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Made available in DSpace on 2016-06-02T19:44:12Z (GMT). No. of bitstreams: 1 4806.pdf: 4530433 bytes, checksum: 1f207159269197e82d5c6ef600171202 (MD5) Previous issue date: 2012-12-03 / Diverse factors can compromise the growth and development of individuals including preterm birth. The literature from the area has indicated that children born prematurely may present altered growth and development, mental retardation and learning disabilities. Thus, preterm birth has been studied in diverse scientific fields including Special Education. In this field the studies focus on primary, secondary and tertiary attention, thus contributing to the prevention of deficiencies, to education strategies and to intervention procedures. The present research aims to verify what composes the field of preterm-birth studies in Brazil, from the Capes Thesis Registry, and also to assess the scientific collaboration networks at the intersection between Special Education and preterm births. The study is structured into two steps denominated Study 1 and Study 2. Study 1 corresponds to bibliometric analysis of scientific production on premature birth available in the Capes Theses Database with the objective of reporting the State of the Art in producing knowledge on this theme as reflected in Brazilian theses and dissertations. The methodology of Study 1 was developed in five steps: step 1: construction of a theoretical reference by reading the scientific texts from the areas of Special Education, Information Science and Preterm Birth to provide a scientific basis for the research; step 2: data collection sourced from abstracts of theses and dissertations available in the Capes Theses Database that presented the preterm topic, between 1987 and 2009; step 3: organization, treatment and construction of bibliometric indicators from the registries; step 4: analysis and interpretation of the results found, capturing the concepts exposed in the theoretical reference on scientific production on preterm birth to underpin the analyses of the data obtained. Study 2 corresponds to preterm-birth scientific collaboration networks in the Special Education field. The method of Study 2 involved identification of registries belonging to the Graduate Programs or research lines in Special Education. It was possible to identify 10 registries pertaining to the Graduate Program in Special Education of the Federal University of Sao Carlos and two linked to the Graduate Programs in Education, with research line directed toward Special Education, representing, respectively, the State University of Rio de Janeiro (UERJ) and Federal University of Santa Maria (UFSM). From these twelve registries were selected the curricula of the professors directing the theses and dissertations to compose the scientific collaboration network. The results of Study 1 reveal: increase in scientific production involving the topic during the study period (1987 to 2009); the production is mostly represented by Masters theses; the most highlighted institution was the University of Sao Paulo, rendering the southeast the most prominent region of the country. In relation to the large areas of knowledge, scientific production on preterm birth is concentrated in the Health Sciences area linked to programs in Medicine and Nursing. CAPES, CNPq and FAPESP were the primary funding agencies. As to the gender of thesis and dissertation authors, 79.8% are female and 20.2% male. It was also found that the predominant risk conception is medical/biological while the predominant study locations were neonatal intensive treatment units. The most frequent objectives were studies on aspects of breastfeeding, nutrition, suckling, weaning, periodontal diseases and milk composition. The majority of these studies were directed at preterm cases of gestational time from 31 to 34 weeks and with very low weight (>1500g). The results of Study 2 revealed that production via partnership, identified in the analyzed interface, is a trend in the academic environment; there are few relationships among the advisors or among the institutions that participated in the present study; as a counterpart, within the groups formed, we observed not only scientific collaboration between the different institutions but also a strong relationship between the advisor and advisee. The results presented herein contributed to a portrayal of the field of preterm-birth studies in Brazil which enables visualization of the potentialities and gaps in this knowledge area, to motivate researchers to seek new data sources, and when relevant and desirable, collaborative partnerships between research group and institutions. / Diversos fatores podem comprometer o crescimento e o desenvolvimento dos indivíduos, dentre eles encontra-se a prematuridade. A literatura da área tem apontado que crianças nascidas prematuramente podem apresentar alterações de crescimento e desenvolvimento, retardo mental e distúrbios de aprendizagem. Por isso, em diversos campos científicos a prematuridade tem sido estudada e, entre eles, encontra-se a Educação Especial. Neste campo os estudos enfocam a atenção primária, secundária e terciária contribuindo para a prevenção de deficiências, para as estratégias de educação e para os procedimentos de intervenção. A presente pesquisa tem como objetivo verificar como se constitui o campo de estudos sobre a prematuridade no Brasil a partir do Banco de Teses da Capes e também verificar as redes