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Biomedical subjects

Jean Bouyer

Publications and source records attributed to Jean Bouyer.

17 recordsLinked to original sources
PubMed2007

Care pathways for ectopic pregnancy: a population-based cost-effectiveness analysis.

OBJECTIVE: To define care pathways in terms of frequency, costs, and outcomes and to assess their cost-effectiveness. DESIGN: Population-based cost-effectiveness study. SETTING: Auvergne EP registry (France). PATIENT(S): Women (n = 1,664) registered between 1994 and 2003. INTERVENTION(S): Standard diagnosis and treatment of EP. MAIN OUTCOME MEASURE(S): Costs before, during, and after hospitalization were assessed from data concerning medical costs of examinations and treatments. One-year fertility was used for effectiveness assessment. We assessed cost-effectiveness for the healthcare system. RESULT(S): Diagnostic ultrasound (47% of scans were nondiagnostic) was essential for the use of methotrexate as a first-line treatment for subacute EP. Hospital and ambulatory care costs were similar for all surgical-care pathways (diagnostic or nondiagnostic ultrasound scan followed by conservative or radical laparoscopy). Hospital and ambulatory-care costs associated with methotrexate treatment were less than half those for surgical-care pathways. In subacute cases, conservative treatments, and methotrexate in particular, were associated with better fertility at similar or lower cost to salpingectomy for EP for reproductive failure. CONCLUSION(S): Conservative treatments are cost-effective with respect to salpingectomy, when subsequent fertility is at stake. Efforts should be made to increase the frequency of diagnostic ultrasound scans, making it possible to increase methotrexate use and cost-effectiveness.

Adolescent↗
PubMed2006

Contraception at the time of abortion: high-risk time or high-risk women?

BACKGROUND: Despite the widespread use of highly effective contraception in France, the incidence of abortion is high. A retrospective population-based cohort study was designed to analyse women's contraceptive history. METHOD: We compared the contraceptive use of 163 women, whose last pregnancy ended in abortion, 6 months before, at the time of, 1 month and 6 months after the event with that of 1787 women who had never had an abortion. RESULTS: A total of 46% of women who experienced an abortion used a highly effective form of contraception 6 months before the event (versus 76% among women who had never had an abortion, P < 0.001). This proportion dropped to 33% at the time of the abortion and increased to 71%, 1 month after. In addition, 50% of women who had an abortion had changed their contraceptive method in the 6 months before the event (compared with 16% in the 6 months before the interview in women who had not had an abortion, P < 0.001). Women with socially deprived backgrounds were less likely to use a highly effective contraception after an abortion. CONCLUSIONS: Abortion is a good opportunity for intervention, but especially so for socially disadvantaged women. It is essential to draw the attention of prescribers and women to the higher risk of contraceptive failure at the start of use of a method.

Abortion, Spontaneous↗
PubMed2006

Menstrual bleeding patterns following levonorgestrel emergency contraception.

PURPOSE: Multiple trials by the World Health Organization have established levonorgestrel as the gold standard in hormonal emergency contraception (EC). However, changes in menstrual patterns following EC have been observed; thus, we undertook this prospective study to identify and determine the characteristics of these changes. MATERIALS: Women requesting EC at either any of two hospitals --1 family planning unit and 12 pharmacies in Yaoundé, Cameroon were enrolled if they had a history of regular menstrual cycles over the previous 3 months and if they agreed to follow-up until the end of the subsequent menstrual cycle. Pretreatment menstrual patterns were compared with those of the EC treatment cycle and the cycle after EC. RESULTS: In a set of 232 participants (mean age, 25 years), we observed 34 (14.7%) cases of incident intermenstrual bleeding and statistically significant changes in menstrual cycle length, menstrual period length and menstrual appearance compared to baseline patterns that differed according to whether EC was taken well before, close to or well after the expected ovulation for that cycle. The majority of these changes disappeared in the following cycle. CONCLUSION: Levonorgestrel EC is associated with significant but transient changes in menstrual patterns in a significant proportion of users.

Adolescent↗
PubMed2006

Male gonadal dose of ionizing radiation delivered during X-ray examinations and monthly probability of pregnancy: a population-based retrospective study.

