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Background The Baby-Friendly Hospital Initiative (BFHI) is associated with improved breastfeeding outcomes in many high-income countries including the UK and the USA, but its effectiveness has never been evaluated in France. We investigated the impact of the BFHI on breastfeeding rates in French maternity units in 2010, 2016 and 2021 to assess if the BFHI aids to reduce inequalities in breastfeeding. Methods We examined breastfeeding in maternity units (exclusive, mixed and any breastfeeding) in mothers of singleton full-term newborns using the 2010 (n  = 13 075), 2016 (n  = 10 919) and 2021 (n  = 10 209) French National Perinatal Surveys. We used mixed-effect hierarchical multinomial regression models adjusting for neonatal, maternal, maternity unit and French administrative department characteristics, and tested certain interactions. Results The adjusted rate of exclusive breastfeeding was higher by +5.8 (3.4–8.1) points among mothers delivering in BFHI-accredited maternity units compared with those delivering in non-accredited units. When compared with average-weight newborns, this difference was sharper for infants with low birthweight: +14.9 (10.0–19.9) points when their birthweight was 2500 g. Mixed breastfeeding was lower by -1.7 points (-3.2–0) in BFHI-accredited hospitals, with no notable difference according to the neonatal or maternal characteristics. Conclusion Mothers delivering in BFHI-accredited maternity units had higher exclusive breastfeeding rates and lower mixed breastfeeding rates than those delivering in non-accredited maternity units. The positive impact of the BFHI was stronger among low-birthweight neonates, who are less often breastfed, helping reduce the gap for this vulnerable group while favouring mothers with higher education levels. [ABSTRACT FROM AUTHOR]

Introduction The prenatal leave law in France protects women during pregnancy and their employment. We aimed to estimate the proportion of women who worked late in their pregnancy, to analyze the occupational, social and medical factors associated with late prenatal leave and to compare the pregnancy outcome of these women and those who left earlier in the pregnancy. Methods The sample was extracted from the 2010 French National Perinatal Survey. All women who delivered within a 1-week period were interviewed before discharge from the maternity unit. Women with a singleton live birth at or after 37 weeks' gestation and who were working during pregnancy (n = 8463) were included. Data were collected on employment, date of leave, and sociodemographic and medical characteristics. Results Overall, 328 women (3.9 %) took a late prenatal leave (at or after 37 weeks' gestation). Women who left late were older than 30 years old, with a high educational level and were living in an urban area. Being self-employed and having a managerial or upper-intellectual occupation was highly associated with late leave, before and after controlling for relevant variables. Perinatal and delivery outcomes were similar for women who took a late leave and those who left before 37 weeks' gestation. Discussion Occupational characteristics are the main determinants of late prenatal leave. Women working in the last month of pregnancy had a favorable social and occupational situation and did not did not experience an adverse pregnancy or birth outcome. Other studies are needed to understand the reasons for late leave and evaluate the post-partum fatigue and health of these women., Author(s): Solène Vigoureux[sup.1] , Beatrice Blondel[sup.1] , Virginie Ringa[sup.2] [sup.3] , Marie-Josèphe Saurel-Cubizolles[sup.1] Author Affiliations: (1) INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPe), Center for Epidemiology [...]

Preterm delivery rates have remained consistently higher in the US than France, but the reasons for this excess remain poorly understood. We examined if differences in socio-demographic risk factors or more liberal use of obstetrical interventions contributed to higher rates in the US. Data on singleton live births in 1995, 1998 and 2003 from US birth certificates and the French National Perinatal Survey were used to analyze preterm delivery rate by maternal characteristics (age, parity, marital status, education, race (US)/nationality (France), prenatal care and smoking). We distinguished between preterm deliveries with a cesarean or a labor induction and those without these interventions. Unadjusted and adjusted risk ratios (RR) for the US compared to France were estimated using log-binomial regression. Preterm delivery rates were 7.9 % in the US and 4.7 % in France (risk ratio [RR] = 1.7, 95 % confidence interval [CI] 1.6-1.8). The US had more teen mothers and late entry to prenatal care, but fewer women smoked, although adjustment for these and other confounders did not reduce RR (1.8, 95 % CI 1.7-1.9). Preterm delivery rates associated with labor induction or cesarean were 3.3 % in the US and 2.1 % in France (RR 1.6, 95 % CI 1.5-1.7); the corresponding rates for preterm delivery without these interventions were 4.5 and 2.5 % (RR 1.8, 95 % CI 1.7-1.9), respectively. Key socio-demographic risk factors and more obstetric intervention do not explain higher US preterm delivery rates. Avenues for future research include the impact of universal access to health services (universal health insurance?) on health care quality and the association between more generous social policies, stress and the risks of preterm delivery., Author(s): Jennifer Zeitlin[sup.1] [sup.2] , Beatrice Blondel[sup.1] , Cande V. Ananth[sup.3] [sup.4] Author Affiliations: (1) Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epope), INSERM, Center for Epidemiology and Statistics Sorbonne [...]

