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Biomedical subjects

J Bouyer

Publications and source records attributed to J Bouyer.

At least 19 recordsLinked to original sources
PubMed1999

Ruptured tubal ectopic pregnancy: risk factors and reproductive outcome: results of a population-based study in France.

OBJECTIVE: The aim of this study was to investigate the determinants of tubal rupture and to describe its treatment and effect on subsequent fertility. STUDY DESIGN: The data were taken from a population-based register from Auvergne (France). All women aged between 15 and 45 years residing permanently in this area and treated for ectopic pregnancy by surgical or medical procedures have been registered since 1992. They are then followed up prospectively until the age of 45 years. This study is an analysis of 849 tubal ectopic pregnancies registered between January 1992 and December 1996. Women with tubal rupture were compared with those in whom no tubal rupture occurred. The risk factors for tubal rupture were identified by calculating crude and adjusted odds ratios. The effects of tubal rupture on subsequent fertility were assessed by calculating cumulative intrauterine pregnancy rates and were analyzed by log-rank tests and Cox regression. RESULTS: The rate of rupture for this population was 18%. Four factors were identified that increased the risk of rupture (results of the multivariate analysis): never having used contraception (odds ratio 1.7 [1.0 to 3. 3]), a history of tubal damage together with infertility (odds ratio 1.6 [0.9 to 2.7]), induction of ovulation (odds ratio 2.5 [1.1 to 5. 6]), and a high level of beta-human chorionic gonadotropin (at least 10,000 IU/L) when ectopic pregnancy was suspected (odds ratio 2.9 [1. 5 to 5.6]). The overall cumulative frequency of intrauterine pregnancy was not significantly lower after tubal rupture (adjusted risk ratio 0.85 [0.53 to 1.38]). CONCLUSION: Although tubal rupture seriously affects the immediate health of the women concerned, it seems to have no independent effect on subsequent fertility. Better knowledge of the risk factors should make it possible to identify those women who will not benefit from nonsurgical treatment.

Adolescent↗
PubMed1999

Polymorphisms of the endothelin-A and -B receptor genes in relation to blood pressure and myocardial infarction: the Etude Cas-Témoins sur l'Infarctus du Myocarde (ECTIM) Study.

Endothelin-1 is a potent vasoconstrictor that has also mitogenic properties, stimulating the synthesis and secretion of several vasoactive molecules. There is much evidence to suggest that endothelin-1 might be involved in the pathogenesis of hypertension, atherosclerosis, and ischemic heart disease. Endothelin-1 exerts its effects through at least two receptors, ET(A) and ET(B), which are encoded by different genes and have separate tissue distributions and biologic properties. The objective of this study was to identify polymorphisms of the ET(A) and ET(B) receptor genes and to study their association with myocardial infarction (MI) and blood pressure. The coding regions and 1.3 kb upstream of the ET(A) and ET(B) receptor genes were explored by polymerase chain reaction/single strand conformation polymorphism. Six polymorphisms were found in the ET(A) receptor gene and three in the ET(B) receptor gene. Most of these polymorphisms were frequent. Associations between the detected polymorphisms, blood pressure, and MI were examined in the ECTIM study, a multicenter study comparing 652 patients having survived an MI and 773 controls from Belfast (Northern Ireland) and France. Alleles at the different polymorphic sites were similarly distributed in patients with MI and controls. Allele frequencies were similar in both countries, except for the ET(A)/-231 G allele, which appeared more frequently in France than in Belfast (P < .01). The mean systolic and diastolic blood pressure levels did not significantly differ between genotypes. However, a C/T substitution located in the nontranslated part of exon 8 of the ET(A) receptor gene (ET(A)/EX8nt1363) was associated with pulse pressure (P < .005). These results do not support an involvement of the endothelin receptor genes in a predisposition to MI or the determination of blood pressure levels, but suggest that a polymorphism of the ET(A) receptor gene might influence the pulse pressure. This result will have to be confirmed in other studies.

Adult↗
PubMed1998

Risk of ectopic pregnancy and previous induced abortion.

OBJECTIVES: This study investigated the role of prior history of induced abortion in subsequent ectopic pregnancies. METHODS: Data from two French case-control studies were used to examine the effect of induced abortion on ectopic pregnancy risk. Case patients (n = 570) were women admitted for ectopic pregnancy during the study period; controls (n = 1385) were women who delivered in the same center. RESULTS: The analysis among women with no previous ectopic pregnancy showed that, after control for the main ectopic pregnancy risk factors, prior induced abortion was associated with an increased risk of ectopic pregnancy (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.0, 2.0); there was a significant trend between number of previous induced abortions and ectopic pregnancy risk (ORs = 1.4 for 1 previous induced abortion and 1.9 for 2 or more). CONCLUSIONS: This study suggests that induced abortion may be a risk factor for ectopic pregnancy for women with no previous ectopic pregnancy, particularly in the case of women who have had several induced abortions.