de colaboração científica na intersecção entre Educação Especial e prematuridade. A pesquisa está estruturada em duas etapas denominadas Estudo 1 e Estudo 2. O Estudo 1 corresponde à análise bibliométrica da produção científica em prematuridade disponibilizadas no Banco de Teses da Capes com o objetivo de relatar o estado da arte da produção do conhecimento sobre essa temática refletida nas dissertações e teses brasileiras. O método do Estudo 1 foi desenvolvido em quatro etapas: etapa 1: construção do referencial teórico por meio de leitura de textos científicos das áreas de Educação Especial, Ciência da Informação e Prematuridade para embasar cientificamente a pesquisa; etapa 2: coleta de dados utilizando como fonte os resumos das teses e dissertações disponibilizadas no Banco de Teses da Capes que apresentaram a temática da prematuridade, no período de 1987 a 2009; etapa 3: organização, tratamento e construção dos indicadores bibliométricos dos registros; etapa 4: análise e interpretação dos resultados encontrados, recuperando-se os conceitos expostos no referencial teórico sobre produção científica em prematuridade para fundamentar as análises dos dados obtidos. Os resultados do Estudo 1 revelam: aumento da produção científica envolvendo a temática no período estudo (1987 a 2009); a produção está representada, em sua maioria, pelas dissertações de mestrado; a instituição que mais se destacou foi a Universidade de São Paulo, consequentemente, a região do país que se destacou foi a região Sudeste. Em relação às grandes áreas do conhecimento a produção científica em prematuridade está concentrada na área de Ciências da Saúde vinculadas aos programas da área de Medicina e Enfermagem. As agências financiadoras que mais se destacaram foram CAPES, CNPq e FAPESP. Com relação ao gênero dos autores das teses e dissertações verificou-se que 79,8% são do sexo feminino 20,2% do sexo masculino. Ficou constatado também que a concepção de risco predominante é a concepção médico/biológico e o local da realização dos estudos predominante foram as Unidades de Tratamento Intensivo Neonatal. Com relação aos objetivos verificou-se que os estudos que tratam sobre os aspectos do aleitamento, nutrição, sucção, desmame, doenças periodentais e composição do leite tiveram maior frequência de aparecimento. Esses estudos foram direcionados, em sua maioria, aos prematuros com tempo gestacional entre 31 a 34 semanas e com muito baixo peso (>1500g). O Estudo 2 corresponde as redes de colaboração científica em prematuridade no campo da Educação Especial. Os resultados do Estudo 2 constataram que a produção em parcerias é uma tendência no meio acadêmico, sendo também identificada na interface analisada; há poucos relacionamentos entre os orientadores e também entre as instituições que participaram do presente estudo; em contrapartida; foi possível observar que dentro dos grupos formados ocorre a colaboração científica entre diferentes instituições e também outra relação forte que pode ser percebida é a de orientador e orientando. Os resultados apresentados contribuíram para retratar o campo de estudos sobre prematuridade no Brasil, permitindo visualizar tanto as potencialidades como as lacunas dessa área do conhecimento, despertando nos pesquisadores motivação para a busca de novas fontes de dados e, se pertinente e desejável, parcerias entre grupos de pesquisas e instituições, numa perspectiva colaborativa.

Made available in DSpace on 2016-06-02T19:46:30Z (GMT). No. of bitstreams: 1 6354.pdf: 1294561 bytes, checksum: 3be7fe07f80854809bf2a4239bbf19d9 (MD5) Previous issue date: 2014-02-20 / Financiadora de Estudos e Projetos / Children born premature and extreme birth weight are more likely to have cognitive, neuropathological and behavioral changes such as attention deficit hyperactivity disorder (ADHD). Early identification of ADHD is important because it is known that the effects caused by this disorder in school and personal lives may pass into adulthood, and the social and educational impact can cause those students requiring specialized educational assistance. In this sense, the present study aimed at identifying early signs suggestive of Attention Deficit Hyperactivity Disorder (ADHD) in children at 3 years of age with a history of extreme preterm birth and low birth weight. The sample comprised 29 children with a history of extreme prematurity and low birth weight with 3 years old now, enrolled in municipal schools. Participants were first characterized with the CCEB (Economic Classification Criterion Brazil) to homogenize the sample. After, were evaluated with the SDQ questionnaire version Pa 3/4 years (for the parents) and version Pr 3/4 years (for teachers). We also used the Denver II screening test in order to evaluate the overall development of these children and relate to behavioral findings. From the statistical correlation - Pearson Correlation - the data we found that there was a significant correlation between the variables IG with hyperactivity subscale, indicated by SDQ Pa (R= -,465*), correlation between IG and birth weight with the hyperactivity subscale, indicated by SDQ Pr ( R= -,528**; R= -,429*, respectivamente). All these correlations were significantly negative which confirms findings in the literature, that is, the lower gestational age and birth weight, the greater are the chances of having behavioral problems suggestive of ADHD. It was also verified that parents and teachers rated similarly children's development. It is