Socio-demographic characteristics of mothers have been associated with exclusive breastfeeding duration, but little is known about the association with maternal full- and part-time employment and return to work in European countries. To study the associations between breastfeeding, any and almost exclusive (infants receiving breast milk as their only milk) breastfeeding, at 4 months of infant's age and the socio-demographic and occupational characteristics of mothers. We used the EDEN mother-child cohort, a prospective study of 2002 singleton pregnant women in two French university hospitals. We selected all mothers (n = 1,339) who were breastfeeding at discharge from the maternity unit. Data on feeding practices were collected at the maternity unit and by postal questionnaires at 4, 8 and 12 months after the birth. Among infants breastfed at discharge, 93 % were still receiving any breastfeeding (83 % almost exclusive breastfeeding) at the 3rd completed week of life, 78 % (63 %) at the 1st completed month, and 42 % (20 %) at the 4th completed month. Time of return to work was a major predictor for stopping breastfeeding: the sooner the mothers returned to work, the less they breastfed their babies at 4 months of infant's age, independently of full-time or part-time employment. The association was stronger for almost exclusive breastfeeding mothers than for any breastfeeding ones. In a society where breastfeeding is not the norm, women may have difficulties combining work and breastfeeding. Specific actions need to be developed and assessed among mothers who return to work and among employers. Keywords Breastfeeding duration * Employment * Socioeconomic status * France, Background Breastfeeding has been shown to have short- and long-term beneficial effects on infant health and it is widely recognised as the optimal infant feeding method. The World Health Organization [...]

Objectives. We assessed socioeconomic differences in probabilities of prenatal diagnoses of Down syndrome and continuation of pregnancies after such diagnoses, along with the effects of these differences on disparities in live-birth prevalences of Down syndrome. Methods. Using population-based data derived from 1433 cases of Down syndrome and 3731 control births, we assessed age-adjusted effects of maternal occupation and geographic origin on prenatal diagnoses, as well as overall and live-birth odds, of Down syndrome. Results. Maternal occupation and geographic origin had significant effects on the probability of a prenatal diagnosis of Down syndrome and on continuation of pregnancy after such a diagnosis. Women in lower-status occupational categories had higher odds of delivering a live-born infant with Down syndrome. In comparison with women in the highest-status occupational category, the age-adjusted odds ratio for a Down syndrome live birth among women without an occupation was 2.4 (95% confidence interval [CI] = 1.7, 3.3). By contrast, there were no disparities in age-adjusted overall likelihood of Down syndrome. Conclusions. Socioeconomic differences in use of prenatal testing have created disparities in the live-birth prevalence of Down syndrome. Overall Down syndrome risk does not vary according to socioeconomic status.