BACKGROUND: Male gonadal exposure to ionizing radiation may disrupt spermatogenesis, but its influence on the fecundity of couples has been rarely studied. We aimed to characterize the influence of male gonadal dose of ionizing radiation delivered during radiodiagnostic on the monthly probability of pregnancy. METHODS: We recruited a random sample of women who retrospectively described 1110 periods of unprotected intercourse beginning between 1985 and 1999 and leading either to a live birth or to no pregnancy; their duration was censored after 13 months. The male partner answered a telephone questionnaire on radiodiagnostic examinations. We assigned a mean gonadal dose to each type of radiodiagnostic examination. We defined male dose for each period of unprotected intercourse as the sum of the gonadal doses of the X-ray examinations experienced between 18 years of age and the date of discontinuation of contraception. Time to pregnancy was analysed using a discrete Cox model with random effect allowing to estimate hazard ratios of pregnancy. RESULTS: After adjustment for female factors likely to influence fecundity, there was no evidence of an association between male dose and the probability of pregnancy (test of homogeneity, p = 0.55). When compared to couples with a male gonadal dose between 0.01 and 0.20 milligrays (n = 321 periods of unprotected intercourse), couples with a gonadal dose above 10 milligrays had a hazard ratio of pregnancy of 1.44 (95% confidence interval, 0.73-2.86, n = 31). CONCLUSION: Our study provides no evidence of a long-term detrimental effect of male gonadal dose of ionizing radiation delivered during radiodiagnostic on the monthly probability of pregnancy during the year following discontinuation of contraceptive use. Classification errors due to the retrospective assessment of male gonadal exposure may have limited the statistical power of our study.

Adult↗
PubMed2006

Feasibility of the current-duration approach to studying human fecundity.

Approaches for monitoring time trends in couples' fecundity and for studying its sensitivity to environmental factors are needed. Two approaches rely on the inclusion of a cross-sectional sample of couples currently "at risk" of pregnancy either with follow up (prevalent cohort) or without follow up (current-duration design). To illustrate the feasibility of the current-duration design, we contacted a random sample of 1204 French women age 18 to 44 years in 2004 and recruited those who were currently having unprotected sexual intercourse. The current duration since the beginning of unprotected intercourse was defined for 69 women (5.7%). An additional 15 women (1.2%) were planning to start trying to become pregnant within the next 6 months. Parametric methods allowed, based on current duration of unprotected intercourse, estimation of fecundity as if the couples had been followed prospectively. The estimated proportion of couples not pregnant after 12 months of unprotected intercourse was 34% (95% confidence interval [CI] = 15-54%). The accelerated-failure time model allows study of the influence of environmental factors on fecundity. As an illustration, tobacco smoking by the woman was associated with a doubling in the median duration of unprotected intercourse before pregnancy (adjusted time ratio = 2.4; 95% CI = 1.1-5.2). We quantified the influence of time trends in the prevalence of smoking on this estimate. We suggest ways to quantify or avoid other potential bias. In conclusion, it is possible to recruit a sample of couples currently having unprotected intercourse. The current-duration design appears feasible with approximately 5 times as many women eligible for study as for an incident cohort design.

Adolescent↗
PubMed2006

Social, demographic and situational characteristics associated with inconsistent use of oral contraceptives: evidence from France.

CONTEXT: Oral contraceptives are the most popular form of reversible contraception used in developed countries. Their efficacy depends on how consistently and correctly they are used. METHODS: The incidence of inconsistent pill use was estimated from data from a random sample of 1,234 pill users who participated in a French population-based survey in 2000. Multivariate logistic regressions were used to identify the social, demographic and situational characteristics associated with inconsistent use. RESULTS: Twenty percent of women missed at least one pill during the four weeks prior to the interview, 7% missed two or more pills, and 10% missed at least one pill without using contraceptive backup during subsequent sexual intercourse. Inconsistent pill use was related to situational characteristics that are likely to change over time. The odds of having missed pills were elevated among women whose last intercourse had been with an occasional partner or who had small children. Women who did not have a daily pill-taking routine also had elevated odds of inconsistent use. The likelihood of having missed a pill and not used contraceptive backup was elevated among women who felt they had not been involved in the choice of contraceptive method prescribed by their physician. CONCLUSIONS: Service providers may need to better address women's preferences and needs, to help them choose the contraceptive method that best fits their sexual, emotional.

Adolescent↗
PubMed2005

Influence of paternal age on the risk of spontaneous abortion.