concluded that children with a history of preterm birth and low birth weight have signs suggestive of ADHD at 3 years of age, and that the performance of screening for early detection of these signals facilitates therapeutic intervention and can thereby reduce the performance impact academic school with a history of extreme preterm birth and low birth weight. / Crianças nascidas prematuras extremas e com baixo peso, igual ou inferior a 2500g, estão mais propensas a apresentarem alterações cognitivas e neuropatológicas, bem como alterações comportamentais, tais como o Transtorno de Déficit de Atenção e Hiperatividade (TDAH). A identificação precoce do TDAH é importante, pois sabe-se que as repercussões causadas por este transtorno na vida escolar e pessoal podem repercutir até a vida adulta, e o impacto social e educacional pode fazer com que esses alunos necessitem de assistência educacional especializada. Neste sentido, o presente estudo teve por objetivo geral identificar sinais precoces sugestivos do Transtorno de Déficit de Atenção e Hiperatividade (TDAH), em crianças aos 3 anos de idade com histórico de nascimento prematuro extremo e baixo peso ao nascer. A amostra foi composta por 29 crianças com histórico de prematuridade extrema e baixo peso ao nascer com 3 anos de idade atual, matriculadas na rede municipal de ensino. Os participantes foram caracterizados primeiramente com o CCEB (Critério de Classificação Econômica Brasil), a fim de homogeneizar a amostra. Após foram avaliado com o questionário SDQ versão Pa3/4anos (destinado a pais) e versão Pr3/4 anos (destinado a professores). Foi utilizado também, o teste de triagem Denver II, no intuito de avaliar o desenvolvimento global destas crianças e relacionar com os achados comportamentais. A partir da análise estatística correlacional Correlação de Pearson - dos dados foi possível verificar que houve uma correlação significativa entre as variáveis IG com a subescala hiperatividade, indicados pelo SDQ Pa (R= -,465*), correlação entre IG e peso ao nascer com a subescala hiperatividade, indicados pelo SDQ Pr ( R= -,528**; R= - ,429*, respectivamente). Todas essas correlações se apresentaram significativamente negativa o que corrobora com os achados da literatura, isto é, quanto menor a IG e peso ao nascer, maiores são as chances de apresentarem problemas comportamentais sugestivos de TDAH. Foi possível verificar também, que pais e professores avaliaram de forma semelhante o desenvolvimento das crianças. Conclui-se assim, que crianças com histórico de nascimento prematuro e baixo peso apresentam sinais sugestivos de TDAH aos 3 anos de idade, e que a realização de triagem para detectar precocemente estes sinais facilita a intervenção terapêutica e pode com isso reduzir o impacto no desempenho acadêmico de escolares com histórico de nascimento prematuro extremo e baixo peso.

Les yeux forment des avant-postes visuels importants du cerveau. Comme les autres organes, la rétine sensorielle des yeux est vulnérable aux effets nocifs des facteurs environnementaux, tels que la lumière et l'oxygène. Dans ce travail, nous nous sommes concentrés sur l’impact de l’exposition à une lumière constante et l’hyperoxie prolongée sur l'architecture et la fonction rétinienne. Dans la première partie de notre étude, nous avons montré qu’ une exposition de sept jours à une lumière constante perturbe la phagocytose des bâtonnets et cônes et régule négativement leur renouvellement dans la « rétine riche en cônes " d’Arvicanthis ansorgei. Notre étude donne un aperçu sur la physiopathologie des cônes, ce qui représente la principale source de handicap visuel dans une variété de pathologies rétiniennes, y compris la rétinite pigmentaire (RP) et la dégénérescence maculaire liée à l'âge (DMLA). Dans la deuxième partie de notre étude, nous avons montré qu’ une exposition de cinq jours à l’hyperoxie entraîne chez les souris néonatales une perte significative de cellules ganglionnaires dans les régions périphériques de la rétine, et de cellules à mélanopsine (ipRGC). L’exposition prolongée à l’hyperoxie perturbe également la capacité de photoentrainment des animaux probablement due à la perte des ipRGC et la perte de la rhodopsine dans les segments externes des bâtonnets chez les animaux traités. / Eyes form important visual outposts of the brain. Just like other organs, sensory retina in the eyes is also vulnerable to the injurious effects of environmental factors; such as light and oxygen. In this work, we have focused on the impacts of constant prolonged light and hyperoxia on the retinal architecture and function. In the first part of our study, we show that seven days of constant light disrupts rod and cone phagocytosis and downregulates their turnover in the “cone rich retina” of Arvicanthis ansorgei. The study gives an insight on the cone pathophysiology, which represents the major source of visual handicap in a variety of retinal pathologies, including retinitis pigmentosa (RP) and age-related macular degeneration (AMD). In the second part of our study, we show that five days of hyperoxia treatment in the neonatal mice results in the significant loss of retinal ganglion cells in the peripheral regions; the loss of melanopsin expressing retinal ganglion cells (ipRGC) was found to be significant. Hyperoxia also affects the photoentrainment capability of the animals probably because of the loss of ipRGC and the loss of rhodopsin in the outer segments of the photoreceptors in the treated animals.

