atosiban y el nifedipino pueden emplearse de entrada con objetivo tocolítico, incluso para los embarazos múltiples. El nifedipino presenta la ventaja de administrarse por vía oral y su coste es bajo. Los betamiméticos, debido a sus efectos adversos maternos en ocasiones muy graves, no deben utilizarse. Un tratamiento de mantenimiento pasadas las primeras 48 horas resulta inútil, incluso peligroso. En caso de fracaso del tocolítico empleado de entrada, se puede cambiar de fármaco tocolítico sin asociarlos. Ningún estudio ha valorado el interés de una nueva tocólisis en una mujer que ya haya recibido una corticoterapia. En este caso, se debe plantear la tocólisis de forma individualizada cuando el beneficio esperado parezca importante, como, por ejemplo, para permitir una transferencia in utero.

LINKED CONTENTThis article is linked to Luu et al and Bouri and Hart papers. To view these articles, visit https://doi.org/10.1111/apt.15504 and https://doi.org/10.1111/apt.15535.

Adrenal vein thromboses are rare events requiring curative anticoagulant therapy and labor management to minimize the risk of hemorrhage. Patients should receive thromboprophylaxis for subsequent pregnancies and a full thrombophilia investigation.

Introduction Pregnancies in women with lupus nephritis are at high-risk of complications, while scarcity of scientific knowledge on prognostic factors impedes a fair medical counseling. We aimed to identify determinants associated with maternal and fetal complications. Materials We retrospectively reviewed medical charts of pregnancies that lasted more than 22 weeks in 66 patients with pre-existing lupus nephritis between 2004 and 2013 in France. Univariate and multivariate analyses were conducted to identify determinants for maternal complications, lupus renal flare and fetal prematurity or death. Results Eighty-four pregnancies were identified. A maternal complication occurred in 31 pregnancies (36.9%): mostly preeclampsia (17 pregnancies, 20.2%) and renal flares (12 pregnancies, 14.3%). Overall fetal survival was 94.0% (79/84). Maternal pregnancy complications were independently associated with prepregnancy body mass index >25 kg/m2 (OR 3.81, 95% CI 1.03–14.09) and immunological activity (positive anti-dsDNA antibodies or Farr assay lupus) (OR 4.95, 95% CI 1.33–18.43). Renal lupus flares were independently associated with maternal age (OR 1.50, 95% CI 1.12–2.01) and prepregnancy immunological activity (OR 15.99, 95% CI 1.57–162.68) while a remission time >12 months had a protective effect (OR 0.17, 95% CI 0.04–0.68). Three parameters were associated with a higher risk of fetal prematurity or death: a prepregnancy body mass index >25 kg/m2 (HR 3.58, 95% CI 1.45–8.83), hypertension (HR 8.97, 95% CI 3.32–24.25), and immunological activity (HR 3.34, 95% CI 1.30–8.63). Conclusion Maternal age, prepregnancy hypertension, body mass index >25 kg/m2 and lupus immunological activity may be considered as the main determinants for fetal and maternal complications. A remission time above 12 months for patients with lupus nephritis could be associated with a reduced risk of renal flare during pregnancy.

Les enfants nés de mères atteintes de maladie inflammatoire chronique intestinale (MICI) peuvent être exposés in utero aux anti-TNFα. Les données de sécurité sur l’administration des vaccins vivants chez ces enfants durant la première année de vie sont parcellaires, avec un décès décrit après vaccination contre le Bacille Calmette-Guerin (BCG). Nous avons décrit l’utilisation et la sécurité des vaccins recommandés avant l’âge de 1 an dans cette population. Les données d’enfants nés de mères atteintes de MICI entre 2013 et 2014 ont été rétrospectivement extraites du SNDS (Système national des données de santé). Étaient considérés tous les vaccins recommandés en France avant ou à 1 an (BCG pour la tuberculose, diphtérie-tétanos-poliomyélite, coqueluche, Haemophilus Influenzae B, Hépatite B, Pneumocoque, méningocoque C, et Rougeole-Oreillon-Rubéole). Les complications reliées à chaque vaccin et les complications infectieuses (dont la tuberculose) ont été recherchées pendant la première année de vie. Parmi 4741 enfants, 670 (14,1 %) étaient exposés in utero aux anti-TNFα, avec un traitement concomitant par thiopurines dans 16,0 % (n = 107) et corticoïdes dans 19,3 % (n = 214) des cas. Parmi ces 670 enfants, 315 (47 %) l’étaient jusqu’à l’accouchement. Les enfants exposés aux anti-TNFα étaient moins vaccinés par le BCG (88/670, 13,1 % versus 780/4071, 19,2 % respectivement, p < 0,05) et vaccinés plus tard (jours, moyenne ± ET, 128 ± 117 versus 71,6 ± 88,2 respectivement, p < 0,001). Chez les enfants exposés, la vaccination anti-tuberculeuse était majoritairement (73 %) faite avant l’âge de 6 mois, mais sans événement indésirable tuberculeux détecté durant la première année. La couverture vaccinale avant 6 mois des autres vaccins recommandés était > 85 % dans les deux groupes. Chez les enfants exposés in utero aux anti-TNFα, les cliniciens ne repoussent pas l’administration des vaccins vivants comme recommandé, mais aucun cas d’infection tuberculeuse disséminée n’a été observé chez les enfants vaccinés avant l’âge de 6 mois. Chez les enfants à risque de tuberculose, la décision d’administrer précocement le vaccin contre la tuberculose devrait se baser sur le risque individuel plutôt que sur l’exposition prénatale aux anti-TNFα.

