Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 4 uppsatser.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-05, page: 2667. Advisers: Kim Waller; Steven Kelder. Includes bibliographical references.

Submitted by ANDRESSA TRECENTI DAMACENA null (dretrecenti@hotmail.com) on 2016-05-04T11:16:43Z No. of bitstreams: 1 Dissertacao Andressa - Repositório.pdf: 2946507 bytes, checksum: 9abbfaa6ae7910659e2f50cdfcba9757 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-05-04T20:44:45Z (GMT) No. of bitstreams: 1 damacena_at_me_bot.pdf: 2946507 bytes, checksum: 9abbfaa6ae7910659e2f50cdfcba9757 (MD5) / Made available in DSpace on 2016-05-04T20:44:45Z (GMT). No. of bitstreams: 1 damacena_at_me_bot.pdf: 2946507 bytes, checksum: 9abbfaa6ae7910659e2f50cdfcba9757 (MD5) Previous issue date: 2016-02-23 / Introdução: Pré-eclâmpsia é uma síndrome sistêmica específica da gestação com etiopatogenia ainda não esclarecida, porém acredita -se ser decorrente de alterações no processo de invasão trofoblástica, com consequente inadequado suprimento sanguíneo uterino e estresse oxidativo do tecido placentário. O aumento da concentração de ácido úrico sérico materno (AU) em mulheres com pré-eclâmpsia tem sido associado com a gravidade da hipertensão, proteinúria e prognóstico materno e perinatal na gestação. Objetivos: Identificar a associação entre a concentração sérica de ácido úrico e resultados maternos e perinatais adversos e correlacionar a concentração sérica do ácido úrico materno com recémnascidos pequenos para idade gestacional e proteinúria materna. Sujeitos e Métodos: Foi realizado estudo retrospectivo, em gestantes com pré-eclâmpsia, as quais foram estratificadas de acordo com a dosagem de ácido úrico sérico em dois grupos: I (inferior a 6 mg/dL) e II (igual ou superior a 6 mg/dL) e avaliados resultados adversos maternos e perinatais. Resultados: No grupo II houve maior frequência de crise hipertensiva(25%), eclampsia(6,9%), síndrome HELPP parcial (7,8%) e síndrome HELLP(6,9%), maior número de recém-nascidos pequenos para idade gestacional(47%), menor peso do recém-nascido, maior porcentagem de óbito fetal(1,8%), de prematuridade(68%) e de índice de Apgar no 1º minuto(38%). Conclusões: Os resultados demonstram que as paciente com ácido úrico elevado apresentam piores resultados adversos tanto maternos quanto perinatais, sendo assim a dosagem de ácido úrico sérico materna associadas a outros exames clínicos e laboratoriais, pode auxiliar nos processos de decisão na prática obstétrica. / Introduction: Preeclampsia is a specific systemic disease of pregnancy with unknown etiology, but it is believed to be due to changes in the process of trophoblastic invasion, leading to an inadequate uterine blood supply and oxidative stress of the placental tissue. Increasing of maternal uric acid serum concentration (UA) in women with pre-eclampsia has been associated with the severity of hypertension, proteinuria and maternal and perinatal outcome on pregnancy. Objectives: Identify the association between serum uric acid and adverse maternal and perinatal outcomes. More specifically, the correlation of maternal UA serum concentration with newborn size for gestational age and maternal proteinuria. Subjects and Methods: Cross observational study in pregnant women with preeclampsia, which were stratified according to dose of serum uric acid into two groups, as follow: I (below 6 mg/dL) and II (greater or equal to 6 mg/dL). Maternal and perinatal adverse outcomes were examined. Results were analyzed by T - Student and chi-square tests and correlations were evaluated by Pearson test. The level of significance used was 5%. Results: In group II there were a greater frequency of hypertensive crisis, eclampsia, partial HELPP syndrome and HELLP syndrome. Also it were observed an increased number of small newborns for gestational age, lower weight of the newborn, the higher percentage of fetal death, prematurity and index Apgar at 1 minute. Conclusions: The results suggest that patients with higher uric acid have worse adverse outcomes both for maternal and perinatal. In conclusion, the dosage of maternal serum uric acid associated with other clinical and laboratory tests can help in the decision on obstetrical practice.