Les nouveau-nés ne sont pas des patients comme les autres. Contrairement aux patients plus âgés, il existe pour les nouveau-nés des recommandations qui guident leur prise en charge ou leur non-prise en charge dès la naissance en fonction de critères spécifiques, notamment l’âge gestationnel. Or l’âge gestationnel est imprécis, et demeure un mauvais prédicteur de la survie ou du pronostic des nouveau-nés. De tels critères ne sont pas utilisés pour les patients plus âgés. En plus d’être réanimés différemment, les nouveau-nés décèdent aussi autrement. Contrairement aux patients plus âgés qui décèdent majoritairement en recevant des soins actifs à visée curative, de nombreux nouveau-nés décèdent suite à une décision de réorientation de soins, et souvent ceux-ci meurent malgré une relative stabilité physiologique, en raison d’inquiétudes se rapportant à leur qualité de vie future. Lorsqu’interrogés, malgré le fait qu’une majorité d’intervenants en santé croient que la réanimation d’un nouveau-né fragile ou à risque à la naissance est dans son meilleur intérêt, une majorité presqu’équivalente d’intervenants seraient prêts à redéfinir ce meilleur intérêt en fonction de la famille et à malgré tout à lui offrir des soins de confort. Ceci n’est pas le cas avec les patients plus âgés. Cette dévalorisation est expliquée par le fait que les nouveau-nés sont perçus comme moralement différents des patients plus âgés. Les raisons de ce statut moral particulier sont multiples, mais incluent notamment le contexte historique et socioculturel, l’absence de relations sociales préexistantes, un attachement perçu comme étant moindre, et l’influence de biais, de valeurs et d’expériences personnelles et professionnelles défavorables aux nouveau-nés. Nous croyons que cette différence de statut moral doit être identifiée et reconnue, et doit alimenter certaines réflexions professionnelles et sociales, notamment par rapport à sa désirabilité et aux conséquences qui en découlent. / Neonates are different. Contrary to older patients, professional guidelines specifically addressing the resuscitation or the non-resuscitation of neonates have been established and are being used by healthcare institutions worldwide. These guidelines are mostly built around gestational age criteria. Unfortunately, gestational age is imprecise and is not a good predictor of survival or long-term prognosis. This may not be the typical perspective when dealing with older patients. Not only are neonates resuscitated differently, their modes of death are also not the same. Unlike older patients who mostly die while receiving acute care, many neonates die following a decision to withdraw or withhold care, and the majority of these die in a condition of relative physiologic stability because of concerns for their future quality of life. When investigated or surveyed, even though a majority of health care providers believe resuscitating a fragile neonate is in the baby’s best interest, a similar majority is also willing to redefine this best interest according to family wishes and to accept comfort care. This is not the case with older patients. This devaluation is explained by the fact that neonates are perceived as being morally different. The reasons explaining this difference in moral status are many but include the historical and socio-cultural context, the absence of long standing pre-existing social relationships, an attachment to neonates that is perceived as being inferior, and the influence of professional and personal biases, values, and experiences that are unfavorable to neonates. We believe this difference in conferred moral status needs to be recognized and acknowledged, and should further professional and social reflections about its desirability and consequences.