Background: Pregnancy in hemodialysis (HD) women is a rare event and often associated with maternal and fetal complications. Scarcity of available data from large cohorts impedes fair medical counseling. Methods: This is a descriptive, retrospective, multi-centric study. Pregnant women on HD during the period from 1985 to 2015 in France were included. The primary outcome was a living infant discharged from hospital, while secondary outcomes included gestational age and birth weight. Results: We identified 100 pregnancies in 84 women on HD, from 41 centers. Chronic HD was initiated during pregnancy for 17.7% (14/79) of patients explaining a 19.8% prevalence of catheter (19/96) and a preserved residual diuresis for 50% of pregnancy (43/86). Seventy-six (89.4%) women performed daily dialysis during the third trimester (6 times per week). Our primary outcome was met for 78% of newborns with a mean gestational age of 33.2 ± 3.9 weeks and a mean birth weight of 1,719 ± 730 g. Conclusions: Our study is one of the largest series of ­pregnancies in HD patients. Despite recent progresses, these pregnancies remain at high risk, reinforcing the need for an early nephrologist-obstetrician skilled team co-management.

Les maladies inflammatoires chroniques intestinales (MICI) nécessitent un traitement chronique, pouvant interférer avec le désir de grossesse chez les jeunes femmes. Une MICI non contrôlée en début de grossesse est un facteur de mauvais pronostic maternel et fœtal. L’utilisation, hors autorisation, des antagonistes du « Tumor Necrosis Factor α » (anti-TNFα) durant la grossesse, augmente actuellement, et peuvent exposer la femme et le fœtus à des complications iatrogènes. Les recommandations actuelles sur les anti-TNFα dans cette population sont discordantes. Cette étude visait à évaluer, les modalités d’utilisation et le rapport bénéfice-risque des anti-TNFα pendant la grossesse chez les patientes atteintes de MICI, et durant la première année de vie chez les enfants exposés in utero. Il s’agit d’une cohorte rétrospective incluant 11 275 grossesses chez 8726 femmes atteintes de MICI enceintes entre 2011 et 2014, identifiées dans le Système national d’information inter-régimes de l’assurance maladie. Le critère de jugement principal composite regroupait les complications liées au traitement, à la maladie et à la grossesse. Le risque était analysé par régression logistique, ajusté sur l’âge au début de grossesse, les caractéristiques de la MICI (type, sévérité et ancienneté) et la prise concomitante de thiopurines. Au total, 1457 grossesses (12,9 %) ont été exposées aux anti-TNFα, principalement l’infliximab et l’adalimumab, dont 1313/7722 (17,0 %) maladies de Crohn et 144/3553 (4,1 %) rectocolites hémorragiques. Les anti-TNFα étaient associés à un risque accru de complications maternelles (Odds Ratio ajusté (aOR) = 1,45 ; IC 95 % [1,29–1,64]) et d’infections (aOR = 1,35 ; [1,19–1,50]). Aucun risque infectieux n’a été retrouvé chez l’enfant (aOR = 0,90 [0,77–1,06]). L’utilisation des anti-TNFα durant la grossesse est associée à un risque de complications maternelles, mais semble sûre chez l’enfant durant la première année de vie. Un suivi plus long chez l’enfant ainsi que d’autres analyses chez la mère ajustées sur les traitements concomitants et les facteurs environnementaux, sont nécessaires pour estimer plus précisément le rapport bénéfice–risque des anti-TNFα durant la grossesse.

