RESUMEN
OBJECTIVE: To establish normal current values of various biochemical parameters during pregnancy in the northern area of Paris (France) in a subgroup from the PreCARE cohort and to study their changes according to the term of pregnancy, and to determine the influence of maternal precarity. DESIGN: The PreCAREbio cohort of pregnant women was defined in the PreCARE study, a multicenter cohort study. SETTING: Participants completed detailed questionnaires at enrolment and immediately postpartum. Data were collected prospectively. 26 biochemical parameters were longitudinally assessed. POPULATION: All women registered to deliver or who delivered at one of the four participating university hospitals in Paris between October 2010 and November 2011 were eligible for study inclusion (n=10,419). METHODS: We studied 26 biochemical markers during pregnancy and the influence of maternal social deprivation. MAIN OUTCOME MEASURES: Baseline values for 26 biochemical markers and their changes according to the term of pregnancy, and the influence of maternal social deprivation on these biochemical markers. RESULTS: 386 patients with 1733 blood samples recruited in one of the four centers in the PreCARE cohort were included. Baseline concentrations (median, 2.5th and 97.5th percentile) for each marker and did not differ at the different time points. Mean concentrations of each biochemical marker did not differ between socially deprived women and non-socially deprived women. CONCLUSIONS: We have established normal values for 26 biochemical parameters during pregnancy. We have also shown no difference in these values between socially deprived and non- socially deprived women.
RESUMEN
STUDY OBJECTIVE: To evaluate the French quality of care of endometrial cancer using published relevant quality indicators and researche explanatory factors influencing its management. STUDY DESIGN: We used databases from the "Echantillon Généraliste de Bénéficiaires", sample of the French population, to identify cases operated on between 2005-2014. Quality indicators evaluated were: three years survival rate, time between surgery and adjuvant treatment, use of IRMT and 3DCRT for radiotherapy, rate of minimally invasive surgery. Multilevel analysis was performed to identify explanatory factors. RESULTS: 405 women were included. 323 had a follow-up of more three years, and 250 were alive at three years (77.0%). 70 (17.3%) underwent minimally invasive surgery. 73 women of the 153 who received adjuvant treatment (47.8%) started it within 60 days after surgery. Among the 60 patients who received adjuvant radiotherapy, 50 (83.3%) underwent the IRMT or 3DCRT technique. In multilevel analysis, diabetes (OR = 1.24: 95% CI [1.08; 1.41]), and age under 65 (OR = 1.15: 95% CI [1.01; 1.35]) were associated with an increase of the three years survival rate. Lymphadenectomy (OR = 1.12: 95% CI [1.03; 1.22]), and management in an university institution (OR = 1.13: 95% CI [1.01; 1.25]) were associated with adequate technique for the adjuvant radiotherapy. Laparoscopic surgery increased after 2010 (OR = 1.18: 95% CI [1,10; 1,25]). CONCLUSION: Improvements should be made to increase the rate of laparoscopy and reduce the delay before adjuvant treatment for the management of endometrial cancer in France, specifically in non-university centers.