BACKGROUND:Hyperemesis gravidarum (HG) remains one of the most disabling complications of the first trimester, with a high risk of recurrence after a prior episode that weighs heavily on family planning and on patients' mental health. Recent work places GDF15 at the core of HG pathophysiology, suggesting that a low pre-gestational baseline GDF15 level may predispose to hypersensitivity when its concentration rises sharply in the first trimester. The preconception desensitization hypothesis therefore opens a path to preventing recurrence. Observational data indicate that metformin, which increases GDF15, could reduce the risk of HG when used before conception. One observational cohort reports a non-significant trend toward lower HG risk after preconception metformin exposure (aOR ≈ 0.50 ; 95% CI 0.07-3.39) but no effect on nausea and vomiting of pregnancy (NVP); results are limited by low statistical power. In parallel, a large retrospective survey reports a substantial and statistically significant reduction in the risk of HG and severe NVP with preconception metformin (aOR ≈ 0.29 for a first pregnancy; aOR ≈ 0.18 for a second pregnancy after adjustment for recurrence). POSITION:The mechanistic rationale is compelling and the clinical signals are encouraging, but no randomized trial has yet demonstrated the preventive efficacy of metformin; additional studies are needed before any practice recommendation can be made.

CONTEXT:Breast milk (BM) provides the optimal combination of essential nutrients and bioactive molecules for infant growth and development. However, accumulating evidence from our group and others indicates that maternal factors, such as obesity, can alter BM composition, potentially affecting offspring health outcomes. Bile acids (BA), both primary and secondary, have been identified in human BM but the precise composition and their role in BM remain largely underexplored. OBJECTIVE:In this study, we analyzed BA profiles in BM and plasma in lactating mothers with obesity or not, across 2 independent clinical cohorts. METHODS:BM and plasma samples were collected from breastfeeding women classified as normal weight (N) or with obesity (O). BA concentrations were quantified by reverse phase liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). RESULTS:BAs were present in BM, primarily as glyco- and tauro-conjugated of the primary BAs cholic (CA) and chenodeoxycholic acid (CDCA), although at lower levels than in plasma under normal-weight conditions. Maternal obesity led to a marked increase in total BM BA levels while plasma BA concentrations and composition remained unchanged. Additionally, BM BA levels were positively correlated with maternal pre-pregnancy body mass index, circulating leptin (a marker of adiposity), and insulin levels. CONCLUSION:Our findings identify maternal obesity as a significant modifier of BM BA composition, with potential implications for neonatal digestion, maturation, and health. Further research is warranted to elucidate the impact of these alterations on infant health and development.

Background:We tested whether COVID-19 vaccination affects the risk of preeclampsia (PE) given the well-documented association between COVID-19 and PE, and their overlapping risk factors and pathophysiological pathways. Methods:We analysed individual level data from pregnant women prospectively enrolled from 18 countries in two consecutive cohorts between 2020 and 2022 during the COVID-19 pandemic using identical methodology. Pregnant women were recruited either with a COVID-19 diagnosis or as concomitant, consecutive, non-diagnosed controls from the same hospitals. Following vaccine availability, vaccination status was documented to define a vaccine-exposed subgroup. Multivariable logistic regression models assessed the odds of PE adjusting for confounders and cohort as a proxy for viral strain, stratifying by pre-existing morbidities and SARS-CoV-2 infection. Survival analyses estimated PE incidence according to vaccination status and pre-existing morbidities. Findings:Of 6527 pregnant women, 2166 (33.2%) were diagnosed with COVID-19 and 3753 (57.5%) were unvaccinated. Of the 2774 vaccinated women, 1795 (64.7%) received mRNA vaccines; 848 (30.6%) received the initial regimen plus a booster dose, of whom 66.6% received a booster with an mRNA vaccine. We confirmed an independent association between COVID-19 and PE (aOR: 1.45; 95% CI: 1.15-1.84), particularly in unvaccinated women (aOR: 1.78; 95% CI: 1.31-2.42). Overall, after adjusting for confounders, any vaccination gave a protective effect against PE during the index pregnancy (aOR: 0.85; 95% CI: 0.65-1.10), that was stronger with a booster dose (aOR: 0.67; 95% CI: 0.45-0.99). Among women with pre-existing morbidities who received a booster dose the odds were reduced by 58% (aOR: 0.42; 95% CI: 0.20-0.87) - an effect mainly observed in women diagnosed with COVID-19. Adjustment for study site and cohort year did not alter the magnitude of the effect. Vaccination amongst women who received a booster dose was also associated with decreased odds of maternal (aOR: 0.68; 95% CI: 0.55-0.83) and perinatal (aOR: 0.71; 95% CI: 0.54-0.95) morbidity and mortality, and preterm birth (aOR: 0.67; 95% CI: 0.53-0.85). Interpretation:COVID-19 vaccination with a booster reduces the odds of PE by 30% approaching 60% reduction among women with pre-existing morbidities. Funding:The original INTERCOVID study was supported in Oxford by the COVID-19 Research Response Fund from the University of Oxford (Ref 0009083).

