Search PubMed⌕ Search

Biomedical subjects

L Séguin

Publications and source records attributed to L Séguin.

17 recordsLinked to original sources
PubMed2001

Socio-economic disparities in preterm birth: causal pathways and mechanisms.

Preterm birth is the leading cause of infant mortality in industrialised societies. Its incidence is greatly increased among the socially disadvantaged, but the reasons for this excess are unclear and have been relatively unexplored. We hypothesise two distinct sets of causal pathways and mechanisms that may explain social disparities in preterm birth. The first set involves chronic and acute psychosocial stressors, psychological distress caused by those stressors, increased secretion of placental corticotropin releasing hormone (CRH), changes in sexual behaviours or enhanced susceptibility to bacterial vaginosis and chorioamnionitis, cigarette smoking or cocaine use, and decidual vasculopathy. The second hypothesised pathway is a gene-environment interaction based on a highly prevalent mutation in the gene for methylenetetrahydrofolate reductase (MTHFR), combined with low folate intake from the diet and from prenatal vitamin supplements, consequent hyperhomocysteinemia, and decidual vasculopathy. We propose to test these hypothesised pathways and mechanisms in a nested case-control study within a prospectively recruited and followed cohort of pregnant women with singleton pregnancies who deliver at one of four Montreal hospitals that serve an ethnically and socio-economically diverse population. Following recruitment during the late first or early second trimester, participating women are seen at 24-26 weeks, when a research nurse obtains a detailed medical and obstetric history; administers several scales to assess chronic and acute stressors and psychological function; obtains blood samples for CRH, red blood cell and plasma folate, homocysteine, and DNA for the MTHFR mutation; and performs a digital and speculum examination to measure cervical length and vaginal pH and to obtain swabs for bacterial vaginosis and fetal fibronectin. After delivery, each case (delivery at < 37 completed weeks following spontaneous onset of labour or prelabour rupture of membranes) and two controls are selected for placental pathological examination, hair analysis of cotinine, cocaine, and benzoylecgonine, and analysis of stored blood and vaginal specimens. Statistical analysis will be based on multiple logistic regression and structural equation modelling, with sequential construction of models of potential aetiological determinants and covariates to test the hypothesised causal pathways and mechanisms. The research we propose should improve understanding of the factors and processes that mediate social disparities in preterm birth. This improved understanding should help not only in developing strategies to reduce the disparities but also in suggesting preventive interventions applicable across the entire socio-economic spectrum.

Adult↗
PubMed2000

Socio-economic disparities in pregnancy outcome: why do the poor fare so poorly?

In this paper, we review the evidence bearing on socio-economic disparities in pregnancy outcome, focusing on aetiological factors mediating the disparities in intrauterine growth restriction (IUGR) and preterm birth. We first summarise what is known about the attributable determinants of IUGR and preterm birth, emphasising their quantitative contributions (aetiological fractions) from a public health perspective. We then review studies relating these determinants to socio-economic status and, combined with the evidence about their aetiological fractions, reach some tentative conclusions about their roles as mediators of the socio-economic disparities. Cigarette smoking during pregnancy appears to be the most important mediating factor for IUGR, with low gestational weight gain and short stature also playing substantial roles. For preterm birth, socio-economic gradients in bacterial vaginosis and cigarette smoking appear to explain some of the socio-economic disparities; psychosocial factors may prove even more important, but their aetiological links with preterm birth require further clarification. Research that identifies and quantifies the causal pathways and mechanisms whereby social disadvantage leads to higher risks of IUGR and preterm birth may eventually help to reduce current disparities and improve pregnancy outcome across the entire socio-economic spectrum.

Canada↗
PubMed2000

[The Edinburgh Postnatal Depression Scale: the validity of its Quebec version for a population low socioeconomic status mothers].