The frequency of chromosomal anomalies in spermatozoa appears to increase with male age. Because these anomalies play a role in the etiology of spontaneous abortion, an influence of paternal age on risk of spontaneous abortion is plausible but not established. The aim was to characterize this influence in a prospective study among 5,121 California women, who as members of a prepaid health plan were interviewed in 1990 or 1991 when they were less than 13 weeks' pregnant and who were followed until the end of pregnancy. The risk of spontaneous abortion between weeks 6 and 20 of pregnancy was studied using a Cox model adjusted for maternal age. The adjusted hazard ratio of spontaneous abortion associated with paternal age of 35 years or more, compared with less than 35 years, was 1.27 (95% confidence interval: 1.00, 1.61), with no modification by maternal age. Among women aged less than 30 years, the hazard ratio of spontaneous abortion associated with paternal age of 35 years or more was 1.56 for first trimester spontaneous abortion and 0.87 for early second trimester spontaneous abortion (test of interaction, p = 0.25). In conclusion, the risk of spontaneous abortion increased with increasing paternal age, with a suggestion that the association is stronger for first trimester losses.

Abortion, Spontaneous↗
PubMed2005

High reproducibility of serum anti-Mullerian hormone measurements suggests a multi-staged follicular secretion and strengthens its role in the assessment of ovarian follicular status.

BACKGROUND: Our aim was to compare the intercycle reproducibility of serum anti-Mullerian hormone (AMH) measurements with that of other markers of ovarian follicular status. METHODS: Forty-seven normo-ovulatory, infertile women underwent serum AMH, inhibin B, estradiol and FSH measurements and early antral follicle (2-12 mm in diameter) counts by transvaginal ultrasound on cycle day 3 during three consecutive menstrual cycles. Reproducibility of measurements was estimated using intra-class correlation coefficient (ICC) calculation. We also assessed the number of replicate measurements theoretically needed to reach satisfactory reliability of results. RESULTS: Serum AMH showed significantly higher reproducibility (ICC, 0.89; 95% confidence interval, 0.83-0.94) than inhibin B (0.76; 0.66-0.86; P < 0.03), estradiol (0.22; 0.03-0.41; P < 0.0001) and FSH levels (0.55; 0.39-0.71; P < 0.01), and early antral follicle counts (0.73; 0.62-0.84; P < 0.001), and reached satisfactory reliability with a single measurement. CONCLUSIONS: The improved cycle-to-cycle consistency of AMH as compared with other markers of ovarian follicular status is in keeping with its peculiar production by follicles at several developmental stages and further supports its role as a cost-effective, reliable marker of ovarian fertility potential.

Adult↗
PubMed2005

The remaining barriers to the use of emergency contraception: perception of pregnancy risk by women undergoing induced abortions.

Although access to and knowledge of emergency contraception (EC) have improved, numerous unplanned pregnancies occur each year. We thus assessed the remaining barriers to EC use in a population of women seeking an abortion in four abortion centers in France in 2002. A self-administered questionnaire was completed by 1365 women. Most women have heard of EC (89%), but access to information remained limited in socially disadvantaged populations. Nevertheless, the unperceived risk of pregnancy appeared to be the most limiting factor to EC use. Only 38.5% of women were aware of pregnancy risk at the time of the intercourse that made them pregnant. Of these women, 48% minimized the risk later, resulting in the decision not to use EC. As the perception of risk is commonly reevaluated by women over time, which probably affects EC use, it could be important to promote advance supply of EC so that women could use it immediately after a recognized unprotected intercourse.

Abortion, Induced↗
PubMed2005

Previous induced abortions and the risk of very preterm delivery: results of the EPIPAGE study.