Orientador: Vera Terezinha Medeiros Borges / Resumo: Introdução: Pré-eclâmpsia é uma síndrome sistêmica específica da gestação com etiopatogenia ainda não esclarecida, porém acredita -se ser decorrente de alterações no processo de invasão trofoblástica, com consequente inadequado suprimento sanguíneo uterino e estresse oxidativo do tecido placentário. O aumento da concentração de ácido úrico sérico materno (AU) em mulheres com pré-eclâmpsia tem sido associado com a gravidade da hipertensão, proteinúria e prognóstico materno e perinatal na gestação. Objetivos: Identificar a associação entre a concentração sérica de ácido úrico e resultados maternos e perinatais adversos e correlacionar a concentração sérica do ácido úrico materno com recémnascidos pequenos para idade gestacional e proteinúria materna. Sujeitos e Métodos: Foi realizado estudo retrospectivo, em gestantes com pré-eclâmpsia, as quais foram estratificadas de acordo com a dosagem de ácido úrico sérico em dois grupos: I (inferior a 6 mg/dL) e II (igual ou superior a 6 mg/dL) e avaliados resultados adversos maternos e perinatais. Resultados: No grupo II houve maior frequência de crise hipertensiva(25%), eclampsia(6,9%), síndrome HELPP parcial (7,8%) e síndrome HELLP(6,9%), maior número de recém-nascidos pequenos para idade gestacional(47%), menor peso do recém-nascido, maior porcentagem de óbito fetal(1,8%), de prematuridade(68%) e de índice de Apgar no 1º minuto(38%). Conclusões: Os resultados demonstram que as paciente com ácido úrico elevado apresentam piores resulta... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Preeclampsia is a specific systemic disease of pregnancy with unknown etiology, but it is believed to be due to changes in the process of trophoblastic invasion, leading to an inadequate uterine blood supply and oxidative stress of the placental tissue. Increasing of maternal uric acid serum concentration (UA) in women with pre-eclampsia has been associated with the severity of hypertension, proteinuria and maternal and perinatal outcome on pregnancy. Objectives: Identify the association between serum uric acid and adverse maternal and perinatal outcomes. More specifically, the correlation of maternal UA serum concentration with newborn size for gestational age and maternal proteinuria. Subjects and Methods: Cross observational study in pregnant women with preeclampsia, which were stratified according to dose of serum uric acid into two groups, as follow: I (below 6 mg/dL) and II (greater or equal to 6 mg/dL). Maternal and perinatal adverse outcomes were examined. Results were analyzed by T - Student and chi-square tests and correlations were evaluated by Pearson test. The level of significance used was 5%. Results: In group II there were a greater frequency of hypertensive crisis, eclampsia, partial HELPP syndrome and HELLP syndrome. Also it were observed an increased number of small newborns for gestational age, lower weight of the newborn, the higher percentage of fetal death, prematurity and index Apgar at 1 minute. Conclusions: The results suggest that pati... (Complete abstract click electronic access below) / Mestre

Introdução: Idade gestacional (IG) e peso ao nascer, assim como a frequência de nascimentos PIG (pequeno para idade gestacional), são importantes preditores da morbimortalidade neonatal. Os partos cesáreos têm sido indicados como um dos fatores que tem colaborado para o aumento da prematuridade. Conhecer a distribuição populacional da IG segundo tipo de parto e estabelecer a proporção de nascimentos considerados PIG e seus fatores de risco pode contribuir para o conhecimento do perfil dos nascidos vivos no Município de São Paulo (MSP). Objetivos: Estudar o padrão de distribuição da idade gestacional nos nascimentos ocorridos no MSP; calcular a prevalência de PIG com base em três curvas de crescimento fetal (Alexander, Fenton e Kim e Intergrowth); e investigar os fatores risco para PIG. Metodologia: Estudo transversal com base nos dados do Sistema de Informações sobre Nascidos Vivos (Sinasc). Foram estudados nascimentos hospitalares e de gestações únicas, nos anos de 2013 e 2014, no município de São Paulo. Realizou-se uma análise de distribuição dos nascimentos segundo IG, comparando tipo de parto e de hospital (SUS e não SUS). Para cálculo da prevalência de PIG usou-se a idade gestacional baseada na data da última menstruação (DUM) e as três curvas