Objectif: Cette étude vise à examiner l’issue de la grossesse des mères-nées haïtiennes pour la prématurité, la naissance de faible poids (NFP) et le retard-de-croissance intra-utérine (RCIU) et étudier leur tendance temporelle au Québec. Méthode: Étude populationnelle sur les naissances vivantes simples au Québec de 1981-2006 (N = 2 193 637). À l’aide des modèles de régression logistique, prenant comme référence les mères-nées canadiennes, les associations entre l’issue défavorable de grossesse et les mères-nées haïtiennes étaient étudiées. Résultats: Les proportions de prématurité, de NFP et du RCIU sont plus fréquentes chez les mères-nées haïtiennes (8,5%, 7,5% et 12,6% respectivement) que chez les Canadiennes (5,8%; 5,1% et 11,5% respectivement). Ajustés pour les variables de confusions potentielles (âge maternel, éducation, parité, statut matrimonial, sexe, période-de-naissance), les susceptibilités de prématurité, NFP et RCIU demeuraient plus élevés chez les mères-nées haïtiennes (RC 1,44 IC 95% [1,36-1,52] ; RC 1,40 IC 95% [1,32-148] ; RC 1,09 IC 95% [1,04-1,14] respectivement). Les susceptibilités de prématurité, de NFP et du RCIU augmentaient avec le temps chez les mères-nées haïtiennes. Conclusion : Les mères-nées haïtiennes ont une issue de grossesse défavorable pour la prématurité, NFP et RCUI comparée aux mères-nées canadiennes. Des recherches sur les facteurs responsables de ces associations et des interventions pour améliorer la santé périnatale des immigrants haïtiens, diminuer les inégalités de santé sont nécessaires au Québec. / Objective: This study aimed to examine birth outcomes among Haitian-born mothers specifically prematurity, low birth weight (LBW) and small for gestational age (SGA) births and their trends over time in Quebec. Method: Analysing for a 25 years period a cohort of 2 193 637 singleton live births from the Quebec birth file. Multiple logistic regression models were used to examine adverse birth outcomes for Haitian-born relative to Canadian-born mothers. Results: Haitian-born mothers had higher proportions of preterm birth, LBW and SGA (8.5%, 7.5% and 12.6% respectively) outcomes than Canadian-born mothers (5.8%, 5.1% and 11.5% respectively). In models accounting for maternal age, education, marital status, gravidity, infant sex and period, Haitian-born had a greater odds of premature births, LBW and SGA (OR 1.44 CI 95% [1,36-1,52]; OR 1.40 95% [1,32-148]; OR 1.09 95% [1,04-1,14] respectively) relative to Canadian-born mothers. When examined over time the odds of premature birth, LBW and SGA increased with time among Haitian-born mothers in Québec. Conclusion: Haitian-born mothers have a greater likelihood of adverse birth outcomes relative to Canadian-born mothers. Research on the factors underlying these associations and interventions to improve prenatal health and reduce health disparity among Haitian-born minority are needed in Quebec.

L’infection génitale par le Virus du Papillome Humain (VPH) est l’infection transmissible sexuellement la plus fréquente. Sa prévalence la plus élevée est retrouvée chez les femmes en âge de procréer. Bien que la littérature expérimentale s’accorde sur la plausibilité biologique de l’effet du VPH sur les issues négatives de grossesse, les résultats des études observationnelles sont équivoques. Parmi ces issues négatives figure l’accouchement prématuré qui reste une cause majeure de mortalité périnatale et de morbidité à vie dans le monde. La présente thèse avait alors pour but de faire la lumière sur la qualité de la littérature actuelle sur les issues négatives de grossesse en lien avec le VPH en général et d’approfondir l’association entre le VPH et l’accouchement prématuré en particulier. À cette fin, trois objectifs de recherche étaient visés, à savoir: 1) évaluer systématiquement l’ampleur de l’association entre l’infection VPH et les issues négatives de grossesse dans la littérature et la qualité des évidences sur ces relations, 2) estimer l’association entre l’infection VPH pendant la grossesse et l’accouchement prématuré et 3) identifier les déterminants de la transmission du VPH dans le placenta chez les femmes infectées par le VPH au niveau vaginal. Trois analyses ont été menées pour répondre à chacun des objectifs. D’abord, nous avons effectué une revue systématique et des méta-analyses pour chacune des issues négatives de grossesse suivantes: avortement spontané, rupture prématurée et/ou préterme et des membranes, accouchement prématuré, faible poids de naissance, retard de croissance intra-utérine, troubles hypertensifs gestationnels et mortinaissance. Ensuite, en utilisant les données des femmes éligibles de la cohorte prospective HERITAGE (n=899), nous avons estimé l’association entre l’infection VPH (pendant la grossesse et dans