OBJECTIVES: To evaluate the risk of very preterm birth (22-32 weeks of gestation) associated with previous induced abortion according to the complications leading to very preterm delivery in singletons. DESIGN: Multicentre, case-control study (the French EPIPAGE study). SETTING: Regionally defined population of births in France. SAMPLE: The sample consisted of 1943 very preterm live-born singletons (< 33 weeks of gestation), 276 moderate preterm live-born singletons (33-34 weeks) and 618 unmatched full-term controls (39-40 weeks). METHODS: Data from the EPIPAGE study were analysed using polytomous logistic regression models to control for social and demographic characteristics, lifestyle habits during pregnancy and obstetric history. The main mechanisms of preterm delivery were classified as gestational hypertension, antepartum haemorrhage, fetal growth restriction, premature rupture of membranes, idiopathic preterm labor and other causes. MAIN OUTCOME MEASURES: Odds ratios for very preterm birth by gestational age and by pregnancy complications leading to preterm delivery associated with a history of induced abortion. RESULTS: Women with a history of induced abortion were at higher risk of very preterm delivery than those with no such history (OR + 1.5, 95% CI 1.1-2.0); the risk was even higher for extremely preterm deliveries (< 28 weeks). The association between previous induced abortion and very preterm delivery varied according to the main complications leading to very preterm delivery. A history of induced abortion was associated with an increased risk of premature rupture of the membranes, antepartum haemorrhage (not in association with hypertension) and idiopathic spontaneous preterm labour that occur at very small gestational ages (< 28 weeks). Conversely, no association was found between induced abortion and very preterm delivery due to hypertension. CONCLUSION: Previous induced abortion was associated with an increased risk of very preterm delivery. The strength of the association increased with decreasing gestational age.

Abortion, Induced↗
PubMed2004

Ectopic pregnancy is again on the increase. Recent trends in the incidence of ectopic pregnancies in France (1992-2002).

BACKGROUND: We aimed to assess the recent incidence trends of ectopic pregnancies (EP) in France (1992-2002). METHODS: A population-based register of all women aged 15-44 years with EP was set up in Auvergne (central France). We calculated rates of EP as a 'reproductive failure' or as a 'contraceptive failure', frequencies of exposure to the two main risk factors for EP (cigarette smoking and chlamydial infection) and contraceptive methods between 1992 and 2002. RESULTS: The overall EP rate decreased by 2%, from 96.4 per 100 000 women aged 15-44 in 1992 to 95.3 per 100 000 in 2002. However, the rate of 'reproductive failure' EP increased by 17%, while the rate of 'contraceptive failure' EP, mostly intrauterine device failure, decreased by 29%. CONCLUSION: Appropriate analysis reveals that the rate of EP as reproductive failure is increasing again in France. This result is of interest for many European and North America countries where chlamydial infections or smoking or both are increasing in women of reproductive age. The rates of EP as contraceptive failure and of that as reproductive failure evolve differently in the population and should not be confused in epidemiological studies.

Adolescent↗
PubMed2004

Maternal life events and adverse pregnancy outcomes: lessons from the Auvergne ectopic pregnancy registry.

OBJECTIVE: To investigate stressful maternal life events as candidate risk factors for ectopic pregnancy. DESIGN: Population-based registry study. SETTING: Auvergne ectopic pregnancy registry (France). PATIENT(S): Women (n = 641) registered between 1997 and 2000. INTERVENTION(S): Standard treatment of ectopic pregnancy. MAIN OUTCOME MEASURE(S): Based on the Psychiatric Epidemiology Life Events Scale, we analyzed the nonresponse bias, the confounding effects of sociobehavioral factors associated with both life events and ectopic pregnancy, and the potential buffering effects of socio-cultural variables. A multivariate model was constructed to test the association between life events and ectopic pregnancy, adjusting for identified confounders and testing interactions. RESULT(S): The primary hypothesis that life events might be independent risk factors for ectopic pregnancy was not confirmed in this study, which nevertheless illustrated the numerous biases and measurement problems confronting association studies of life events with adverse pregnancy outcomes. CONCLUSION(S): Recommendations are made for future studies on life events and adverse pregnancy outcomes to avoid most selection, information, and confounding biases. Methodological improvements are needed for measurement of life events to develop measures that more closely consider the consequences of stress and the mechanisms of buffering.

Adult↗
PubMed2004

Access to health care for induced abortions: analysis by means of a French national survey.