de crescimento fetal citadas. Foi empregada a regressão multinível para avaliação dos fatores de risco materno, do recém-nascido e socioeconômicos individuais, sendo a variável de contexto a vulnerabilidade do distrito de residência. Resultados: Houve um desvio à esquerda da IG para o total de nascimentos e entre os nascidos na rede não SUS, mais acentuado entre nascimentos por cesárea. A mediana de IG na rede SUS foi 39 semanas e na rede não SUS, 38. A prevalência de PIG variou consideravelmente, sendo 6,4 por cento dos nascimentos utilizando a curva Intergrowth e 12,4 por cento e 12,2 por cento com base nas curvas de Fenton e Kim e Alexander, respectivamente. Maiores prevalências de PIG foram encontradas em extremos de IG, pré-termos e termos tardios. Os fatores de risco para PIG, independente da prematuridade, foram malformação congênita, RN sexo feminino, primiparidade e pré-natal com menos de quatro consultas. Entre os não PT também estiveram associados: mãe adolescente, baixa escolaridade materna, raça/cor negra e gestante usuária do SUS, bem como morar em distrito com alta vulnerabilidade. Recém-nascidos PT estiveram associados com idade materna acima de 35 anos. Conclusão: A diferença na duração da gestação está relacionada ao tipo de hospital em que ocorrem os nascimentos e à alta frequência de cesáreas na rede privada. As prevalências de PIG foram bastante distintas entre as curvas, mostrando que esse indicador deve ser avaliado com cautela, pois alguns RN podem ser erroneamente classificados como PIG. O contexto de vulnerabilidade no MSP esteve associado a nascer PIG de forma discreta. Os fatores de risco individuais explicaram melhor o desfecho e foram diferentes segundo a prematuridade, desvantagens socioeconômicas e foram risco apenas entre não prematuros / Introduction: Gestational age (GA), birth weight and the frequency of small for gestational age (SGA) births are important predictors of neonatal morbidity and mortality. Cesarean section has been indicated as one of the factors that has contributed to the increase of prematurity. The aims of this study were to know the population distribution of GA according to type of delivery and to establish the proportion of births considered SGA and how its risk factors may contribute to the knowledge of the profile of live births in the city of São Paulo (SP). Another important objectives were study the pattern of distribution of gestational age in the births occurred in SP, to assess the prevalence of SGA based on three fetal growth curves (Alexander, Fenton and Kim and Intergrowth) and investigate the risk factors for SGA. Methodology: Cross-sectional study based on data from the Live Birth Information System (Sinasc). We studied hospital births and single pregnancies, in the years of 2013 and 2014, in the city of São Paulo. An analysis of the distribution of births according to GA, comparing type of delivery and hospital (public and private) was performed. Gestational age based on the date of the last menstruation (LMP) and the three fetal growth curves were used to calculate the prevalence of SGA. Multilevel regression was used to assess maternal, newborn and socioeconomic risk factors, with the context variable being the vulnerability of the residence district. Results: There was a shift to the left of the GA for total births and among those born in the private hospitals, more pronounced among cesarean births. The median GA in the public hospitals was 39 weeks and in the privates, 38. The prevalence of SGA varied considerably, with 6.4 per cent of births using the Intergrowth curve and 12.4 per cent and 12.2 per cent based on the curves of Fenton and Kim and Alexander, respectively. Higher prevalences of SGA were found in preterm (PT), and late term extremes. The risk factors for SGA, independent of prematurity, were congenital malformation, female newborn, primiparity and prenatal with less than four visits. Among the non preterms were also associated: adolescent mother, low maternal schooling, race / black color and pregnant user public health service, as well as living in a district with high vulnerability. PT newborns were associated with maternal age above 35 years. Conclusion: The difference in the length of gestation is related to the type of hospital where births occur and the high frequency of cesarean sections in the private hospitals. As SGA prevalences were very different between the curves, showing that this indicator should be evaluated with caution, some items may be erroneously classified as SGA. The context of vulnerability in SP was associated with being born SGA discretely. Individual risk factors better explain the outcome and were different according to a prematurity, socioeconomic disadvantages and were only risk among non preterms

