Aline Bohet

Maternal Personal Exposure to Airborne Benzene and Intrauterine Growth

Background Studies relying on outdoor pollutants measures have reported associations between air pollutants and birth weight. Objective Our aim was to assess the relation between maternal personal exposure to airborne benzene during pregnancy and fetal growth. Methods We recruited pregnant women in two French maternity hospitals in 2005–2006 as part of the EDEN mother–child cohort. A subsample of 271 nonsmoking women carried a diffusive air sampler for a week during the 27th gestational week, allowing assessment of benzene exposure. We estimated head circumference of the offspring by ultrasound measurements during the second and third trimesters of pregnancy and at birth. Results Median benzene exposure was 1.8 μg/m3 (5th, 95th percentiles, 0.5, 7.5 μg/m3). Log-transformed benzene exposure was associated with a gestational age–adjusted decrease of 68 g in mean birth weight [95% confidence interval (CI), −135 to −1 g] and of 1.9 mm in mean head circumference at birth (95% CI, −3.8 to 0.0 mm). It was associated with an adjusted decrease of 1.9 mm in head circumference assessed during the third trimester (95% CI, −4.0 to 0.3 mm) and of 1.5 mm in head circumference assessed at the end of the second trimester of pregnancy (95% CI, −3.1 to 0 mm). Conclusions Our prospective study among pregnant women is one of the first to rely on personal monitoring of exposure; a limitation is that exposure was assessed during 1 week only. Maternal benzene exposure was associated with decreases in birth weight and head circumference during pregnancy and at birth. This association could be attributable to benzene and a mixture of associated traffic-related air pollutants.

Maternal exposure to nitrogen dioxide during pregnancy and offspring birth weight: comparison of two exposure models.

Background Studies of the effects of air pollutants on birth weight often assess exposure with networks of permanent air quality monitoring stations (AQMSs), which have a poor spatial resolution. Objective We aimed to compare the exposure model based on the nearest AQMS and a temporally adjusted geostatistical (TAG) model with a finer spatial resolution, for use in pregnancy studies. Methods The AQMS and TAG exposure models were implemented in two areas surrounding medium-size cities in which 776 pregnant women were followed as part of the EDEN mother–child cohort. The exposure models were compared in terms of estimated nitrogen dioxide (NO2) levels and of their association with birth weight. Results The correlations between the two estimates of exposure during the first trimester of pregnancy were r = 0.67, 0.70, and 0.83 for women living within 5, 2, and 1 km of an AQMS, respectively. Exposure patterns displayed greater spatial than temporal variations. Exposure during the first trimester of pregnancy was most strongly associated with birth weight for women living < 2 km away from an AQMS: a 10-μg/m3 increase in NO2 exposure was associated with an adjusted difference in birth weight of −37 g [95% confidence interval (CI), −75 to 1 g] for the nearest-AQMS model and of −51 g (95% CI, −128 to 26 g) for the TAG model. The association was less strong (higher p-value) for women living within 5 or 1 km of an AQMS. Conclusions The two exposure models tended to give consistent results in terms of association with birth weight, despite the moderate concordance between exposure estimates.

Trends and determinants of use of long-acting reversible contraception use among young women in France: results from three national surveys conducted between 2000 and 2010

OBJECTIVEnTo investigate trends and determinants in the use of long-acting reversible contraceptives (LARCs), including intrauterine devices and implants, over the last decade among young women in France.nnnDESIGNnData drawn from three cross-sectional national probability surveys.nnnSETTINGnNot applicable.nnnPATIENT(S)nA total of 1,204 women, ages 15 to 29, who are at potential risk of an unintended pregnancy in 2000; 1,921 in 2005; and 1,281 in 2010.nnnINTERVENTION(S)nNone.nnnMAIN OUTCOME MEASURE(S)nLogistic regression models were used to explore trends in LARC use since 2000 and to examine determinants of LARC use in 2010.nnnRESULT(S)nA minority of women were using LARC methods, with a significant increase between 2000 and 2010, from 4.6% to 6.4%. The odds of LARC use in 2010 were higher among women 20 to 29 years, parous women, women with a history of unintended pregnancy, women in difficult financial situations, smokers, and women in the care of a gynecologist.nnnCONCLUSION(S)nThis study shows that little progress has been made in LARC use among young women in France, despite these methods being widely available and reimbursed by the national health system.