BACKGROUND: With an incidence of 15 per thousand, abortion is a common reproductive event in France. This study describes conditions of access to health care for abortions based on women's reports, taking into account the woman's background and the influence of the first professional contacted. METHODS: A representative sample of 2,863 women, aged 18 to 44, was interviewed by telephone between September 2000 and January 2001. Of these women, 480 had an abortion in the last 10 years. MAIN RESULTS: The choice of first professional depended on women's background, as we found differences according to age, educational level or past induced abortion. This choice affected subsequent access conditions, in terms of time delay or complexity of patterns of care to access abortion services. Women who first contacted a private gynaecologist, which is the most frequent situation in France, had more direct and shorter patterns of care. Conversely, general practitioners were associated with longer and more indirect patterns of care, especially when women were less well educated. CONCLUSION: This study reveals the heterogeneous nature of patterns of access to an abortion in France. It also raises questions concerning the training of general practitioners, who seem to be less well prepared to take charge of a request for an abortion than other professionals. Efforts must be made to better inform women and these professionals about the process required for abortions.

Abortion, Induced↗
PubMed2003

Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France.

This case-control study was associated with a regional register of ectopic pregnancy between 1993 and 2000 in France. It included 803 cases of ectopic pregnancy and 1,683 deliveries and was powerful enough to investigate all ectopic pregnancy risk factors. The main risk factors were infectious history (adjusted attributable risk = 0.33; adjusted odds ratio for previous pelvic infectious disease = 3.4, 95% percent confidence interval (CI): 2.4, 5.0) and smoking (adjusted attributable risk = 0.35; adjusted odds ratio = 3.9, 95% CI: 2.6, 5.9 for >20 cigarettes/day vs. women who had never smoked). The other risk factors were age (associated per se with a risk of ectopic pregnancy), prior spontaneous abortions, history of infertility, and previous use of an intrauterine device. Prior medical induced abortion was associated with a risk of ectopic pregnancy (adjusted odds ratio = 2.8, 95% CI: 1.1, 7.2); no such association was observed for surgical abortion (adjusted odds ratio = 1.1, 95% CI: 0.8, 1.6). The total attributable risk of all the factors investigated was 0.76. As close associations were found between ectopic pregnancy and infertility and between ectopic pregnancy and spontaneous abortion, further research into ectopic pregnancy should focus on risk factors common to these conditions. In terms of public health, increasing awareness of the effects of smoking may be useful for ectopic pregnancy prevention.

Adult↗
PubMed2002

Choosing marginal or random-effects models for longitudinal binary responses: application to self-reported disability among older persons.

BACKGROUND: Longitudinal studies with binary repeated outcomes are now widespread in epidemiology. The statistical analysis of these studies presents difficulties and standard methods are inadequate. METHODS: We consider strategies for modelling binary repeated responses and focus on two specific issues: the choice between marginal and random-effects models, and the choice of the time point origin. These issues are addressed using the example of self-reported disability in older women assessed annually for 6 years. The indicator of disability "needing help to go outdoors or home-confined" is used. RESULTS: In view of the observed associations between the responses for consecutive years, the baseline response was considered as a covariate. We compared the marginal and random-effects models first when only the influence of time and age is analysed and second when individual risk factors are studied in an aetiological perspective. There were substantial differences between the parameter estimates. They were due to differences between specific concepts related to the two models and the large between-individual heterogeneity revealed by the analysis. CONCLUSIONS: A random-effects model appears to be most suitable for the analysis of self-reported disability in older women.

Activities of Daily Living↗
PubMed2002

Familial aggregation of fetal growth restriction in a French cohort of 7,822 term births between 1971 and 1985.

An association between fetal growth restriction and increased rates of metabolic and cardiovascular diseases in adulthood has been reported. This study evaluated familial aggregation of fetal growth restriction in term births. The population consisted of 3,505 sibships comprised of 7,822 full-term singleton infants born between 1971 and 1985 in Haguenau, France, and selected from a regional register of births. Sib-sib odds ratios were estimated for being born small for gestational age (SGA), defined as having a birth weight below the 10th percentile of the sex-specific curve of birth weight by week of gestation. SGA births were further stratified according to ponderal index (birth weight/length(3)). After adjustment for maternal factors, the sib-sib odds ratios were 4.8 (95% confidence interval (CI): 3.7, 6.3) for all SGA births, 7.7 (95% CI: 4.1, 14.7) for SGA births with a low ponderal index (<10th percentile), and 4.4 (95% CI: 2.3, 8.2) for SGA births with a normal ponderal index (25th-75th percentile). None of the maternal factors investigated significantly influenced the magnitude of these odds ratios. This strong residual sib-sib aggregation suggests a role for genetic and/or shared environmental factors in the etiology of fetal growth restriction, especially when associated with a low ponderal index.

Cohort Studies↗