To compare labour duration and the effectiveness of cervical ripening by transcervical balloon versus oral misoprostol in women with elevated body mass index (BMI ≥ 25 kg/m2). A retrospective single-centre cohort (2022–2024) at Montpellier University Hospital including singleton term pregnancies (37–42 weeks) with cephalic presentation, BMI > 25 and Bishop score < 6. Mechanical balloon versus oral misoprostol (25 µg/2 h or 50 µg/4 h) were compared by survival analysis assessing induction-to-delivery interval and by logistic regression assessing vaginal delivery rates, all adjusting for key covariates. Exclusion criteria: maternal age < 18 years, scarred uterus, low-lying placenta. Among 7336 births, 2225 (30.3

Introduction During the perinatal period, women have an increased risk for psychiatric disorders, which are highly prevalent in this context. In addition, there are significant delays in diagnosing these conditions, worsening their prognosis and increasing their societal burden. Studies describing psychiatric disorders in the perinatal period often focus on specific disorders; only postpartum depression and, to a lesser extent, anxiety disorders are studied. There are also very few evaluations conducted by clinicians based on a semistructured interview, relying on the diagnostic criteria of international nosography.Methods and analysis This multicentric prospective study will recruit 140 adult pregnant women based on randomly selected second trimester (T2) ultrasound consultations. The primary outcome is the prevalence of any psychiatric disorder assessed with a standardised psychiatric assessment, the Mini-International Neuropsychiatric Interview (M.I.N.I.). Within 10 days after the T2 ultrasound appointment, we will conduct the M.I.N.I., collect demographic data, evaluate suicidal behaviour with the Columbia-Suicide Severity Rating Scale, describe negative life events from the past year using the Paykel questionnaire and evaluation of social deprivation (Evaluation of the Deprivation and Inequalities of Health in Healthcare Centres score). Participants will also complete self-administered psychiatric questionnaires that screen for specific pathologies. We will build a biological sample collection. At two months post partum, we will repeat the questionnaires, adding an assessment of mother-child bonding. Patients can choose between in-person or telemedicine visits on both occasions.Ethics and dissemination All participants will be required to provide written informed consent. The study has received ethical approval from the French National Committee (‘Comité de Protection des Personnes Ouest VI’) (approval number: 23.03919.000236). Results will be disseminated through peer-reviewed journal publications and at scientific conferences and meetings.Trial registration number NCT06297252.

INTRODUCTION:Spontaneous rupture of membranes before 37 weeks of amenorrhea (preterm premature rupture of membranes [pPROM]) is associated with two main complications: prematurity and fetal infection. Biological parameters, particularly C-reactive protein (CRP) levels, were monitored during a continued pregnancy. Group A represented our previous practice, that is, regular CRP monitoring with induced birth or cesarean section after two consecutive levels above 20 mg/L. Group B represented our practice after the publication of the national recommendations and the absence of induced delivery based on an isolated CRP level with no sign of intrauterine infection. This study aimed to assess the effect of these recommendations on neonatal morbidity and mortality rates. MATERIAL AND METHODS:This retrospective bicentric cohort study included 169 singleton pregnancies with pPROM <32 weeks, managed in 2017-2018 (Group A, n = 96) and 2020-2021 (Group B, n = 73). Maternal characteristics, inflammatory markers, delivery modalities, and neonatal outcomes were compared. Multivariate logistic regression using Firth's penalized likelihood method was employed to identify independent predictors of fetal mortality and severe neonatal morbidity. RESULTS:Group B showed higher rates of early-onset neonatal infection (19.2 % vs. 7.3 %, p = 0.03), elevated CRP levels at birth, and more frequent positive neonatal blood cultures (5.5 % vs. 0 %, p = 0.04). Histological chorioamnionitis was also more prevalent (71.2 % vs. 50 %, p < 0.005). In multivariate analysis, fetal mortality was independently associated with shorter latency between rupture and delivery and male fetal sex. Belonging to Group B was associated with lower odds of fetal death (OR 0.15, 95 % CI [0.02-1.01], p = 0.05). Severe neonatal morbidity was significantly associated with lower birth weight (OR 3.76, 95 % CI [1.56-9.02], p = 0.003), while CRP evolution, latency, sex, and gestational age at birth were not independent predictors. CONCLUSION:Severe neonatal morbidity remained frequent and was primarily influenced by fetal maturity factors, notably birth weight. These results suggest that while a less interventionist approach may be safe for maternal outcomes, careful monitoring is essential to prevent infectious complications. CRP remains a useful biomarker, but its interpretation must consider context and timing of intervention.