Abortion, Induced↗
PubMed1998

Ectopic pregnancy and occupational exposure of hospital personnel.

OBJECTIVES: An earlier study found a relationship between occupational exposure to antineoplastic drugs and ectopic pregnancy. The present investigation aimed at confirming this finding in a larger and specifically planned study and at analyzing the relationship between ectopic pregnancy and other chemical or physical agents in the hospital work environment. METHODS: A case-referent study (140 cases and 279 referents) was carried out in 1995 in a population of women working in hospitals throughout France. The sample size was computed to have an 80% statistical power to detect a 2-fold increased risk of ectopic pregnancy (odds ratio 2). Information was collected about past and present work conditions (exposures to antineoplastic drugs, solvents, disinfectants, anesthetic gases and ionizing radiation), and known risk factors of ectopic pregnancy. Multivariate analysis was performed using logistic regression. RESULTS: No significant association between occupational exposure and ectopic pregnancy was found, either when past exposure was considered or when exposure was considered within the 3 months before conception. The relationships remained nonsignificant after adjustment for job category and for the known risk factors of ectopic pregnancy. CONCLUSIONS: It was concluded that the results of this study should be interpreted as an absence of relationship between exposure to chemical or physical agents and ectopic pregnancy.

Adult↗
PubMed1998

[Tobacco and ectopic pregnancy. Arguments in favor of a causal relation].

BACKGROUND: The risk associated with smoking has been studied for a long time in fertility epidemiology. This paper reviews the association between smoking and ectopic pregnancy (EP) using results collected in our previous studies. It provides arguments for a causal interpretation of this association. METHODS: Data came from three case-control studies performed between 1988 and 1996 and from the register of ectopic pregnancies in Auvergne (France) from 1992 to 1995. The methods are those classically used in the analysis of case-control studies. RESULTS: The risk of EP increased significantly with smoking (p < 0.01): the adjusted OR are 1.5 for 1-9 cigarettes a day, 2.0 for 10-19 cigarettes a day, and 2.5 for more than 20 cigarettes a day. The attributable risk of smoking ranged between 17% and 32% according to the study. Similarly, the risk of EP recurrence increased significantly with smoking (p < 0.02): after adjustment, OR = 1.3 for 1-9 cigarettes a day, OR = 1.5 for 10-19 cigarettes a day, and OR = 1.7 for more than 20 cigarettes a day. Finally, smoking was associated with the site of EP. CONCLUSIONS: Thus there is a large body of arguments towards a causal relationship between smoking and EP. This provides additional arguments to persuade women to stop or to reduce smoking, especially hypofertile women.

Case-Control Studies↗
PubMed1998

[Predicting the risk of extra-uterine pregnancy. Construction and validation of a French risk scale].

This paper reports the construction and validation of a composite measurement scale to predict the risk of ectopic pregnancy in France. The data from three case-control studies of ectopic pregnancy conducted in France were used. Fourteen potential factors were found to be associated to ectopic pregnancy, which were grouped by multiple correspondence analysis in four dimensions: infection, pelvic surgery, smoking and induced conception. Logistic regression was further used to model the relationship between candidate risk factors (single or grouped as suggested by multiple correspondence analysis) and ectopic pregnancy. The regression coefficients of the final model were scaled and rounded to integers so as to make the scoring system simpler to use. The resulting composite measurement scale was finally validated on two independent samples. It allows simple determination (with a nomogram) of the absolute risk of developing ectopic pregnancy, for a given level of risk factors. This indicator for the risk of ectopic pregnancy could be used by clinicians to predict occurrence and provide an indication as to which type of early pregnancy follow-up and information should be given to women planning a pregnancy. It could also be used to provide earlier diagnostic screening in case of mild symptoms.

Case-Control Studies↗
PubMed1997

Construction of composite scales for risk assessment in epidemiology: an application to ectopic pregnancy.

Composite scoring systems that combine information contained in a number of risk factors are being used increasingly in clinical practice, planning, and health risk appraisal. The authors propose a methodological framework for the construction and validation of a composite measurement scale to assess the risk, considered as a continuous phenomenon, of developing a particular disease or outcome. This framework integrates several statistical methods, especially those concerning model fitting, coefficient rounding, and validation strategy. It also uses psychometric methods, addressing important measurement properties such as measurement level, content and construct validity, and reliability of the constructed scale. The proposed framework is illustrated by application to the construction of a composite scale for measurement of the risk of ectopic pregnancy.