This paper investigates the construct validity and reliability of a Quebec version of the Edinburgh Postnatal Depression Scale (EPDS) for a population of low-socioeconomic-status mothers. This scale was constructed for the specific purpose of measuring mothers' symptoms of depression during the postnatal period in an effort to alleviate the validity problems that could arise from depression scales intended for the general population. Two hundred and twenty-four mothers participating in a Quebec prevention program, "Naître égaux, grandir en santé" (Martin & Boyer, 1995) filled out the EPDS between the 22nd and the 35th day postpartum. A confirmatory factor analysis, conducted with LISREL, gives a 2-factor structure for the EPDS, the first representing symptoms of depression and the second symptoms of anxiety. This structure differs from the one presented by Cox, Holden, and Sagovsky (1987), authors of the EPDS. It corresponds, however to the results of other authors who looked at the EPDS with confirmatory factor analysis (Pop, Komproe, & van Son, 1992) and indicates a good construct validity. The reliability of the scale also appears satisfactory, with a Cronbach alpha co-efficient of 0.82.

Adolescent↗
PubMed1999

Depressive symptoms in the late postpartum among low socioeconomic status women.

BACKGROUND: Postpartum depression has been the focus of much research in the past 15 years, but little is known about factors associated with depression of longer duration or later onset. The purpose of this longitudinal study was to analyze the relationship between stressful life conditions and postnatal depression in a group of women of low socioeconomic status from the third week to the sixth month postpartum. METHODS: Nulliparas who met criteria for low socioeconomic status were recruited from the prenatal care clinics of four Montreal hospitals. Questionnaires were verbally administered in the home at 30 weeks' gestation, at 3 and 9 weeks postpartum, and at 6 months postpartum. Blockwise multiple linear regression analyses were performed by entering predictor variables that included sociodemographic characteristics, chronic stressors, life events, and social support network. RESULTS: Sixty-eight women participated in the study. At 6 months postpartum, 38.2 percent of the mothers had a Beck Depression Inventory score of 10 or more. After accounting for previous depression, analyses indicated that chronic stressors (maternal health problems, infant difficulty, lack of money for basic needs, frequent conflicts with network members) and poor social support (informational and emotional) were associated with postnatal depressive symptoms. CONCLUSIONS: Health practitioners should recognize that high depressive symptomatology frequently occurs among low socioeconomic status first-time mothers at six months postpartum. Chronic stressors and inadequate social support are the most important factors associated with this problem.

Adult↗
PubMed1999

Socio-environmental factors and postnatal depressive symptomatology: a longitudinal study.

This study analyses the relationships between stressful life conditions and postnatal depressive symptomatology in a group of women of low socioeconomic status (SES) and a group of women of high SES from the third to the ninth week postpartum. Nulliparous pregnant women were recruited from the prenatal care clinics of four hospitals. Multiple linear regression analyses demonstrated that after accounting for SES group membership and depressive symptomatology during pregnancy, early postnatal chronic stressors (frequent conflictual episodes with network members, maternal health problems) and social support were linked to later postnatal depressive symptomatology.

Case-Control Studies↗
PubMed1995

Chronic stressors, social support, and depression during pregnancy.

OBJECTIVES: To analyze the relationships between stressful life conditions, social support, and depressive symptomatology during pregnancy in women of low socioeconomic status and a comparison group of women of higher socioeconomic status. METHODS: Study participants were recruited from four hospital prenatal care clinics. Low socioeconomic status was defined as no more than 11 years of education and a household income below the poverty level. Higher socioeconomic status was defined as at least 12 years of education and a household income at least one and one-half times the poverty level. All subjects were nulliparous, over 18 years of age, and French-speaking. Questionnaires were administered verbally at the participants' homes during the 30th week of pregnancy, approximately. The Beck Depression Inventory was used to measure depressive symptomatology during the preceding 7 days. RESULTS: Approximately 47% of the low socioeconomic status women and 20% of the higher socioeconomic status women scored 10 or more on the Beck Depression Inventory, indicating a depressive state. Multiple regression analysis demonstrated that chronic stressors (eg, financial and housing problems), negative life events, and inadequate social support were all linked to high depressive symptomatology during pregnancy. CONCLUSION: During pregnancy, depressive symptoms are common, especially in women of low socioeconomic status, and are strongly related to socioenvironmental factors.