le placenta) et l’accouchement prématuré. Dans un modèle de régression logistique, un ajustement pour la confusion a été assuré par pondération par l’inverse de probabilité de l’infection VPH au premier trimestre en fonction des caractéristiques maternelles. Enfin, l’analyse des déterminants du VPH dans le placenta a été réalisée sur l’échantillon de la cohorte de femmes positives au VPH au premier trimestre de grossesse (n=354) en utilisant un modèle d’équations d’estimation généralisée. La revue systématique et les méta-analyses ont montré que l’infection VPH est associée à plusieurs issues négatives de grossesse dont l’accouchement prématuré. Cependant, ces résultats doivent être interprétés avec prudence, compte tenu des limites dans certaines études en raison d’erreur de mesure de l’exposition au VPH, d’une détection du VPH en dehors de la période de grossesse, et d’un contrôle insuffisant pour la confusion. Les résultats de notre étude de cohorte prospective ont montré que la persistance des VPH16/18 pendant la grossesse et la présence du VPH dans le placenta sont associées à l’accouchement prématuré avec un odds ratio ajusté (aOR) de 3,72 (IC 95% 1,47-9,39) et 2,53 (IC 95% 1,06- 6,03) respectivement. Cet effet est indépendant des antécédents de traitement de dysplasies cervicales. Par ailleurs, la présence du VPH dans le placenta est associée à l’origine ethnique autre que blanc (aOR 1,78; IC 95% 1,08-2,96), aux anomalies cervicales (aOR 1,92; IC 95% 1,14-3,24), à l’infection génitale ou urinaire (aOR 2,32; IC 95% 1,15-4,68), à la coinfection VPH au 1er trimestre (aOR 2,56; IC 95% 1,72-3,83), à la persistance d’un VPH à haut risque autre que les génotypes 16/18 (2,31; IC 95% 1,20-4,45) et à la persistance des VPH-16/18 pendant la grossesse (aOR 4,55; IC 95% 2,40-8,66). Dans l’ensemble, les résultats de cette thèse apportent de nouvelles connaissances sur l’infection VPH vaginale pendant la grossesse et dans le placenta. L’association entre l’accouchement prématuré et la persistance du VPH-16/18 en cours de grossesse ou l’infection VPH dans le placenta indique qu’un certain nombre d’accouchements prématurés, jusque-là inexpliqués, pourraient être en lien avec le VPH. Cet effet direct de l’infection VPH sur l’accouchement prématuré vient s’ajouter à celui, déjà montré, du traitement cervical des lésions dysplasiques. Le VPH placentaire est associé aux marqueurs d’une réponse immunitaire inadéquate contre le VPH vaginal. Nos résultats plaident en faveur de la couverture vaccinale optimale contre le VPH dans le but d’alléger le fardeau des naissances prématurées. / Human Papillomavirus (HPV) genital infection is the most common sexually transmitted infection. Its highest prevalence is found in women of childbearing age. Although experimental studies agree on the biological plausibility of detrimental effect of HPV on pregnancy outcomes, observational studies yielded contradictory findings. Among these negative outcomes there is preterm delivery, which remains a major cause of perinatal mortality and lifelong morbidity worldwide. Therefore, this thesis aimed to shed light on the quality of the current literature on negative outcomes related to HPV in general and specifically to further investigate the association between HPV and preterm birth. We targeted three research objectives: 1) systematic assessment of the association between HPV infection and negative pregnancy outcomes in the literature and the quality of the evidence on these relationships, 2) estimate the association between HPV infection during pregnancy and preterm delivery; and 3) to identify the determinants of HPV transmission in the placenta in women infected with in the first trimester. Three analyzes were carried out to meet each of the objectives. We performed a systematic review and meta-analyzes for each of the following negative pregnancy outcomes: spontaneous abortion, premature and / or preterm rupture and membranes, preterm birth, low birth weight, intra-uterine growth retardation, pregnancy induced hypertensive disorders and stillbirth. Using data from eligible women in the HERITAGE prospective cohort (n = 899), we assessed the association between HPV infection (during pregnancy and in the placenta) and preterm birth. In a logistic regression model, we adjusted for confounding by inverse propensity treatment weighting of HPV infection in the first trimester based on maternal characteristics. Finally, the analysis of the determinants of HPV in the placenta was performed on the sample of the cohort of HPV positive women in the first trimester of pregnancy (n = 354) using a generalized estimation equations model. The systematic review and meta-analyzes showed that HPV infection is associated with several negative pregnancy outcomes including