BACKGROUND: In early 2023, when Omicron was the variant of concern, we showed that vaccinating pregnant women decreased the risk for severe COVID-19-related complications and maternal morbidity and mortality. OBJECTIVE: This study aimed to analyze the impact of COVID-19 during pregnancy on newborns and the effects of maternal COVID-19 vaccination on neonatal outcomes when Omicron was the variant of concern. STUDY DESIGN: INTERCOVID-2022 was a large, prospective, observational study, conducted in 40 hospitals across 18 countries, from November 27, 2021 (the day after the World Health Organization declared Omicron the variant of concern) to June 30, 2022, to assess the effect of COVID-19 in pregnancy on maternal and neonatal outcomes and to assess vaccine effectiveness. Women diagnosed with laboratory-confirmed COVID19 during pregnancy were compared with 2 nondiagnosed, unmatched women recruited concomitantly and consecutively during pregnancy or at delivery. Mother-newborn dyads were followed until hospital discharge. The primary outcomes were a neonatal positive test for COVID-19, severe neonatal morbidity index, severe perinatal morbidity and mortality index, preterm birth, neonatal death, referral to neonatal intensive care unit, and diseases during the neonatal period. Vaccine effectiveness was estimated with adjustment for maternal risk profile. RESULTS: We enrolled 4707 neonates born to 1577 (33.5%) mothers diagnosed with COVID-19 and 3130 (66.5%) nondiagnosed mothers. Among the diagnosed mothers, 642 (40.7%) were not vaccinated, 147 (9.3%) were partially vaccinated, 551 (34.9%) were completely vaccinated, and 237 (15.0%) also had a booster vaccine. Neonates of booster- vaccinated mothers had less than half (relative risk, 0.46; 95% confidence interval, 0.23-0.91) the risk of being diagnosed with COVID-19 when compared with those of unvaccinated mothers; they also had the lowest rates of preterm birth, medically indicated preterm birth, respiratory distress syndrome, and number of days in the neonatal intensive care unit. Newborns of unvaccinated mothers had double the risk for neonatal death (relative risk, 2.06; 95% confidence interval, 1.06-4.00) when compared with those of nondiagnosed mothers. Vaccination was not associated with any congenital malformations. Although all vaccines provided protection against neonatal test positivity, newborns of booster-vaccinated mothers had the highest vaccine effectiveness (64%; 95% confidence interval, 10%-86%). Vaccine effectiveness was not as high for messenger RNA vaccines only. Vaccine effectiveness against moderate or severe neonatal outcomes was much lower, namely 13% in the booster-vaccinated group (all vaccines) and 25% and 28% in the completely and booster-vaccinated groups, respectively (messenger RNA vaccines only). Vaccines were fairly effective in protecting neonates when given to pregnant women <100 days (14 weeks) before birth; thereafter, the risk increased and was much higher after 200 days (29 weeks). Finally, none of the neonatal practices studied, including skin-to-skin contact and direct breastfeeding, increased the risk for infecting newborns. CONCLUSION: When Omicron was the variant of concern, newborns of unvaccinated mothers had an increased risk for neonatal death. Neonates of vaccinated mothers had a decreased risk for preterm birth and adverse neonatal outcomes. Because the protective effect of COVID-19 vaccination decreases with time, to ensure that newborns are maximally protected against COVID-19, mothers should receive a vaccine or booster dose no more than 14 weeks before the expected date of delivery.

