Jacques Lepercq
University of Paris
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Publication
Featured researches published by Jacques Lepercq.
American Journal of Obstetrics and Gynecology | 2009
Tatiana Radaelli; Jacques Lepercq; Ali Varastehpour; Subhabrata Basu; Patrick M. Catalano; Sylvie Hauguel-de Mouzon
OBJECTIVE Changes in metabolic homeostasis in pregnant diabetic women are potential determinants of increased adiposity of the fetus. The aim of this study was to characterize diabetes mellitus-induced changes in genes for fetoplacental energy metabolism in relation to fetal adiposity. STUDY DESIGN Placentas of women with type 1 diabetes mellitus, gestational diabetes mellitus (GDM), or no complications were analyzed by microarray profiling. The pattern of gene expression was assessed in primary placental cell cultures. RESULTS Diabetes mellitus was associated with 49 alterations in gene expression at key steps in placental energy metabolism, with 67% of the alterations related to lipid pathways and 9% of the alterations related to glucose pathways. Preferential activation of lipid genes was observed in pregnancy with GDM. Type 1 diabetes mellitus induced fewer lipid modifications but an enhancement of glycosylation and acylation pathways. Oleate enhanced expression of genes for fatty acid esterification and the formation of lipid droplets 3 times as much as glucose in cultured placental cells. CONCLUSION These results point to fatty acids as preferential lipogenic substrates for placental cells and suggest that genes for fetoplacental lipid metabolism are enhanced selectively in GDM. The recruited genes may be instrumental in increasing transplacental lipid fluxes and the delivery of lipid substrates for fetal use.
Gynecologic and Obstetric Investigation | 2003
Jacques Lepercq; Michèle Guerre-Millo; Jocelyne André; Michèle Caüzac; Sylvie Hauguel-de Mouzon
To investigate placental leptin production in placental insufficiency, placental leptin production was measured in women with severe preeclampsia (group 1) and in normotensive pregnancies associated with intrauterine growth restriction (group 2), compared to controls (group 3). Placental leptin content was increased 3-fold in group 1 compared to group 2 (192.5.1 ± 39.5 vs. 67.8 ± 10.6 ng/g) and 8-fold in group 1 compared to group 3 (192.5.1 ± 39.5 vs. 25.4 ± 6.9 ng/g). Placental leptin content was positively correlated with maternal leptin/BMI ratio (r = 0.62) and the resistance index of the umbilical artery (r = 0.60). These data demonstrate that placental insufficiency is associated with a dramatic increase in placental leptin production. This results in a rise in maternal leptinemia that may be taken as an early index of placental dysfunction.
Diabetes & Metabolism | 2012
E. Bismuth; C. Bouche; Jacques Lepercq; V. Lubin; D. Rouge; José Timsit; A. Vambergue
AIM The clinical guidelines reported by the French-Speaking Diabetes Society (Société francophone du diabète) include updated recommendations for preconceptual planning and care in the management of pregnancy in women with type 1 diabetes mellitus (T1DM). METHODS The working group included diabetologists, as well as an obstetrician, a nurse and a dietician. A review of the literature was performed using PubMed and Cochrane databases. Guidelines published by foreign diabetes societies were also consulted. RESULTS In women with T1DM, pregnancy increased the risks of hypoglycaemia, diabetic ketoacidosis, pregnancy-induced hypertension, infections and worsening of diabetic microvascular disease. Moreover, T1DM during pregnancy had an impact on the embryo and the fetus, and may have increased the risk of spontaneous miscarriages, malformations, premature births, and fetal and neonatal complications. However, intensive glycaemic control and preconceptual care have been shown to decrease the rate of fetal demise and malformations. Also, the use of insulin analogues during pregnancy is now regarded as safe. Tight glucose control and frequent follow-up are recommended throughout pregnancy in women with T1DM. Their obstetric management should take place in a maternity hospital with an appropriate perinatal environment and in close collaboration with diabetologists. CONCLUSION Pregnancy planning and adequate management during pregnancy are mandatory for improving the outcomes of women with T1DM.
