Les nouvelles grossesses

Collection questions – Presses Universitaires de France

Pr Jean-Claude PONS, 1998

Sujets :
– Grossesse à haut risque
– Procréation médicalement assistée
– Grossesse
– Techniques reproduction
– Législation médicale — France
– Bioéthique — France
– bioéthique — désir d’enfant — foetus — grossesse
– Aspect physiologique
– Aspect psychologique
– Femme enceinte
– Hygiène
– Santé

Le Distilbène DES, en savoir plus

L’impossible enfant

Don d’ovocytes, l’envers du décor

Géraldine Jumel-Lhomme relate cinq années d’odyssée dans l’univers segmenté et méconnu de l’assistance médicale à la procréation où médecine et business s’entremêlent dans un brouillage croissant de repères, de valeurs. Elle présente de l’intérieur le vécu tourmenté de son couple diagnostiqué infertile, elle-même ayant été exposée in utero au Distilbène. La rigidité de la loi française de bioéthique les a conduits à franchir les frontières afin de se soumettre à des fiv avec don d’ovocytes dans des cliniques étrangères. L’auteur décrit ces pratiques souvent lourdes et maltraitantes, décrypte certains tabous et démonte les principaux avatars de cette situation. Elle propose des pistes de réflexion, des éclairages nouveaux sur des sujets qui interpellent notre société.

Contrepoints par Marie Darrieusecq, Geneviève Delaisi de Parceval, Sylvie Epelboin, Marie-José Soubieux.

“Même ceux qui sont familiers des parcours d’enfant à tout prix seront surpris, émus par la lecture de ce livre. Encore davantage évidemment ceux qui ne connaissent de l’amp que ses succès largement déployés dans les médias.”
Geneviève Delaisi de Parseval

“Personne ne peut sortir indemne d’un parcours de maternité aussi terrifiant que celui emprunté par Géraldine Jumel-Lhomme. Personne ne peut sortir indemne de la lecture de son livre !”
Marie-José Soubieux

“Ce que raconte Géraldine Jumel-Lhomme est très personnel, mais aussi caractéristique. C’est d’ailleurs une des forces de son témoignage, que de nouer l’intime (le très intime, le fond du ventre) à l’exemplarité.”
Marie Darrieusecq

Le Distilbène DES, en savoir plus

Le bonheur d’être mère

Pr Michel Tournaire – 2005 – Editions Odile Jacob

Aujourd’hui, les femmes sont de plus en plus nombreuses à travailler et à décider de faire un enfant plus tard. Les grossesses après 35 ans sont-elles particulières ? Comment mettre toutes les chances de son côté pour vivre une grossesse réussie ? Comment éviter les risques ? Les progrès de la médecine permet-tent désormais à ces grossesses de se dérouler presque comme toutes les autres, à condition d’être bien suivie. Le professeur Michel Tournaire vous guide pas à pas, depuis votre désir de maternité jusqu’à la naissance, et vous conseille au quotidien pour une grossesse épanouie.

Sommaire

  • CE QU’IL FAUT SAVOIR AVANT VOTRE GROSSESSE
  • Une grossesse après 35 ans
  • Faites le point sur votre santé et votre mode de vie
  • Mettez toutes les chances de votre côté pour être enceinte
  • BIEN VIVRE VOTRE GROSSESSE
  • Les trois premiers mois
  • Du quatrième au sixième mois
  • Les trois derniers mois
  • La naissance et les premières semaines de votre bébé
  • QUELLES SONT LES DIFFICULTES POSSIBLES ?
  • Et si la grossesse ne vient pas ?
  • Quelles sont les complications possibles de la grossesse et de l’accouchement ?

Michel Tournaire, professeur de gynécologie et d’obstétrique, expert Distilbène DES, est chef de service de la maternité de l’hôpital Saint-Vincent-de-Paul à Paris.

Le Distilbène DES, en savoir plus

Traité de Gynécologie

Le chapitre 50 traite du DES et pathologie gynécologique

Le chapitre 50 traite du DES et pathologie gynécologique.

Pr Hervé FERNANDEZ – 2004 – Editions Flammarion – Collection “Médecines-Sciences”.