Adolescent↗
PubMed1991

[Post natal depression: the socio-environmental factors].

In the weeks and months that follow the birth of a child, between 10 and 20 per cent of mothers experience serious or moderate symptoms of depression. This state of psychological distress affects the mother-infant interaction, and can modify the child's development in the longer term. Recent studies increasingly link these symptoms to environmental and psychosocial stress factors. The setting up of relevant and efficient prevention and promotion programs requires a better understanding of the effect of stress and social support on the mental health of mothers.

Child Development↗
PubMed1989

The components of women's satisfaction with maternity care.

For a better understanding of how women's satisfaction with maternity care is affected, a representative sample of 1790 women from the Montreal area who had delivered four to seven months earlier were mailed a postal questionnaire; 938 (52.4%) completed and returned it. With factor analysis, we determined five dimensions to women's satisfaction: (a) the delivery itself, (b) medical care, (c) nursing care, (d) information received and participation in the decision-making process, and (e) physical aspects of the labor and delivery rooms. Multiple regression analysis was used to determine explicative factors for each of these dimensions of satisfaction. Items relative to the delivery process such as pain intensity, complications, and length of labor were the most important for the delivery experience itself. Participation in the decision-making process was the first component of satisfaction with medical care. Information received appeared to be the major component of their satisfaction with nursing care. The physical environment did not affect women's satisfaction with obstetric care.

Adolescent↗
PubMedDate not supplied

[Factors associated with low birth weight: a multivariate analysis].

The low birth weight of infants is a major public health problem of unknown cause in Benin. We recruited 4,213 pregnant women from a maternity ward in Cotonou for a prospective study. The women were interviewed and further information was obtained from their maternity records. The women were followed until delivery. We found that 6.9% of the births occurred pre-term and there was intrauterine growth retardation in 10.9% of cases. Multiple regression analysis showed that the risks of giving birth to underweight infants were highest for women who were themselves underweight, who had complications due to bleeding or malaria or had social and psychological risk factors. For these particular women, unwanted pregnancy (ORa = 1.60; CI = 1.30-2.00) and lifting heavy loads (ORa = 1.30; CI = 1.10-1.60) were high risk factors. However, adequate prenatal care (ORa = 0.85; CI = 0.69-0.99) and having given birth before were protective factors, reducing the likelihood of a low birth weight. These results have implications for preventive care, in terms of nutrition during pregnancy and psychosociological factors.

Adult↗
PubMedDate not supplied

[Recruitment of Montreal women of very low socioeconomic status for a randomized clinical study].

Studies show that it is difficult to recruit women of low socioeconomic status as clinical research participants. Such an objective was attained though as our results demonstrate in an evaluative study of a program implemented to lower the percentage of low birthweight in four CLSCs of the Island of Montreal between 1994 and 1996. The global recruitment strategy enabled us to reach 56.2% of our goal in 1994 and 77.4% in 1996. Two conclusions can be drawn from this result: the effectiveness of the three methods of recruitment varied according to each participating CLSC, and the global strategy, combined with the mobilization of community resources, was successful in enrolling women of low socioeconomic status.

Adolescent↗
PubMedDate not supplied

[Determinants of satisfaction with medical prenatal care in Quebec women].

This study aims at identifying determinants of satisfaction with medical care during pregnancy, a topic little explored until now. 937 women from the Montreal area answered a mailed questionnaire 4 to 7 months after giving birth. Results show a high level of satisfaction with prenatal care among respondents. Multiple regression analysis reveals that information variables emerge as the main determinants of satisfaction. In fact, not having received desired information appears as the strongest predictor; information pertaining to the delivery process is most often cited by women. The other predictors are events happening during the delivery process. Contrary to findings from other studies, sociodemographic data and characteristics of the physicians do not predict satisfaction. The discussion suggests some guidelines for the measurement of satisfaction with prenatal care as well as implications for practice.

Adolescent↗