Fetal Diagnosis and Therapy | 2003
Marie Helene Poissonnier; O. Picone; Yves Brossard; Jacques Lepercq
Objectives: To determine the perinatal outcome in severe red-cell fetomaternal alloimmunization. Methods: Retrospective series of 32 affected fetuses treated with intravenous fetal exchange transfusion (IFET) before 22 weeks of gestation. The main outcome measures were the degree of fetal anemia, fetal transfusions and perinatal outcome. Results: The first IFET was performed at 19.8 ± 1.8 weeks of gestation. All fetuses were severely anemic and hemoglobin levels were not different between 20 hydropic and 12 nonhydropic fetuses (4.1 ± 2.5 vs. 5.6 ± 2.8 g/dl, p = 0.33). The initial maternal anti-D level ranged from 4 to 76 µg/l and was not correlated to fetal anemia (r = –0.07). Conclusion: The overall perinatal survival rate was 78% compared to a previous perinatal loss rate excluding first pregnancies of 55.5%.
Fetal Diagnosis and Therapy | 1998
Jacques Lepercq; Sylvie Beaudoin; F. Bargy
To determine the incidence of urinary tract abnormalities detected in the presence of moderate fetal renal pelvis dilatation, we followed up pre- and postnatally 116 fetuses and children between 1985 and 1995. At prenatal ultrasound, 50 (43%) fetuses showed regressive dilatations, 57 (49%) a stable pattern, and 9 (8%) an evolutive pattern. In the presence of an evolutive dilatation, urinary tract obstruction was present in 8 cases. When a stable pattern was observed, i.e., a patent uropathy was present, surgical correction was performed in 27 of 53 (51%) cases. Regarding the postnatal evolution of 50 prenatal regressive moderate dilatations, we observed in 12 of 50 (24%) vesicoureteric reflux, of which 5 (10%) required surgical correction, and it is concluded that careful and extensive follow-up is mandatory.
Gynecologie Obstetrique & Fertilite | 2001
S Hauguel-de Mouzon; Jacques Lepercq
Resume La leptine, produit proteique du gene Ob , est synthetisee dans le placenta a des taux comparables a ceux de la cellule adipeuse. La leptine placentaire est liberee principalement dans la circulation maternelle ou sa concentration devient maximale au deuxieme trimestre de la grossesse pour decroitre en quelques heures apres la delivrance. Outre sa presence dans le placenta, la leptine est aussi detectee dans le plasma fœtal des 18 semaines d’amenorrhee. Chez le nouveau-ne, la leptinemie est positivement correlee au poids de naissance, ce qui suggere que l’adipocyte fœtal determine la leptinemie fœtale, sans exclure une participation placentaire. La production de leptine placentaire est accrue dans le choriocarcinome, la pre eclampsie et le diabete de type 1. Les estrogenes, le stress hypoxique et l’insuline sont les principaux facteurs susceptibles d’augmenter la production placentaire de leptine. La leptine liberee dans la circulation maternelle pourrait participer a la regulation de l’homeostasie energetique de la mere. La leptine placentaire peut agir localement en activant des voies de signalisation recrutees par des recepteurs placentaires specifiques. Le role de la leptine fœtale et les consequences de l’augmentation de la production placentaire de leptine dans certaines pathologies gravidiques sont a elucider.
Obstetrics & Gynecology | 2010
Jacques Lepercq; Jean Patrick Le Meaux; Antoine Agman; José Timsit
OBJECTIVE: To identify factors associated with cesarean delivery in nulliparous women with type 1 diabetes mellitus. METHODS: We performed a nested case-control study within a cohort of nulliparous women with type 1 diabetes mellitus. Independent factors and odds ratios were identified by logistic regression. RESULTS: Among 209 women, a cesarean delivery was performed without labor in 94 women (45%). Gestational weight gain higher than 15 kg (39% compared with 23%; odds ratio [OR], 2.2; 95% confidence interval [CI], 1.1–4.5) and suspected macrosomia (79% compared with 21%; OR, 13.1; 95% CI, 5.3–32.2) were independently associated with cesarean delivery without labor. Among 115 women who underwent a trial of labor, 54 (47%) had a cesarean delivery. Prepregnancy body mass index more than 25 kg/m2 (84% compared with 39%; OR, 7.5; 95% CI, 1.9–29.4) and Bishop score 3 or lower (66% compared with 25%; OR, 5.9; 95% CI, 2.2–16.1) were independently associated with cesarean delivery in labor. Preconception care, presence of a nephropathy, hemoglobin A1C levels during pregnancy, preeclampsia, and preterm delivery were not associated with cesarean delivery. The rates of wound infection and endometritis were 0.7% and 3%, respectively. CONCLUSION: The rate of cesarean delivery in nulliparous women with type 1 diabetes mellitus is very high. Prepregnancy body weight, gestational weight gain, and accuracy of the prediction of fetal macrosomia are potentially modifiable risk factors for cesarean delivery. LEVEL OF EVIDENCE: II
