			Home About us Contact

EPIPAGE Study (epipage + study)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Previous induced abortions and the risk of very preterm delivery: results of the EPIPAGE study

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2005
Caroline Moreau
Objectives To evaluate the risk of very preterm birth (22,32 weeks of gestation) associated with previous induced abortion according to the complications leading to very preterm delivery in singletons. Design Multicentre, case-control study (the French EPIPAGE study). Setting Regionally defined population of births in France. Sample The sample consisted of 1943 very preterm live-born singletons (<33 weeks of gestation), 276 moderate preterm live-born singletons (33,34 weeks) and 618 unmatched full-term controls (39,40 weeks). Methods Data from the EPIPAGE study were analysed using polytomous logistic regression models to control for social and demographic characteristics, lifestyle habits during pregnancy and obstetric history. The main mechanisms of preterm delivery were classified as gestational hypertension, antepartum haemorrhage, fetal growth restriction, premature rupture of membranes, idiopathic preterm labor and other causes. Main outcome measures Odds ratios for very preterm birth by gestational age and by pregnancy complications leading to preterm delivery associated with a history of induced abortion. Results Women with a history of induced abortion were at higher risk of very preterm delivery than those with no such history (OR + 1.5, 95% CI 1.1,2.0); the risk was even higher for extremely preterm deliveries (<28 weeks). The association between previous induced abortion and very preterm delivery varied according to the main complications leading to very preterm delivery. A history of induced abortion was associated with an increased risk of premature rupture of the membranes, antepartum haemorrhage (not in association with hypertension) and idiopathic spontaneous preterm labour that occur at very small gestational ages (<28 weeks). Conversely, no association was found between induced abortion and very preterm delivery due to hypertension. Conclusion Previous induced abortion was associated with an increased risk of very preterm delivery. The strength of the association increased with decreasing gestational age. [source]

In-hospital mortality of newborn infants born before 33 weeks of gestation depends on the initial level of neonatal care: the EPIPAGE study

ACTA PAEDIATRICA, Issue 3 2003
JP Empana
Aim: To determine the relation between the level of initial neonatal care and in-hospital mortality of infants born before 33 wk of gestation in the era of surfactant therapy. Methods: A 1 y prospective population-based survey was conducted in the north of France, as part of the EPIPAGE (Epidemiologie des Petits Ages Gestationnels) survey. Perinatal data were recorded for 585 very premature newborns transferred to a neonatal intensive care unit in 1997. The relation between the level of the neonatal unit that provided care for the first consecutive 48 h and in-hospital mortality was assessed by multivariate logistic regression, and adjusted for perinatal data and initial disease severity, estimated by the Clinical Risk Index for Babies (CRIB). Results: The average gestational age (mean ± SD) was 31.6 ± 0.62 wk in level I, 30.7 ± 0.21 in level II, 29.9 ± 0.13 in non-teaching level III, and 29.0 ± 0.15 in the level III teaching unit (p < 0.0001). The mean in-hospital mortality rate was 8.4% and did not differ by level of care (ptrend= 0.17). After adjustment for perinatal data and CRIB, however, with the teaching unit as the reference, the risk of death was significantly higher in level I,II units [adjusted odds ratio (ORa) = 7.9, 95% confidence interval (95% CI) 2.2,29.1], but not in the non-teaching level III units (ORa = 0.8, 95% CI 0.3,2.1). Conclusion: In-hospital mortality in non-teaching level III units was similar to that in a teaching unit, but significantly higher in level I-level II units. Neonatal care of newborns delivered before 33 wk of gestation should initially occur in level III units. [source]

The complex relationship between smoking in pregnancy and very preterm delivery

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2004
Results of the Epipage study
Objective To assess the relationship between cigarette smoking during pregnancy and very preterm births, according to the main mechanisms of preterm birth. Design Case,control study (the French Epipage study). Setting Regionally defined population of births in France. Population Eight hundred and sixty-four very preterm live-born singletons (between 27 and 32 completed weeks of gestation) and 567 unmatched full-term controls. Methods Data from the French Epipage study were analysed using a polytomous logistic regression model to control for social and demographic characteristics, pre-pregnancy body mass index and obstetric history. The main mechanisms of preterm delivery were classified as gestational hypertension, antepartum haemorrhage, premature rupture of membranes, spontaneous preterm labour and other miscellaneous mechanisms. Main outcome measures Odds ratios for very preterm birth for low to moderate (1,9 cigarettes/day) and heavy (,10 cigarettes/day) maternal smoking in pregnancy, estimated according to the main mechanisms leading to preterm birth. Results Smokers were more likely to give birth to very preterm infants than non-smokers [adjusted odds ratio (aOR) 1.7, 95% confidence interval (CI) 1.3,2.2]. Heavy smoking significantly reduced the risk of very preterm birth due to gestational hypertension (aOR 0.5, 95% CI 0.3,1.0), whereas both low to moderate and heavy smoking increased the risk of very preterm birth due to all other mechanisms (aOR between 1.6 and 2.8). Conclusion These data from the Epipage study show that maternal smoking during pregnancy is a risk factor for very preterm birth. The impact of maternal smoking on very preterm birth appears to be complex: it lowers the risk of very preterm birth due to gestational hypertension, but increases the risk of very preterm birth due to other mechanisms. These findings might explain why maternal smoking is more closely related to preterm birth among multiparous women than among nulliparous women. [source]