OBJECTIVE:To assess women's experiences with skin-related side effects following subcutaneous low molecular weight heparin (LMWH) injections after a cesarean section, and to analyze their impact on treatment adherence. METHOD:A questionnaire was developed in collaboration with Cesarine, a patients' association, to explore various aspects of LMWH administration, including prevention methods, cutaneous side effects, treatment compliance, perceived constraints, apprehension, and understanding of treatment benefits. Additionally, women's opinions on an alternative oral administration approach were solicited, taking into consideration breastfeeding contraindication. The questionnaire was on the Facebook® page and blog of the association. RESULTS:One hundred and sixty-four women participated in the survey. Among them, 139 women (84.8%) reported bruising, while 117 (71.3%) reported pruritus, erythema, or nodules at the injection site. Treatment discontinuation was observed in 36 cases (22%), decided mostly by the women themselves (77.8%). The main reasons cited for discontinuation were discomfort during injection (71.4%), skin reactions (31.4%), and a perceived lack of effectiveness (54.3%). Furthermore, 88 women (53.7%) wanted to quit the treatment prematurely, citing similar reasons. Thirty-three women (20.1%) reported oversights. For most women, the treatment was perceived as burdensome and caused apprehension. An alternative oral administration method was of interest to 131 women (79.9%). However, only 28 (17.8%) would have accepted if the medication was incompatible with breastfeeding. CONCLUSION:Cutaneous side effects of LMWH injections, as well as injection process itself, have a negative impact on adherence in the postpartum period following a c-section. These findings highlight the need to explore alternative to improve women's compliance and comfort.

Objective: To establish a predictive model for adverse immediate neonatal adaptation (INA) in fetuses with suspected severe fetal growth restriction (FGR) after 34 gestational weeks (GW). Methods. We conducted a retrospective observational study at the University Hospitals of Strasbourg between 2000 and 2020, including 1,220 women with a singleton pregnancy and suspicion of severe FGR who delivered from 34 GW. The primary outcome (composite) was INA defined as Apgar 5 -minute score <7, arterial pH <7.10, immediate transfer to pediatrics, or the need for resuscitation at birth. We developed and tested a logistic regression predictive model. Results. Adverse INA occurred in 316 deliveries. The model included six features available before labor: parity, gestational age, diabetes, middle cerebral artery Doppler, cerebral-placental inversion, onset of labor. The model could predict individual risk of adverse INA with confidence interval at 95 %. Taking an optimal cutoff threshold of 32 %, performances were: sensitivity 66 %; specificity 83 %; positive and negative predictive values 60 % and 87 % respectively, and area under the curve 78 %. Discussion. The predictive model showed good performances and a proof of concept that INA could be predicted with pre-labor characteristics, and needs to be investigated further.

Educational programs incorporating physical activity (PA) sessions and nutritional workshops have demonstrated potential benefits for overweight and obese pregnant women. However, participation in such programs remains challenging. This prospective study aimed to investigate the factors influencing participation and regular attendance, while examining changes in health behaviors, along with obstetric and neonatal outcomes. Pregnant women with at 12–22 weeks’ gestation a BMI ≥ 25 kg/m2 were invited to join an educational program combining three nutritional workshops conducted in groups and 12 weekly PA sessions. They self-selected their participation into the program. Regardless of program uptake and regularity of attendance, the women’s PA levels, eating behaviors, and affectivity were assessed using validated questionnaires at 20–24 weeks, 32–34 weeks, and postpartum. A multivariable logistic regression model was used to determine the factors influencing participation. Of the 187 women enrolled in the study, 61.5

Objectif : Évaluer le ressenti de femmes ayant eu une césarienne sur leur ressenti des effets secondaires cutanés liés aux injections d’HBPM par voie sous-cutanée après une césarienne et analyser leur impact sur la compliance au traitement.Méthode : Un questionnaire a été élaboré avec l’association Césarine explorant les modalités de réalisation de la prévention thrombo-embolique par injection sous cutanée d’Héparine de Bas Poids Moléculaire (HBPM), les effets secondaires cutanés, la compliance, la contrainte, l’appréhension et la compréhension du bénéfice du traitement. L’opinion des femmes sur une approche alternative par voie orale était questionnée en tenant compte de la contre-indication en cas d’allaitement. Le questionnaire était sur la page Facebook® et le blog de l’association.Résultats : 164 femmes ont répondu. 139 femmes (84,8%) rapportaient avoir eu des ecchymoses et 117 (71,3%) un prurit, un erythtème ou un nodule au point d’injection lors de l’utilisation d’HBPM. Un arrêt prématuré du traitement était retrouvé dans 36 cas (22%), majoritairement, à l’initiative des femmes seules (77,8%). Les raisons principales invoquées à cet arrêt prématuré étaient l’injection elle-même (71,4%), les réactions cutanées (31,4%), et le sentiment que le traitement était inutile (54,3%). L’envie d’arrêter a été exprimé par 88 femmes (53,7%) avec des raisons identiques à celles de l’arrêt prématuré. Trente-trois femmes (20,1%) ont signalé des oublis. Pour une majorité des femmes, le traitement était vécu comme une contrainte et générait de l’appréhension. Une prise alternative par voie orale aurait intéressée 131 femmes (79,9%). Seules 28 (17,8%) l’auraient accepté si le médicament oral n’est pas compatible avec l’allaitement.Conclusion : Les effets cutanés de l’injection et les injections elles-mêmes impactent négativement la compliance du traitement par HBPM dans le post-partum après césarienne. Ces résultats suggèrent d’explorer des alternatives aux HBPM pour la prévention throbmo-embolique pour en améliorer la compliance ainsi que le confort des femmes.

