Evaluation of the Tuto'Tour pregnancy intervention among pregnant smokers in vulnerable situations / Évaluation du dispositif Tuto'Tour de la grossesse chez les femmes fumeuses enceintes vulnérables.

INTRODUCTION: In France, pregnant women generally receive written information about their pregnancy. The efficacy of these materials is limited for socially disadvantaged women, who are more likely to have lower levels of health literacy. As an alternative tool, awareness-raising videos have become popular, and the "Tuto'Tour de la grossesse" health promotion intervention has been created, which includes videos about smoking. The study objective was to evaluate the acceptability, usability, and accessibility of two videos about smoking among pregnant smokers in vulnerable situations. METHODS: We conducted semi-structured interviews with these women, using a participatory approach. We then carried out a hybrid qualitative analysis, combining an analysis based on a conceptual framework and an inductive analysis. RESULTS: Out of twenty participants, nine were separated from their child's father and nine were unemployed. Twelve participants had less than a baccalaureate level of education and seven had a mother tongue other than French. Participants found the videos acceptable, usable, and accessible. We received positive feedback about the efficacy of the videos in terms of participants' ability, opportunity, and motivation to change their behavior. Suggestions for improving the videos were made. CONCLUSIONS: Other studies have looked at health promotion with similar interventions, but acceptability, usability, and accessibility have not been tested with socially disadvantaged women. These videos, which are acceptable, usable, and accessible to socially disadvantaged people, seem to have an influence on two out of three factors leading to behavior change. They could now be tested on a larger scale in a randomized controlled study.

Introduction: En France, les femmes enceintes reçoivent généralement des informations concernant leur grossesse sous forme écrite. Ces supports présentent des limites pour les femmes en situation de vulnérabilité, à plus haut risque d'avoir une littératie en santé limitée. Ainsi, les vidéos de sensibilisation sont devenues populaires et le dispositif de promotion de santé « Tuto'Tour de la grossesse ¼ a été créé, comprenant des vidéos sur le tabac. L'objectif de notre étude était d'évaluer l'acceptabilité, l'utilisabilité et l'accessibilité de deux vidéos sur le tabagisme chez les femmes enceintes fumeuses en situation de vulnérabilité. Méthodes: Nous avons conduit des entretiens semi-directifs auprès de ces femmes, en suivant une approche participative. Nous avons ensuite procédé à une analyse qualitative hybride, combinant une analyse fondée sur une trame conceptuelle et une analyse inductive. Résultats: Sur vingt participantes, neuf étaient séparées du père de l'enfant et neuf étaient sans emploi. Douze d'entre elles n'avaient pas atteint un niveau de formation équivalent au baccalauréat et sept avaient une langue maternelle autre que le français. Les vidéos ont été jugées acceptables, utilisables et accessibles pour les participantes. Des retours positifs ont été recueillis concernant l'efficacité des vidéos à induire un changement de comportement. Des pistes pour améliorer les vidéos ont été suggérées. Conclusions: D'autres études s'intéressent à des dispositifs similaires mais l'acceptabilité, l'utilisabilité et l'accessibilité n'ont pas été testées. Ces vidéos semblent avoir une influence sur deux des trois facteurs menant à un changement de comportement. Elles peuvent maintenant être testées à plus grande échelle dans une étude contrôlée randomisée.

A nomogram to optimize the timing of antenatal corticosteroids in threatened preterm delivery.