Ce traité, à la fois moderne et pratique, couvre en 60 chapitres toute la gynécologie. Après une première partie de rappels physiologiques, la seconde partie est consacrée aux explorations en gynécologie, depuis l’échographie pelvienne et l’examen des frottis, jusqu’aux dosages hormonaux, à l’hystéroscopie et à la mammographie. La troisième partie, très originale, aborde des problèmes de santé publique. Puis, l’ouvrage traite des principaux symptômes et syndromes observés en gynécologie : l’aménorrhée, les métrorragies, les dyspareunies, etc. Sont ensuite abordés les troubles de la fonction ovarienne et la stérilité conjugale. La quatrième partie du traité expose de façon détaillée toutes les autres pathologies organiques, depuis le fibrome utérin jusqu’à la pathologie vulvaire, en passant par les cancers de l’endomètre, les tumeurs ovariennes, les malformations de l’appareil génital, etc. Dans tous les cas, les auteurs traitent des symptômes, des données de l’examen clinique, des stratégies diagnostiques les mieux adaptées, des indications thérapeutiques et des orientations pronostiques. La contraception, l’IVG, les violences sexuelles, les dysfonctions sexuelles font l’objet de chapitres spécifiques. Enfin est abordée la pathologie mammaire sous tous ses aspects.

Le chapitre 50 traite du DES et pathologie gynécologique.

Le Distilbène DES, en savoir plus

 

Pour que l’enfant paraisse

Comprendre et combatre la stérilité

Dr Anne CABAU – 1991 – Editions Flammarion – Collection Santé Mode d’Emploi

Un chapitre consacré au Distilbène explique que les filles DES ont certes du mal à être enceintes et à mener des grossesses mais que ce n’est pas impossible.

“Pourtant au printemps 1992, une nouvelle grossesse se solda encore par une fausse couche. Dans ces cas-là, on n’a pas le chox : on encaisse ! “

Le Distilbène DES, en savoir plus

 

Valproate should have a restricted licence for prescribing only by nominated prescribers and on a named patient basis

Weighing the risks of valproate in women who could become pregnant

A baby in utero looking out and seeing his/her mother taking valproate is a scenario not to be contemplated. It could be equated to someone being forced to take poison against their will. The result is almost certainly organ damage including brain damage. Beautiful healthy babies forced to ingest poison against their will and ending up with lifelong disability. In cold stark terms this is what is being discussed. A class action by such affected individuals once born and once endowed with human rights and protection, would certainly sober up the situation and rein in any distracted prescribing practices.

This graphic way of reasoning does not take into account the mother’s illness and need for safe treatment, nor the prescribing doctor’s dilemma with imperfect treatments and unpredictable risks to the mother either from epilepsy or bipolar illness. However it is outrageous that thousands of women in Europe and USA are inadvertently taking valproate without knowing what the risks are. A “named patient only” regime by designated prescribers only, may be a safer way to go.
Large court settlements have been awarded to “valproate babies” and it is a sad day for mother and child to have to come to this end, instead of what should and maybe could have been a much happier day (healthy baby and mother). Inevitably due to human error accidents will happen, but what is truly insupportable is that young women and their babies wake up to a sad situation and say “but no body told us.

Babies in utero are human beings, and at present in most jurisdictions their human rights are put on hold until they reach their majority – birth. How would anyone feel about being disabled for life because they were helplessly poisoned while awaiting their inheritance? The same could be said of foetal alcohol people who were poisoned in utero. A class action by those negligently harmed by valproate or any toxin in utero would focus medical and pharmacological opinion on what safeguards need to be in place. Valproate should have a restricted licence for prescribing only by nominated prescribers and on a named patient basis.

Eugene G Breen‘s response to : “Despite international consensus on the harmful effects of valproate during pregnancy, women should not be denied the human right to make their own decisions after fully informed discussion, say Heather Angus-Leppan and Rebecca Liu
Physician/Psychiatrist
62/63 Eccles St Dublin 7, Ireland

Parents’ Preconception Well-Being Affects Child’s Future Health

A series of three articles, published online April 16 in the Lancet, shine a light on this critical period

Medscape Medical News reviewed emerging evidence showing that preconception health of the mother- and father-to-be — especially their diet and weight — affects fertilization, embryo development, and even their child’s risk of future cardiometabolic disease.