COVID-19 has affected pregnant women and their foetuses since the spring 2020. We previously studied 26 infants who were born at 34 plus weeks of gestation and not separated at birth from mothers with symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in the last 2 weeks of pregnancy. The infants were born during the first pandemic wave in Alsace, France, and had favourable outcomes at 1 month of age.1 Short-term favourable outcomes in such patients have also been confirmed by a large Swedish register-based study.2 Little is known about the mid-term or long-term outcomes of such infants, but prenatal exposure to SARS-CoV-2 may affect infants' neurodevelopmental trajectories. One study found that three of eight infants born to mothers with SARS-CoV-2 had abnormal magnetic resonance imaging findings at 44 weeks of corrected age, including delayed myelinisation and unusual white matter signals, but no clinical repercussions.3 This observational study followed up the medical outcomes of our cohort1 when they reached 10 months of age and was carried out from 15 March to 24 April 2020 in the maternity wards of 2 level III public hospitals in Strasbourg and Mulhouse, France. It was approved by the local ethics committee of Strasbourg Medical Faculty (CE-2020-86), and the parents provided written informed consent. The main investigator phoned the parents when the infants were 10 months old, told them about the study and requested consent to interview the infants' usual paediatricians about their medical history. The parents were then sent written study information, a consent form and the questionnaires. If they did not reply after 2 weeks, the questionnaires were completed over the phone and they returned the consent form. The paediatricians were mainly contacted by e-mail. Neurodevelopmental status was measured by the validated French-Canadian version of the Ages and Stages Questionnaires (ASQ), Second Edition, for 10-month-old infants. The questionnaires were completed by at least one French native-speaking parent and contained five main domains covering 30 questions. Abnormal neurodevelopmental was defined as a score of less than 25 in at least one domain. Parental questionnaires were used to collect the infants' medical histories and cross-checked with the data from their paediatricians. These included asthma, bronchiolitis, bacterial pneumonia, otitis, laryngitis, fever without obvious cause or weight gain difficulties. The study comprised 24 of the original 26 mother–infant dyads and their main perinatal characteristics have previously been reported.1 The infants' mean gestational age was 39.0 ± 2.1 weeks, their mean birth weight was 3144 ± 599 grams, and 50% were male. Only one mother was not symptomatic before delivery. Three infants were born preterm, and two had respiratory distress syndrome that required a few hours of ventilation in the neonatal intensive care unit. One had self-limiting hyperthermia in the maternity ward. Only one asymptomatic neonate tested positive for SARS-CoV-2 on Day 3.1 Table 1 summarises the main outcomes. One male showed abnormal neurological development at 10 months, with a ASQ gross motor subdomain score of 15. However, his other subdomain scores were normal and monthly examinations by his paediatrician showed no neurological concerns. He tested negative on Days 0 and 3 and was asymptomatic during the first month of life. A 7-month-old man was hospitalised with pyelonephritis, and his parents described a short febrile seizure. His electroencephalography findings and the paediatric neurologist team's findings were both normal, with no indication for a lumbar puncture or cerebral imaging. He did not relapse or need anti-convulsant medication. This suggests that the seizures did not result from brain tissue damage due to a perinatal infection. No adverse neurological and medical outcomes were detected in our cohort at 10 months of age. Few studies have reported long-term follow-ups in such infants. Ayed et al.4 followed 298 infants with in utero exposure to SARS-CoV-2 until 10–12 months and assessed their neurodevelopmental status with the ASQ, Third Edition. This showed that 10% had neurodevelopmental delay, defined as less than 2 standard deviations in at least 1 subdomain. Edlow et al.5 reported an increased proportion of developmental disease in 1-year-old infants born to mothers with SARS-CoV-2 during pregnancy. The small sample size and absence of a non-SARS-CoV-2 control group were limitations as they prevented definitive conclusions about neurodevelopmental trajectories. Another limitation was the lack of data on breastfeeding-induced immunisation. Finally, we only reported the neurological outcomes of infants exposed in the last 2 weeks of intrauterine life. Data on earlier exposure to the inflammatory stress associated with maternal SARS-CoV-2 infection would have been interesting. Ayed et al.4 reported increased abnormal ASQ scores in infants exposed during the first or second trimester. This 10-month follow-up reassuringly suggested that these infants had not experienced major neurodevelopmental delays after in utero exposure to SARS-CoV-2. Our zero-separation strategy could have contributed to these favourable outcomes. However, long-term follow-up studies of larger population-based cohorts are required to see whether minor difficulties appear later. None.