Fetal Heart Rate (FHR) monitoring is used during delivery for fetal well-being assessment. Classically based on the visual evaluation of FIGO criteria, FHR characterization remains a challenging task that continuously receives intensive research efforts. Intrapartum FHR analysis is further complicated by the two different stages of labor (dilation and active pushing). Research works aimed at devising automated acidosis prediction procedures are either based on designing new advanced signal processing analyses or on efficiently combining a large number of features proposed in the literature. Such multi-feature procedures either rely on a prior feature selection step or end up with decision rules involving long lists of features. This many-feature outcome rule does not permit to easily interpret the decision and is hence not well suited for clinical practice. Machine-learning-based decision-rule assessment is often impaired by the use of different, proprietary and small databases, preventing meaningful comparisons of results reported in the literature. Here, sparse learning is promoted as a way to perform jointly feature selection and acidosis prediction, hence producing an optimal decision rule based on as few features as possible. Making use of a set of 20 features (gathering 'FIGO-like' features, classical spectral features and recently proposed scale-free features), applied to two large-size (respectively; 1800 and; 500 subjects), well-documented databases, collected independently in French and Czech hospitals, the benefits of sparse learning are quantified in terms of: (i) accounting for class imbalance (few acidotic subjects), (ii) producing simple and interpretable decision rules, (iii) evidences for differences between the temporal dynamics of active pushing and dilation stages, and (iv) of validity/generalizability of decision rules learned on one database and applied to the other one.

OBJECTIVES:Inflammatory bowel diseases (IBD) need long-term treatment, which can influence pregnancies in young women. Uncontrolled IBD is associated with poor pregnancy outcomes. Despite the labeling of Anti-tumor necrosis factor (TNF) antibodies (anti-TNFα) which indicates that their use is not recommended during pregnancy, anti-TNFα are increasingly being used during pregnancy and may expose women and their fetuses to treatment-related complications. Existing recommendations on the timing of treatment during pregnancy are inconsistent. We aimed to assess the safety of anti-TNFα treatment in pregnant women with IBD, and up to the first year of life for their children. METHODS:An exposed/non exposed retrospective cohort was conducted on the French national health system database SNIIRAM (Système National d'Information Inter-Régimes de l'Assurance Maladie). All IBD women who became pregnant between 2011 and 2014 were included. Women with concomitant diseases potentially treated with anti-TNFα were excluded. Anti-TNFα exposure (infliximab, adalimumab, golimumab or certolizumab pegol) during pregnancy was retrieved from the exhaustive prescription database in SNIIRAM. The main judgment criterion was a composite outcome of disease-, treatment- and pregnancy-related complications during pregnancy for the mother, and infections during the first year of life for children. RESULTS:We analyzed data from 11,275 pregnancies (8726 women with IBD), among which 1457 (12.9%) pregnancies were exposed to anti-TNFα, mainly infliximab or adalimumab, with 1313/7722 (17.0%) suffering from Crohn's disease and 144/3553 (4.1%) from ulcerative colitis. After adjusting for disease severity, steroid use, age, IBD type, and duration and concomitant 6-mercaptopurine use, anti-TNFα treatment was associated with a higher risk of overall maternal complications (adjusted Odds Ratio (aOR) = 1.49; 95% confidence interval (CI): 1.31-1.67) and infections (aOR = 1.31; 95% CI: 1.16-1.47). Maintaining anti-TNFα after 24 weeks did not increase the risk of maternal complication, but interrupting the anti-TNFα increased relapse risk. No increased risk for infection was found in children (aOR = 0.89; 95% CI: 0.76-1.05) born to mother exposed to anti-TNFα during pregnancy. CONCLUSIONS:Anti-TNFα treatment during pregnancy increased the risk of maternal complications compared to unexposed; however, discontinuation before week 24 increased the risk of disease flare. There was no increased risk for children exposed to anti-TNFα up to 1 year of life.

L’objectif principal de notre étude était de mesurer l’impact de la prise de poids pendant la grossesse sur la variété de présentation à l’expulsion. Les objectifs secondaires étaient de mesurer l’impact de l’indice de masse corporelle (IMC) et de la taille maternelle sur la variété de présentation à l’expulsion. Nous avons réalisé une étude cas-témoins bicentrique rétrospective incluant 130 dégagements en occipito-sacré (OS) et 390 en occipito-pubien (OP). L’impact de la prise de poids, de l’IMC et de la taille sur la probabilité de dégagement en OS a été testé et quantifié par un modèle de régression logistique. Nous avons utilisé le logiciel R et la bibliothèque Epi pour réaliser nos différents tests. Notre étude a montré qu’à partir de 12 kg, chaque kg supplémentaire augmentait de 14 % le risque de dégagement en OS (OR, 1,145, IC à 95 % [1,068–1,227]). La probabilité d’OS augmentait quand l’IMC était plus élevé (OR = 1,12, IC à 95 % [1,07–1,17]). Une prise de poids excessive pendant la grossesse peut entraîner de nombreuses complications fœto-maternelles et favoriser un dégagement en OS. Il est essentiel de dépister et prévenir ces facteurs de risque pendant la grossesse ainsi que de diagnostiquer les variétés postérieures persistantes en salle de naissance.