IUD use in France: women's and physician's perspectives

OBJECTIVEnWhile the intra-uterine device (IUD) is the second most popular contraceptive method in France, its use remains low among women most at risk of unintended pregnancies. Acknowledging the conjoint role of women and physicians in contraceptive decision making, we investigate the determinants of IUD use and IUD recommendations from the user and prescriber perspectives.nnnSTUDY DESIGNnData are drawn from 2 national probability surveys (population-based and physician surveys) on sexual and reproductive health in France. The population based survey comprised 3,563 women ages 15-49 at risk of an unintended pregnancy in 2010 and the physician survey included 364 general practitioners (GPs) and 401 gynecologists practicing in private offices in 2010-2011. Analyses were performed using logistic regression models.nnnRESULTSnAltogether, 21.4% of women were IUD users, with substantial differences by age and parity. Less than 1% of young women (<25 years) and 3% of nulliparous were current IUD users in 2010. The odds of IUD use were four times higher in women followed by a gynecologist as compared to a GP. Mirroring these results, gynecologists were more likely to recommend IUDs than GPs. Misconception about IUD risks was widespread among women and providers. Medical training and information, professional practice settings, and ever use of IUDs also informed physicians likelihood of recommending IUDs, regardless of specialty.nnnCONCLUSIONSnThe study reveals the intersection of individual and professional influences on contraceptive use patterns. The considerable age discrepancy in IUD use in France, with very few young women most at risk of an unintended pregnancy using the method, reflects a knowledge gap shared by users and providers. These findings suggest there are significant opportunities to improve contraceptive care in France.nnnIMPLICATIONSnThis study stresses the need to inform women and doctors about the benefits and risks of IUDs for all women. Substantial efforts are required to improve the medical curriculum, in order to promote evidenced based family planning counseling and provide GPs with the technical skills to insert IUDs.

Estimates of unintended pregnancy rates over the last decade in France as a function of contraceptive behaviors.

OBJECTIVEnWe investigate trends in contraceptive behaviors in France and how they may have contributed to fluctuations in unintended pregnancy rates over time and across subgroups of the population between 2000 and 2010.nnnSTUDY DESIGNnData are drawn from three national surveys in France, comprising 4714 women ages 15 to 49 in 2000, 8613 in 2005 and 5260 in 2010. We used multinomial and simple logistic regression models to explore trends in contraceptive behaviors over time. We estimated trends in unintended pregnancy rates in relation to population shifts in contraceptive behaviors between 2000 and 2010.nnnRESULTSnA third of women were not using contraception at the time of the surveys. However, only 2.4% in 2000, 3.2% in 2005 and 2.4% in 2010 had an unmet need for contraception (p=.002). Among contraceptive users, user-dependent hormonal methods decreased from 59% in 2000 to 52% in 2010 (p<.0001), while long-acting reversible methods increased from 22% to 24% (p=.04). Changes in contraceptive behaviors resulted in fluctuations in unintended pregnancy rates estimated to have risen from 3.16% to 3.49% between 2000 and 2005, and to have decreased to 3.26% in 2010. Small changes in unmet need for contraception exerted the largest effects.nnnCONCLUSIONnThis study indicates that changes in contraceptive behaviors over the past decade in France have potentially resulted in significant fluctuations in unintended pregnancy rates. Our results also demonstrate that a simple algorithm combining contraceptive behaviors and typical-use failure rates may be an acceptable proxy for monitoring trends in unintended pregnancies.nnnIMPLICATIONSnThis study offers a framework towards assessing trends in unintended pregnancies, when data on abortions and unintended births are not available. In the context of high contraceptive coverage, gaps of use undermine efforts to improve contraceptive effectiveness, as small fluctuations in unmet need contribute significantly to trends in unintended pregnancy rates.

Sexual health in the French military: A multidimensional and gendered perspective

BackgroundSexual health in the military comprises a range of concerns including sexually transmitted infections (STI), unintended pregnancy, sexual violence and sexual dysfunction. This study aims to estimate the prevalence of sexual health concerns by gender in the French military and compare these prevalences to estimates in the general population.MethodsCOSEMIL, the first sexual health survey in the French military comprises a probability sample of 1500 military personnel. Chi-square tests were used to compare lifetime abortion, STIs and sexual assault, and recent sexual dysfunction and sexual satisfaction by gender and explore the association between these indicators and current sexual risk (condom use at last intercourse).ResultsWomen were more likely than men to declare negative sexual health outcomes, with the greatest difference related to sexual assault (24.3% versus 5.1% of males, pu2009<u20090.001) and sexual dysfunction hindering sexuality (15.2% of females versus 5.3% of males, pu2009<u20090.001). Women were also twice as likely to report ever having an STI (6.7% versus 3.4%, pu2009=u20090.03). Comparison with the French general population indicates lower percentages of STIs among military men (2.9% versus 4.9%) and higher percentages of abortion (17.6% versus 14.3%) forced sex (10.6% versus 7.4%) and sexual dysfunction (14.2% versus 9.3%) among military women.ConclusionThese results highlight gendered pattern of sexual health in the French military with women suffering greater sexual risks than men. Military health services should include women’s health services to address the sexual and reproductive health gender gap.