BACKGROUND: Recent observational studies reported a high rate of suboptimal use of antenatal corticosteroids (too anticipated or retrospectively not indicated) for women at risk of preterm delivery despite a recommended use within 7 days before delivery. OBJECTIVE: This study aimed to elaborate a nomogram aiming at optimizing the timing of administration of antenatal corticosteroids in case of threatened preterm labor, asymptomatic short cervix, or uterine contractions. STUDY DESIGN: This was an observational retrospective study conducted in a tertiary hospital. All women between 24 and 34 weeks of gestation who received corticosteroids during hospitalization for threatened preterm delivery, asymptomatic short cervix, or uterine contractions requiring tocolysis between 2015 and 2019 were included. Clinical, biological, and sonographic data of women were used to construct logistic regression models for predicting delivery within 7 days. The model was validated on an independent series of women hospitalized in 2020. RESULTS: Among the 1343 women included in this study, the risk factors independently associated with a delivery within 7 days in multivariate analysis were vaginal bleeding (odds ratio, 14.47; 95% confidence interval, 7.81-26.81; P<.001); need for a second-line tocolysis, such as atosiban (odds ratio, 5.66; 95% confidence interval, 3.39-9.45; P<.001); C-reactive protein level (per 1 mg/L increase; odds ratio, 1.03; 95% confidence interval, 1.02-1.04; P<.001); cervical length (per 1 mm increase; odds ratio, 0.84; 95% confidence interval, 0.82-0.87; P<.001); uterine scar (odds ratio, 2.98; 95% confidence interval, 1.33-6.65; P=.008), and gestational age at admission (per week of amenorrhea increase; odds ratio, 1.10; 95% confidence interval, 1.00-1.20; P=.041). Based on these results, a nomogram was developed that, in retrospect, would have allowed physicians to avoid or delay antenatal corticosteroids in 57% of cases in our population. The discrimination of the predictive model was good when applied to the validation set of 232 women hospitalized in 2020. It would have enabled physicians to avoid or delay antenatal corticosteroids in 52% of cases. CONCLUSION: This study developed a simple use, accurate prognostic score to identify women at risk of delivery within 7 days in cases of threatened preterm delivery, asymptomatic short cervix, or uterine contractions and thereby optimized the use of antenatal corticosteroids.

Social context of preterm delivery in France in 2011 and impact on short-term health outcomes: the EPIPAGE 2 cohort study.

BACKGROUND: Low socio-economic context increases the risk of preterm delivery and may affect short-term outcomes in children born preterm. We described the social context of preterm delivery in France in 2011 and compared it with the general population of deliveries over the same period. We also studied how social context influenced pregnancy and delivery characteristics in the preterm population, and how it affected mortality and short-term morbidity in liveborn preterm children (<35 weeks). METHODS: We created an individual socio-economic vulnerability index, derived from multiple correspondence analysis based on maternal social information in the French National Perinatal Survey (NPS-2010). Weighted coordinates were applied to families from the EPIPAGE 2 study, a population-based cohort of preterm infants born in 2011, to quantify the infant's exposure to socio-economic vulnerability. Multivariable logistic models were used to relate the socio-economic context to pregnancy and delivery characteristics, and to assess its impact on short-term outcomes of the infants. RESULTS: Among mothers of preterm infants, gestational age decreased as socio-economic conditions worsened. In the most deprived group, women had more irregular pregnancy care, a higher prevalence of infection during pregnancy, and a lower rate of antenatal corticosteroid administration. The most deprived group was associated with a higher risk of severe morbidity for the preterm neonates. CONCLUSION: Our results emphasise the need for a large population-based surveillance system to identify the most deprived mothers, and to propose appropriate follow-up and care to these women and their infants in order to enhance long-term health.

Development and validation of nomograms for predicting preterm delivery.

OBJECTIVE: The objective of the study was to develop a statistical model for predicting risk of preterm delivery after in utero transfer for threatened preterm delivery in tertiary care centers. STUDY DESIGN: This study was an observational study including a total of 906 patients transferred for threatened preterm delivery at Paule-de-Viguier and Croix-Rousse University Hospitals. Clinical and sonographic data from 1 series were used to construct logistic regression models for predicting preterm delivery and were validated on an independent series. An Internet-based tool was developed to facilitate the use of the nomograms. RESULTS: Based on multivariate analyses, 2 nomograms were built: 1 to predict delivery within 48 hours after transfer and 1 to predict delivery before 32 weeks. Discrimination and calibration of the predictive models were good when applied to the validation set (concordance index 0.73 and 0.72, respectively). CONCLUSION: We developed and validated nomograms to predict the individual probability of preterm birth after transfer for threatened preterm delivery.