The Journal of Maternal-fetal Medicine | 1998
Marion Andreoletti; Jacques Lepercq; Nathalie Loux; Sylvie Beaudoin; Paul Sacquin; Joséphine Borgnon; Tuan Nguyen; Dominique Mahieu; Françoise Toubas; Virginie Di Rico; Denis Farge; Dominique Franco; Pascale Briand; Jamil Hamza; Frédérique Capron; F. Bargy; Anne Weber
In utero allotransplantation of fetal hepatocytes into a preimmune fetus could be used in early treatment of many inherited hepatic metabolic diseases. This study was designed to assess the tolerance to hepatocyte transplantation and to test the feasability and toxicity of such an injection in a primate model. Fetal hepatocytes were obtained from two 120-day-old Macaca mulatta fetuses and cryopreserved. They were thawed, cultured in vitro, and transduced with a recombinant retrovirus expressing beta-galactosidase. Transduction efficiency was 75-85%. Three unrelated fetuses (90, 100, and 104 days old) were each given 1-2 x 10(7) transduced cells via the umbilical vein. This caused vasospasm and severe bradycardia. Two fetuses died in the 48 hours after transplantation; the third survived and was killed at the end of gestation. No evidence of the infused cells was found. Three fetuses (90 days old) were, therefore, given 3-4 10(7) hepatocytes by direct intrahepatic injection. All the fetuses survived without side effect. Donor cells were not apparent from histochemical staining and PCR reactions. There was no evidence of inflammatory reaction. These findings indicate that the protocole could be improved by increasing the number of transplanted cells and using specific hepatic promoters in the retroviral vectors to achieve an effective postnatal chimerism.
Obstetrics & Gynecology | 2013
Grégoire Miailhe; Camille Le Ray; José Timsit; Jacques Lepercq
OBJECTIVE: Type 1 diabetes mellitus (DM) is associated with a threefold to fivefold increased risk for stillbirth during pregnancy. The objective of the present study was to identify factors associated with prelabor urgent cesarean delivery for fetal compromise in women with type 1 DM. METHODS: We performed a nested case–control study within a prospective cohort of single pregnancies in women with type 1 DM managed with standardized protocols regarding treatment of diabetes and prenatal care. Twice-weekly home antenatal surveillance including nonstress test was initiated at 32 weeks of gestation and continued until planned delivery at 38–39 weeks of gestation. We identified factors associated with urgent cesarean delivery for an abnormal nonstress test. The calculated total sample size was 416 pregnancies. Independent factors and adjusted odds ratio (OR) were identified by logistic regression. RESULTS: Among 479 pregnancies, the rate of urgent cesarean delivery for an abnormal nonstress test was 4%. A hemoglobin A1C (Hb A1C) level at delivery of 6.4% or higher occurred in 34% of the pregnancies and was independently associated with urgent cesarean delivery (2% compared with 8%, P=.003, OR 4.16, 95% confidence interval 1.40–12.32). In the multivariable analysis, lack of preconception care and occurrence of gestational hypertension or preeclampsia were not associated with urgent cesarean delivery. The rate of stillbirth was 2 per 1,000. CONCLUSION: In women with type 1 DM, an Hb A1C level at delivery of 6.4% or higher was associated with prelabor urgent cesarean delivery. This suggests that tight glycemic control throughout pregnancy might reduce the risk of late fetal compromise. LEVEL OF EVIDENCE: III
Fetal Diagnosis and Therapy | 1999
Jacques Lepercq; Marie-Hélène Poissonnier; Marie José Coutanceau; Jacques Chavinie; Yves Brossard
Between 1987 and 1996, nine twin pregnancies with fetomaternal Rh alloimmunization were delivered at our institution. Eight pregnancies were dizygotic, and the fetal blood groups were different in 3 cases. The remaining pregnancy was monozygotic and monochorionic-diamniotic. Intravenous fetal exchange transfusion was performed in five pregnancies, up to five times in each twin in one pregnancy. No fetal death occurred. The average gestational age at birth was 35 (range 33–37) weeks. The hemoglobin level was 13.2 (range 9.2–16.5) g/dl. Fetomaternal Rh alloimmunization in twin pregnancy is according to zygosity; each fetus has to be treated separately, except in case of transplacental communication.