Des recommandations de prise de poids gestationnelle idéale ont été proposées en 2009 pour l’institute of Medecine En cas d’IMC>30kg/m2, la prise de poids recommandée doit se situer entre 5 et 9kg. Cependant, ces recommandations ne distinguent pas les différents grades d’obésité. Des données récentes suggèrent que les recommandations de l’IOM ne sont pas assez restrictives pour les femmes enceintes obèses et qu’elles doivent être adaptées au grade de l’obésité.

Évaluation de la douleur des patientes demandeuses d’une Interruption volontaire de grossesse (IVG) médicamenteuse en fonction du terme jusqu’à 14 semaines d’aménorrhée (SA), selon une échelle numérique (EN). Étude prospective observationnelle monocentrique réalisée aux hôpitaux universitaires de Strasbourg du 1er octobre 2019 au 31 décembre 2020. Il n’y a pas de différence significative concernant les douleurs en cas d’IVG médicamenteuses réalisées entre 7–9 SA, et celles réalisées entre 9–14 SA (6,5 ± 2,5 versus 6,6 ± 2,2, p = 0,85). Quel que soit le terme de la grossesse (avant 7 SA, entre 7–9 SA et entre 9–14 SA), les patientes se sont senties soulagées par les antalgiques en cas d’IVG médicamenteuse dans respectivement 88,9 %, 80,3 % et 87,3 % des cas (p = 0,18). La prise d’antalgique a permis une baisse moyenne de 3 points sur l’EN dans les 3 groupes (p = 0,67). Les patientes sont plus algiques en cas de protocole médicamenteux versus chirurgical (douleur maximale 6,0 ± 2,6 versus 1,4 ± 2,0, p < 0,01), mais ont déclaré être soulagées par les antalgiques dans 85,1 et 94,3 % des cas (p = 0,24). La douleur étant similaire quel que soit le terme en cas d’IVG médicamenteuse au-delà de 7 SA, et sa prise en charge antalgique semblant efficace, ce critère ne doit pas orienter le professionnel de santé dans le choix de la méthode. Celui-ci doit appartenir en toute légitimité à la patiente. Pain assessment of patients requesting a medical abortion according to the term, up to 14 weeks, by a numerical rating scale (NRS). This was a single-centre prospective observational study conducted at the University Hospitals of Strasbourg from 1st October 2019 to 31st December 2020. There was no significant difference in pain assessed by the NRS for medical abortion performed between 7–9 weeks and those performed between 9–14 weeks (6.5 ± 2.5 vs. 6.6 ± 2.2, P = 0.85). Regardless of the term (before 7 weeks, between 7–9 weeks and between 9–14 weeks), patients felt relieved by taking painkillers in the case of medical abortion in 88.9%, 80.3% and 87.3% of cases respectively (P = 0.18). The use of analgesics allowed a decrease of 3 points of the NRS in the 3 groups (P = 0.67). Patients were more painful in case of medical protocol vs. surgical (maximum pain at 6.0 ± 2.6 vs. 1.4 ± 2.0, P < 0.01), but declared to be relieved by analgesics in 85.1 and 94.3% of cases (P = 0.24). As pain is similar whatever the term in the case of medical abortion, and its management by analgesics seems to be effective, this criterion should not guide the professional in the choice of method, particularly between 9 and 14 weeks. This choice must be made by the patient.

Guidelines for adequate gestational weight gain were proposed in 2009 by the Institute of Medicine. In case of a BMI > 30 kg/m2, the recommended gestational weight gain should be between 5 and 9 kg. However, these recommendations do not distinguish between different grades of obesity. Recent data suggest that the IOM recommendations are not restrictive enough for obese pregnant women and should be adapted to the grade of obesity.& COPY; 2022 Elsevier Masson SAS. All rights reserved.