Perinatal health: An “alarming” evolution of some indicators – Sciences et Avenir

Falling birth rate, rising neonatal mortality, stable caesarean section… The report describes the state of perinatal health in France for the first time with “alarming” dynamics of some indicators over ten years, especially in foreign countries. France.

This approximately 160-page document, published on Tuesday by Public Health France, collects a range of data on the health status of pregnant women, fetuses and newborns from pregnancy to postpartum (diaper return), from 2010 to 2019.

According to the health agency, this makes it possible for the first time to give a general description of the state of perinatal health in France.

If certain indicators are indicative of a “high and stable level of care” in France, “the report shows a patchy situation across territories with deterioration in overseas departments and regions,” Anne Gallé, director of noncommunicable diseases, told AFP. and trauma in French Public Health.

First observation: declining birth rates in all regions of France except Guyana. The number of births has decreased from 841 thousand in 2010 to 734 thousand in 2019. The main reasons lie in the increase in maternal age of childbearing and the decrease in the birth rate among the youngest women.

For the whole of France, the average age at birth has dropped from 29.4 in 2010 to 30.1 in 2019.

– Diabetes during pregnancy –

At the same time, maternal insecurity appears to be on the rise, with slightly fewer births covered by health insurance (96.8% in 2010 vs. 96.0% in 2019).

Across France, the average age at birth has dropped from 29.4 in 2010 to 30.1 in 2019 (AFP/Archive – MICHEL DAGNO)

And more mothers with irregular public health care status (AME, 1.6% in 2010; 2.5% in 2019) and homeless mothers (5.8% in 2010 in Île-de-France; 22 .8% in 2019).

Although pregnant women smoked less than twenty years ago, France remains one of the European countries with the highest prevalence of maternal smoking in Europe (16.2% of women smoked in the 3rd trimester in 2016).

There is an increase in certain maternal pathologies during pregnancy and the postpartum period, in particular, disorders associated with arterial hypertension (4.5% in 2010; 5.0% in 2019) and gestational diabetes (6.7% in 2019). 2010 and 13.6% in 2019).

This latest increase is partly due to changes in screening methods and an increase in the prevalence of risk factors such as obesity or older maternal age.

The caesarean section rate has remained stable since 2012 (around 20.2%).

The frequency of episiotomies during vaginal delivery also decreased sharply in both primiparous (from 29.5% in 2010 to 10.0% in 2019) and multiparous (from 10.5% to 2.7% over the same period). period).

– Guyana and Mayotte –

Another important observation: the evolution of mortality is controversial, “even disturbing” for both mother and child, Ann Gallay emphasized.

Thus, the maternal mortality rate did not decrease significantly between 2007 and 2009. (9.5 deaths per 100,000 births) and 2013–2015. (8.1 deaths per 100,000 births), as of date of latest available data.

Changes in mortality are contrasting,Mortality trends are contrasting, “even bothering” both mother and child (AFP/Archive – FRED DUFOUR)

And neonatal mortality (between 0 and 27 days of life) increased in metropolitan France from 1.6 deaths per 1,000 births in 2010 to 1.8 deaths per 1,000 births in 2019.

“Work is currently underway to better understand the causes of these deaths,” said Nolwenn Renaud, head of France’s perinatal public health department. In any case, the situation can progress, according to her, “many countries show better results.”

In the overseas departments and regions, the overall picture is even more unfavorable: maternal mortality is 4 times higher than in continental France, stillbirths are 1.5 times higher, neonatal mortality is 2 times higher.

Guyana and Mayotte are the departments where the situation is the worst.

These findings “advocate increased prevention and promotion of perinatal health”, “better access to rights and care, in particular in certain areas” abroad, the report concludes.

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