preterm birth. However, these results should be interpreted with caution, given the limitations in some studies regarding misclassification of HPV exposure, inappropriate HPV time-point detection, and insufficient control for confusion. Our prospective cohort study showed that the persistence of HPV16/18 during pregnancy and the presence of any HPV in the placenta are associated with preterm birth with an adjusted odds ratio (aOR) of 3.72 (CI 95 % 1.47-9.39) and 2.53 (95% CI 1.06-6.03) respectively. These findings are independent of the history of cervical dysplasia treatment. In addition, the presence of any HPV in the placenta is associated with ethnic origin other than white (aOR 1.78; 95% CI 1.08-2.96), cervical abnormalities (aOR 1.92; 95% CI 1.14-3.24), genital or urinary infection (aOR 2.32; 95% CI 1.15-4.68), HPV coinfection in the 1st trimester (aOR 2.56; 95% CI 1.72-3.83), persistence of high-risk HPV other than genotypes 16/18 (2.31; 95% CI 1.20-4.45) and persistence of HPV-16/18 during pregnancy (aOR 4.55; 95% CI 2.40-8.66). Overall, our findings provide new evidence on vaginal HPV infection during pregnancy and in the placenta. The association between preterm birth and persistence of HPV-16/18 during pregnancy or any HPV infection in the placenta indicates that a number of unexplained preterm deliveries may be related to HPV. This direct effect of HPV infection on preterm birth is in addition to that already shown of cervical treatment of dysplastic lesions. Placental HPV is associated with markers of an inadequate immune response against vaginal HPV. Our results argue in favor of an increase in vaccine coverage against HPV in order to reduce the burden of preterm births.

Changes in bone and mineral metabolism and the role of vitamin D in very low birth weight infants. Firstly, the aim of dissertation work was to estimate physiological parathyroid hormone (PTH) levels and their relationship with bone metabolism parameters in otherwise healthy preterm newborns with birth weight 1000-1500 g. Secondly, to evaluate vitamin D status in mothers and their very low birth weight infants (VLBW) at birth and at discharge with currently recommended supplementation of vitamin D. Thirdly, to compare clinical outcomes of VLBW infants with 25-hydroxy vitamin D [25(OH)D] levels ≤ and > 25 nmol/l in umbilical cord blood and finally to evaluate umbilical cord vitamin D as a risk factor for respiratory distress syndrome in preterm infants. It is a set of prospective observational studies involving immature newborns with birth weight below 1500 g. The parameters of mineral and bone metabolism were analysed in umbilical cord blood and newborn serum and urine during hospitalisation (PTH, 25-hydroxy vitamin D, S-Ca, S-P, ALP, U-Ca, U-P) and in pregnant women before delivery (25-hydroxy vitamin D). Bone mineralization was evaluated by bone densitometry. In a pilot study, from the total 134 examined serum samples for PTH levels the estimated reference range was 1.6 - 9.3 pmol/l. From the...

Les nouveau-nés prématurés sont à risque de développer des séquelles neurodéveloppementales pouvant se manifester de la petite enfance jusqu’à l’âge adulte. La relation mère-enfant précoce figure parmi les facteurs pouvant améliorer leur neurodéveloppement. La principale composante de cette relation est la sensibilité maternelle, soit la capacité de détecter, d’interpréter et de répondre rapidement aux besoins du nouveau-né. Cependant, en raison de l’immaturité des nouveau-nés prématurés ainsi que du stress et de l’anxiété vécus par les mères pendant l’hospitalisation, celles-ci sont à risque de développer une sensibilité maternelle sous-optimale. De par leurs compétences, leurs valeurs et leurs activités réservées, les infirmières à l’unité de soins intensifs néonatals (USIN) jouent un rôle de premier plan pour favoriser la sensibilité maternelle dès l’hospitalisation des nouveau-nés prématurés. Les données scientifiques actuelles ne sont suffisantes ni en quantité ni en qualité afin d’orienter les interventions que pourraient concrètement réaliser les infirmières auprès de la dyade mère-nouveau-né prématuré afin de favoriser de façon très précoce, soit dès l’hospitalisation, la sensibilité maternelle. Le but de la thèse comportait deux volets : 1- développer une intervention infirmière très précoce selon une approche combinant la théorie et les données empiriques pour favoriser la sensibilité maternelle et le neurodéveloppement des nouveau-nés prématurés à l’USIN; et 2- mettre à l’essai et évaluer la faisabilité, l’acceptabilité et estimer les effets préliminaires de l’intervention infirmière sur la sensibilité maternelle et le neurodéveloppement des nouveau-nés prématurés à l’USIN. Une intervention infirmière novatrice multifactorielle nommée