Health and nutrition of both men and women before conception is important not only for pregnancy outcomes but also for the lifelong health of their children and even the next generation. The preconception period can be seen in three different ways: from a biological standpoint as the days and weeks before embryo development; from the individual perspective as the time of wanting to conceive; and through a population lens as any time a women is of childbearing age. This Series of three papers highlights the importance and summarises the evidence of preconception health for future health and suggests context-specific interventions. It also calls for a social movement to achieve political engagement for health in this particular phase in life.

Before the beginning : nutrition and lifestyle in the preconception period and its importance for future health

Summary

A woman who is healthy at the time of conception is more likely to have a successful pregnancy and a healthy child. We reviewed published evidence and present new data from low-income, middle-income, and high-income countries on the timing and importance of preconception health for subsequent maternal and child health. We describe the extent to which pregnancy is planned, and whether planning is linked to preconception health behaviours. Observational studies show strong links between health before pregnancy and maternal and child health outcomes, with consequences that can extend across generations, but awareness of these links is not widespread. Poor nutrition and obesity are rife among women of reproductive age, and differences between high-income and low-income countries have become less distinct, with typical diets falling far short of nutritional recommendations in both settings and especially among adolescents. Several studies show that micronutrient supplementation starting in pregnancy can correct important maternal nutrient deficiencies, but effects on child health outcomes are disappointing. Other interventions to improve diet during pregnancy have had little effect on maternal and newborn health outcomes. Comparatively few interventions have been made for preconception diet and lifestyle. Improvements in the measurement of pregnancy planning have quantified the degree of pregnancy planning and suggest that it is more common than previously recognised. Planning for pregnancy is associated with a mixed pattern of health behaviours before conception. We propose novel definitions of the preconception period relating to embryo development and actions at individual or population level. A sharper focus on intervention before conception is needed to improve maternal and child health and reduce the growing burden of non-communicable diseases. Alongside continued efforts to reduce smoking, alcohol consumption, and obesity in the population, we call for heightened awareness of preconception health, particularly regarding diet and nutrition. Importantly, health professionals should be alerted to ways of identifying women who are planning a pregnancy.

Reference

Origins of lifetime health around the time of conception: causes and consequences

Summary

Parental environmental factors, including diet, body composition, metabolism, and stress, affect the health and chronic disease risk of people throughout their lives, as captured in the Developmental Origins of Health and Disease concept. Research across the epidemiological, clinical, and basic science fields has identified the period around conception as being crucial for the processes mediating parental influences on the health of the next generation. During this time, from the maturation of gametes through to early embryonic development, parental lifestyle can adversely influence long-term risks of offspring cardiovascular, metabolic, immune, and neurological morbidities, often termed developmental programming. We review periconceptional induction of disease risk from four broad exposures: maternal overnutrition and obesity; maternal undernutrition; related paternal factors; and the use of assisted reproductive treatment. Studies in both humans and animal models have demonstrated the underlying biological mechanisms, including epigenetic, cellular, physiological, and metabolic processes. We also present a meta-analysis of mouse paternal and maternal protein undernutrition that suggests distinct parental periconceptional contributions to postnatal outcomes. We propose that the evidence for periconceptional effects on lifetime health is now so compelling that it calls for new guidance on parental preparation for pregnancy, beginning before conception, to protect the health of offspring.

Reference

Intervention strategies to improve nutrition and health behaviours before conception

Summary

The nutritional status of both women and men before conception has profound implications for the growth, development, and long-term health of their offspring. Evidence of the effectiveness of preconception interventions for improving outcomes for mothers and babies is scarce. However, given the large potential health return, and relatively low costs and risk of harm, research into potential interventions is warranted. We identified three promising strategies for intervention that are likely to be scalable and have positive effects on a range of health outcomes: supplementation and fortification; cash transfers and incentives; and behaviour change interventions. On the basis of these strategies, we suggest a model specifying pathways to effect. Pathways are incorporated into a life-course framework using individual motivation and receptiveness at different preconception action phases, to guide design and targeting of preconception interventions. Interventions for individuals not planning immediate pregnancy take advantage of settings and implementation platforms outside the maternal and child health arena, since this group is unlikely to be engaged with maternal health services. Interventions to improve women’s nutritional status and health behaviours at all preconception action phases should consider social and environmental determinants, to avoid exacerbating health and gender inequalities, and be underpinned by a social movement that touches the whole population. We propose a dual strategy that targets specific groups actively planning a pregnancy, while improving the health of the population more broadly. Modern marketing techniques could be used to promote a social movement based on an emotional and symbolic connection between improved preconception maternal health and nutrition, and offspring health. We suggest that speedy and scalable benefits to public health might be achieved through strategic engagement with the private sector. Political theory supports the development of an advocacy coalition of groups interested in preconception health, to harness the political will and leadership necessary to turn high-level policy into effective coordinated action.