Adolescent↗
PubMed1997

[Ectopic pregnancy recurrence: role of gynecologic, obstetric, contraceptive and smoking history].

The purpose of this study, based on data from the register of ectopic pregnancy in Auvergne (centre of France), is to identify risk factors of recurrence of ectopic pregnancy (EP). The social characteristics, gynaecological, surgical and reproductive history and conditions of the conception of 96 women with a previous EP were compared to those for 566 women without previous EP. Risk factors associated with the management of the first EP could not be analysed with the data available. Several factors increased the risk of recurrence: previous proved or suspected salpingitis (OR = 3.6), maternal smoking (OR = 1.7 to 2.0 according to the consumption level), maternal age greater than 30 (OR = 2.0), and previous recurrent spontaneous abortions (SA) among childless women (OR = 3.4 to 11.9 according to the number of SA). The last of these factors may reflect another unknown risk factors common to recurrent SA and recurrent EP (for example hormonal or karyotype factors). Previous use of intra uterine device is associated with a decrease in the risk of recurrence of EP (OR = 0.27), but this contraceptive method should be considered as an indicator of good fertility rather than as a protective factor for EP recurrence.

Abortion, Spontaneous↗
PubMed1996

Fertility after ectopic pregnancy: first results of a population-based cohort study in france.

The purpose of this paper was to evaluate the reproductive outcome after ectopic pregnancy (EP) from a population-based register in the centre of France. Since 1992, all the women aged 15-44 years, who permanently reside in the target area and who were treated either by surgical or medical procedures for an ectopic pregnancy in one of the area centres, have been registered and prospectively followed until 45 years of age. The analysis presented was based on the 155 women registered between January 1992 and March 1994 who were followed up for at least 6 months, and who were seeking a new pregnancy. The mean follow-up period was 16 months. A total of 102 women (66%) obtained a pregnancy. The first conception was intrauterine for 92 women, and 10 had a recurrence of ectopic pregnancy. Risk factors of recurrence were prior spontaneous abortion and prior tubal damage. For those women who conceived, the mean time to obtain pregnancy ('time to pregnancy') was 4.8 months. The 1 year cumulative intrauterine pregnancy rate (i.e. the probability of obtaining an intrauterine pregnancy within 1 year of seeking pregnancy) was 70%. After multivariate analysis by a Cox regression, the factors associated with higher fertility were age < 30 years, high educational level and no prior tubal damage.

Adolescent↗
PubMed1996

[Epidemiology of ectopic pregnancy: incidence and risk factors].

During the past two decades, the incidence of ectopic pregnancy (EP) has doubled or tripled in many parts of the world. In France, EP currently constitutes 2 % of livebirths and 1.6 % of all reported pregnancies. These rates seem presently stable. The main identified risk factors include pelvic inflammatory disease (PID)--in particular that due to Chlamydial infection, previous ectopic pregnancy and cigarette smoking. More than 50 % of EP cases are attributable to infectious factors and cigarette smoking, suggesting dramatic effects on EP rates of appropriate prevention programs. A third risk which could be prevented is induced conception cycles, especially by Clomiphene. Other risk factors are pelvic surgery, previous EP and maternal age (especially over 35 years). Further epidemiologic research is needed to identify new risk factors, to monitor incidence rates and to evaluate the effects of public health policies on EP occurrence. French EP registers will certainly contribute to this research.

Female↗
PubMed1996

[Ectopic pregnancy: factors related to ovum anomalies?].

Identified risk factors for ectopic pregnancy (prior pelvic inflammatory disease, smoking at the time of conception, intrauterine device, obstetrical and surgical history) explain from 60 to 65% of the cases. Egg anomalies may also be a risk factor as it is likely that the transport of an abnormal egg along the uterine tube is less efficient than a normal one. We tested this hypothesis with data from two case-control studies with the same design covering a total of 1955 women. The risk of ectopic pregnancy increased specifically with age, which is compatible with our hypothesis. We also studied the associations with spontaneous abortion, considered to be a marker of the risk of pregnancies involving chromosomal malformations. We observed an association between ectopic pregnancy and spontaneous abortions (especially recurrent abortions), not explained by other known risk factors. Although our data do not supply a single definitive demonstration, our results converge to suggest that egg chromosomal anomalies may play a part in ectopic pregnancy aetiology.

Abortion, Spontaneous↗
PubMed1996

[Fertility after ectopic pregnancy. Results of the first three years of the Auvergne Registry].