GP_Posit a été développée. GP_Posit est une intervention individuelle hebdomadaire durant laquelle l’infirmière crée une relation de participation guidée avec la mère, dans un contexte de participation aux soins et au positionnement du nouveau-né prématuré. Basée sur la Théorie de l’Attachement, la Théorie de la Participation Guidée et la Théorie Synactive du Développement, GP_Posit est principalement conçue afin de favoriser la sensibilité maternelle et le neurodéveloppement du nouveau-né prématuré. Ensuite, une étude pilote randomisée à deux groupes a été menée dans une USIN de niveau III d’un centre hospitalier universitaire mère-enfant. Au total, 20 dyades composées de mères et de leur nouveau-né prématuré ont été recrutées et randomisées au groupe expérimental (GP_Posit; n=10) ou au groupe contrôle (soins standards; n=10). Les résultats montrent que GP_Posit est faisable et acceptable pour les mères de nouveau-nés prématurés ainsi que pour l’équipe de recherche. Toutefois, au niveau de la faisabilité et l’acceptabilité du devis relatif à l’essai clinique randomisé, des difficultés ont été rencontrées au niveau du recrutement et la collecte de données au post-test. Les effets préliminaires estimés montrent une tendance vers un effet large indiquant une augmentation de la sensibilité maternelle chez les mères du groupe expérimental. Quant à l’effet préliminaire sur le neurodéveloppement, les nouveau-nés prématurés du groupe contrôle étaient légèrement favorisés. Une seconde étude pilote permettrait de mettre à l’essai des procédures modifiées de recrutement et collecte de données au post-test. Éventuellement, un essai contrôlé randomisé multicentrique à grande échelle permettra d’apprécier davantage les effets de GP_Posit sur la sensibilité maternelle et le neurodéveloppement des nouveau-nés prématurés. / Preterm infants are at risk of neurodevelopmental impairments which can manifest from infancy through adulthood. The early mother-infant relationship is one of the factors that can improve their neurodevelopment. The main component of this relationship is maternal sensitivity, that is the mother’s ability detect, interpret and respond in an appropriate and timely manner to her infant’s needs. However, due to the immaturity of preterm infants as well as the stress and anxiety experienced by mothers during hospitalization, they are at risk of developing suboptimal maternal sensitivity. Neonatal nurses play a key role and have the necessary skills to promote maternal sensitivity in the neonatal intensive care unit (NICU). However, the current evidence is neither sufficient nor of sufficiently good quality to guide the interventions that could be implemented by neonatal nurses to promote maternal sensitivity in the NICU. The aim of the thesis was twofold: 1- develop an innovative very early nursing intervention using an approach combining theory and empirical data to promote maternal sensitivity and neurodevelopment of preterm infants in the NICU; and 2- to implement and assess the feasibility, acceptability and estimate of the preliminary effects of this nursing intervention on maternal sensitivity and neurodevelopment of preterm infants in the NICU. A very early multifaceted nursing intervention named GP_Posit was developed. GP_Posit is a weekly individual intervention where nurses create a guided participation relationship with mothers, in a context of participation in care and positioning of the preterm infant. Based on Attachment Theory, Guided Participation Theory and Synactive Theory of Development, GP_Posit is primarily designed to promote maternal sensitivity and neurodevelopment of the preterm infant. A two-group randomized pilot study was conducted in a level III NICU of a mother-infant teaching hospital. A total of 20 dyads composed of mothers and preterm infants were recruited and randomized to the experimental group (GP_Posit; n = 10) or control group (standard care; n = 10). Results show that GP_Posit is feasible and acceptable for mothers of preterm infants as well as for the research team. Regarding the feasibility and acceptability of the randomized controlled trial study design, challenges were encountered in the recruitment and post-test data collection procedures. The preliminary effects showed a trend towards a large effect in increasing maternal sensitivity in experimental group mothers. As for the preliminary effect on neurodevelopment, preterm infants in the control group had an advantage. A second pilot study would be the opportunity to test modified recruitment and post-test data collection procedures. Eventually, a large-scale, multicenter randomized controlled trial would allow a better understanding of the effectiveness of GP_Posit on maternal sensitivity and preterm infant neurodevelopment.