Reference

Global Exposure to Air Pollution and its Disease Burden : SOGA 2018 Report

Over 95% of world’s population breathe dangerous air, study finds

More than 95% of the world’s population breathe unsafe air and the burden is falling hardest on the poorest communities, with the gap between the most polluted and least polluted countries rising rapidly, a comprehensive study of global air pollution has found.

More Information

  • State of global air 2018, stateofglobalair.
  • Over 95% of world’s population breathe dangerous air, study finds, euractiv, 17 Apr 2018.

Urban outdoor air pollution is a serious threat to healthy brain development which may set the conditions for neurodegenerative diseases

Severe Urban Outdoor Air Pollution and Children’s Structural and Functional Brain Development, From Evidence to Precautionary Strategic Action

According to the latest estimates, about 2 billion children around the world are exposed to severe urban outdoor air pollution. Transdisciplinary, multi-method findings from epidemiology, developmental neuroscience, psychology, and pediatrics, show detrimental outcomes associated with pre- and postnatal exposure are found at all ages. Affected brain-related functions include perceptual and sensory information processing, intellectual and cognitive development, memory and executive functions, emotion and self-regulation, and academic achievement. Correspondingly, with the breakdown of natural barriers against entry and translocation of toxic particles in the brain, the most common structural changes are responses promoting neuroinflammation and indicating early neurodegenerative processes. In spite of the gaps in current scientific knowledge and the challenges posed by non-scientific issues that influence policy, the evidence invites the conclusion that urban outdoor air pollution is a serious threat to healthy brain development which may set the conditions for neurodegenerative diseases. Such evidence supports the perspective that urgent strategic precautionary actions, minimizing exposure and attenuating its effects, are needed to protect children and their brain development.

… continue reading Severe Urban Outdoor Air Pollution and Children’s Structural and Functional Brain Development, From Evidence to Precautionary Strategic Action on Frontiers in Public Health, April 2018.

Featured image credit Bon Bahar.

Prevalence of migraines in adolescents with endometriosis

Cross-sectional study conducted within The Women’s Health Study: From Adolescence to Adulthood—an ongoing longitudinal cohort

Prenatal exposure to estrogenic substances (such as DES) and environmental toxins (such as bisphenols) may increase the incidence of endometriosis in female offspring

2018 Study Abstract

Objective
To determine the prevalence and experience of migraines in adolescents with surgically confirmed endometriosis compared with those without endometriosis.

Design
Cross-sectional study conducted within The Women’s Health Study: From Adolescence to Adulthood—an ongoing longitudinal cohort.

Setting
Boston Center for Endometriosis.

Patient(s)
Adolescent females enrolled November 2012 through November 2016. The case group included adolescents surgically diagnosed with endometriosis. The control group included adolescents without endometriosis, recruited from the local community and clinics.

Intervention(s)
Not available.

Main Outcome Measure(s)
An extensive online health questionnaire regarding medical history, lifestyle, medication use, anthropometrics, and symptom experience and treatments. Migraine diagnosis was self-reported. Migraine pain and noncyclic pelvic pain severity were rated using an 11-point numerical rating scale. Cyclic pelvic pain was categorized.

Result(s)
Adolescents with endometriosis were more likely to experience migraines (69.3%) than those without endometriosis (30.7%) (multivariable odds ratio = 4.77, 95% confidence interval 2.53, 9.02). For each 1-point increase in the migraine numerical rating scale, the odds of endometriosis increased by 22% (multivariable odds ratio = 1.22, 95% confidence interval 1.03, 1.44; Ptrend = .02). Among those with endometriosis, age of menarche was associated inversely with the odds of migraines. Participants with endometriosis and migraines have more dysmenorrhea than those without migraines.

Conclusion(s)
Adolescents with endometriosis are more likely to experience migraines than adolescents without endometriosis. A linear relationship exists between migraine pain severity and the odds of endometriosis, suggesting heightened pain sensitivity for adolescents with endometriosis. Due to the strong correlation, patients who present with either condition should be screened for comorbidity to maximize the benefits of care.