OBJECTIVE. Perinatal regionalization has been organized into 3 ascending levels of care, fitting increasing degrees of pathology. Current recommendations specify that very premature infants be referred prenatally to level III facilities, yet not all very preterm neonates require level III intensive care. The objective of our study was to determine the antenatal factors that, in association with gestational age, predict the need for neonatal intensive care in preterm infants, to match the size of birth with the level of care required. METHODS. Data were analyzed from a cohort of very preterm infants born in nine French regions in 1997. We defined the need for neonatal intensive care as follows: (1) the requirement for specialized management (mechanical ventilation for >48 hours, high frequency oscillation, or inhaled nitric oxide) or (2) poor outcome (transfer to a level III facility within the first 2 days of life or early neonatal death). Triplet pregnancies and pregnancies marked by fetal malformations or intensive care requirements for the mother before delivery were excluded. RESULTS. We focused our study on 1262 neonates aged 30, 31 and 32 weeks' gestation, where the need for intensive care was 42.8%, 33.2%, and 22.8%, respectively. Multivariate analysis showed that the risk factors for intensive care requirement with low gestational age were twin pregnancies, maternal hypertension, antepartum hemorrhage, infection, and male gender. Antenatal steroid therapy and premature rupture of membranes were protective factors against intensive care requirement. CONCLUSION. Infants www.pediatrics.org/cgi/doi/10.1542/peds.2005-2149 doi:10.1542/peds.2005-2149 Key Words perinatal regionalization, NICUs, in utero transfer, very preterm, cohort study Abbreviations GA--gestational age NIC--neonatal intensive care IUGR--intrauterine growth restriction OR--odds ratio CI-- confidence interval, PROVIDING ADEQUATE CARE to preterm neonates is an important issue for perinatal medicine. The incidence of preterm deliveries has increased in all developed countries with quite similar trends. (1) In [...]

Objectives. We sought to evaluate socioeconomic disparities in serum screening for Down syndrome and assess whether such disparities are more likely to reflect limits in access or information or, rather, informed decisionmaking. Methods. A nationally representative sample of 12869 French women completed interviews after giving birth. Results. We found substantial disparities in the likelihood of (1) women not being offered screening, (2) screening not being offered as a result of late prenatal care, and (3) women not knowing whether or not they had undergone screening. Except in the case of nationality, there was essentially no evidence of differences in refusal of testing. Conclusions. Rather than representing informed decisionmaking, socioeconomic disparities in screening for Down syndrome are mostly due to limits in access or to information. (Ant J Public Health. 2004:94:484-491)

Objectives. We studied the effects of twins and triplets on perinatal health indicators in the overall population in the 1980s and 1990s in Canada, England and Wales, France, and the United States. Methods. Data were derived mostly from live birth registration. We used rates, relative risks, and population attributable risks for twins and triplets separately. Results. In each country, the increase in multiple births, and the increase in preterm delivery among multiple births, contributed almost equally to the rise in or stabilization of the overall rates of preterm delivery. Twins contributed a much larger proportion of the preterm deliveries and tow-birthweight newborns than did triplets. Conclusions. Twins have a major population-based impact on the trends of perinatal health indicators.

Objectives. We sought to describe prenatal care use in the United States and in three European countries where accessibility to prenatal care has been reported to be better than it is in the United States. Methods. We analyzed the 1980 US National Natality Survey, the 1981 French National Natality Survey, a 1979 sample of Danish births, and a survey performed from 1979 to 1980 in one Belgian province. Results. The proportion of women who began prenatal care late (after 15 weeks) is highest in the United States (21.2%) and lowest in France (4.0%). This contrasts with the median number of visits, which is greater in the United States (11) than in Denmark (10) or in France (7). Across all maternal ages, parities, and educational levels, late initiation of prenatal care is more frequent in the United States, and median number of visits in the United States is equal to or higher than that in the other countries. Conclusions. In countries that offer nearly universal access to prenatal care, women begin care earlier during pregnancy and have fewer visits than women in the United States. (Am J Public Health. 1993;83:31-36), Women in the US are more likely to begin prenatal care late or to receive no care at all than women in three European countries where there is almost universal access to health care. The percentage of women who began prenatal care after 15 weeks of pregnancy was 21.2% in the US, 13.2% in Belgium, 7.8% in Denmark and 4.0% in France. Overall, the proportion of women who received no care was low in all four countries but was highest (1%) in the US. Even among white Americans, the percentage of women who began prenatal care late was greater than in the European countries. The average number of prenatal visits was also highest in the US, and there were more women with at least 13 visits in the US than in any other country. The number of visits within each country did not significantly differ according to socioeconomic group. These findings suggest that ensuring universal access to health care in the US could result in earlier prenatal care without leading to an increase in the number of visits.