The reproductive outcome after ectopic pregnancy is evaluated from a population-based register in the center of France. Since 1992, all the women aged 15-44 years, who permanently reside in the target area and who were treated either by surgical or medical procedures for an ectopic pregnancy in one of the area centers, are registered and prospectively followed until 45 years of age. The analysis presented was based on the 221 women registered between January 1992 and December 1994 who were followed up for at least 6 months, and who were seeking a new pregnancy. The mean follow-up period was 19.8 months. 155 women (70%) obtained a pregnancy. The first conception was intrauterine for 136 women, and 19 had a recurrence of ectopic pregnancy. Risk factors of recurrence were prior spontaneous abortion and prior tubal damage. For those women who conceived, the mean time to obtain pregnancy ("time to pregnancy") was 7.6 months. The one year cumulative intrauterine pregnancy rate (i.e. the probability of obtaining an intrauterine pregnancy within 1 year of seeking pregnancy) was 64%. After multivariate analysis by a Cox regression, the factors associated with lower fertility were aged over 30 years, low educational level, history of infertility and prior tubal damage.

Adolescent↗
PubMed1995

[Incidence of extra-uterine pregnancy and characteristics of treated patients. First results of the Auvergne registry].

OBJECTIVES: To evaluate the course and frequency of ectopic pregnancy in a single population for a prolonged period in order to study the simultaneous changes in distribution of risk factors, identify new risk factors and evaluate the effect of new diagnostic and therapeutic methods on subsequent fertility and the effectiveness of preventive measures. METHODS: All women residing in the Registry zone and treated surgically or medically for ectopic pregnancy were included in the study and followed to the age of 45 years. RESULTS: In 1992, the incidence of ectopic pregnancy was 20.2 per 1,000 live births (n = 160). At least one currently recognized risk factor was found in 80% of the women. A past history of salpingitis was noted in 13% and nearly one half smoked or had smoked at the time of conception. Nineteen percent had a past history of pelvic surgery and 19% had a history of infertility. The ectopic pregnancy recorded was the second one in 9%. Nearly one-third of the ectopic pregnancies recorded (31%) were diagnosed in patients with a intrauterine device. None of these latter patients had other risk factors. Vaginal echography was used for diagnosis in 75% of the cases. Surgery was used as first intention treatment in 94% and medical treatment (methotrexate) was used in 6%.

Adult↗
PubMed1995

Performance of odds ratios obtained with a job-exposure matrix and individual exposure assessment with special reference to misclassification errors.

OBJECTIVES: Individual assessment of exposure by experts and the use of a job-exposure matrix are the two main methods of evaluating past occupational exposures in community-based case-referent studies. The objective of this study was to compare the performance of the estimations of the odds ratio in the two methods. This paper focuses on job-exposure matrices whose entries consist of proportions of persons exposed. METHODS: Simulations were used to compare the variances of the estimations of the odds ratios obtained with the two methods and to study the consequences with respect to bias and the precision of the odds ratios estimated for misclassifications of exposure produced by either the experts or the matrix. RESULTS: When there was no misclassification, the results showed that the precision obtained with the job-exposure matrix was about three times less than that achieved by experts in a large range of practical situations. However, when potential errors of exposure assessment were taken into account, the simulations suggested that the test of the hypothesis OR = 1 against the alternative OR not equal to 1 when exposure was assessed with an unbiased job-exposure matrix had a statistical power close to that obtained when exposure was assessed by an expert with high sensibility and specificity. CONCLUSIONS: The evaluation of exposure with an unbiased job-exposure matrix in studies of the association between exposure and disease had a statistical power close to that expected in practice with a good expert in the large range of practical situations which were investigated.

Bias↗
PubMed1994

[Job exposure matrices].

During the last years, the use of Job Exposure Matrices (JEMs) for the evaluation of past occupational exposures has grown. This approach is described in this paper. The definition of a JEM is provided. The development process of a JEM is discussed. It includes the choice of the job classification system which influences the degree to which the matrix can be used in other studies, the precise definition of exposures and the choice of entries which should provide more information than the oversimplified exposed/non exposed dichotomy. When comparing JEMs and experts' evaluation of exposure, all aspects of both methods have to be looked at and a balance struck between the advantages and shortcomings of each of them. The problem should not be reduced to a single choice between the precision provided by experts, and the cost savings and standardization offered by JEMs. Statistical analysis with a JEM must be adapted to the job classified information it provided. When an appropriate method is used, the loss of power with a JEM compared to experts' evaluation is rather small or even null. Finally, it is important to avoid a systematic opposition between JEMs and expert assessments, as one positive result of their comparison may be the improvement of both methods of exposure evaluation.

Biometry↗