Introdução:A história natural da Síndrome dos Ovários Policísticos (SOP) tem início durante a fase do crescimento fetal, que é umperíodo em que ocorre a diferenciação e a maturação funcional dos órgãos e tecidos. Quando surgem condições adversas durante a vida fetal, existe predomínio do processo catabólico, que promove a restriçãode crescimento intra-útero e o nascimento de recém-nascidos (RN) pequenos para a idade gestacional (PIG). Durante esta fase de hipoxemia fetal crônica, surgem alterações na expressão gênica de proteínas nucleares (reprogramação fetal) que poderão codificar manifestações fenotípicas na vida adulta, a depender das células que foram acometidas. Este processo, associado à predisposição genética e aos fatores ambientais, pode favorecer o surgimento da SOP. Objetivo:Avaliar se os RN de termo PIG (femininos) têm maior prevalência de SOP na idade adulta quando comparados aos RN Adequados para Idade Gestacional (AIG) na população da coorte de indivíduos nascidos em Ribeirão Preto durante o período de 31.05.1978 e 01.06.1979. Casuística e Métodos:Foram convocadas 440 mulheres de novembro/2007 à outubro/2008 para avaliação de repercussões reprodutivase metabólicas no menacme. Deste total, concordaram em participar da pesquisa 355 pacientes (268 AIG e 87 PIG), sendo que 138 AIGs e 37 PIGs foram excluídas devido ao uso de anticoncepcional hormonal (97) e pela presença de gestação ou amamentação (78). Todas as mulheres foram submetidas à anamnese (com avaliação da idade, das características do ciclo menstrual, dos sinais/sintomas do hiperandrogenismo, do peso, da altura e do índice de massa corpórea). Realizamos a dosagem hormonal (FSH, LH, prolactina, testosterona, DHEAS, 17-OH progesterona, insulina), a avaliação bioquímica (lipidograma, glicemia e teste de tolerância oral com 75 gramas de glicose), a SHBG e a ultra-sonografia pélvica para definição do diagnóstico de SOP. Também avaliamos o índice de androgênios livres (FAI),a resistência insulínica (RI) (através do HOMA) e a prevalência da síndrome metabólica (SMET). A coleta foi realizada entre o terceiro e o quinto dia do ciclo menstrual, após jejum de 12 horas. Resultados:a prevalência de SOP foi mais elevada no grupo PIG (32%) do que em mulheres do grupo AIG (13,8%), com risco relativo de 2,02 (IC95%: 1,27 - 3,21, p=0,0097) . Em relação aos critérios de SOP,a irregularidade menstrual (PIG: 51% vs AIG: 25,4%, p=0,0012) e o hiperandrogenismo (PIG: 41,2% vs AIG:22,3%, p=0,01) foram mais elevados nas pacientes PIG. Já a ultrassonografia, os exames bioquímicos, o FAI, e a avaliação hormonal não apresentaram diferenças significativas entre os grupos. Também não houve diferenças entre os grupos em relação às prevalências de SMET e RI. Conclusão: Mulheres PIG ao nascimento representam um grupo de risco para o desenvolvimento da SOP durante o menacme. Estudos de seguimento destas mulheres devem ser realizados para avaliar a relação do pesoao nascer com a prevalência de doenças cardiovasculares e metabólicas ao longo da vida. / Introduction:The natural history of Polycystic Ovary Syndrome (POS) starts during fetal growth, a period during which the differentiation and functional maturation of organs and tissues occurs. When adverse conditions arise during fetal life there is a predominance of the catabolic process, which promotes intrauterine growth restriction and the birth of small for gestational age (SGA) newborns (NB). During this phase of chronic fetal hypoxemia, changes in the gene expression of nuclearproteins arise (fetal reprogramming) that might code for phenotypic manifestations during adult life depending on the affected cells. This process, together with genetic predisposition and environmental factors, may favor the onset of POS. Objective:To determine whether term female SGA NB have a higher prevalence of POS during adult age compared to women adequate for gestational age (AGA) at birth in the population of the cohort of individuals born in Ribeirão Preto during the period from 31.05.1978 to 01.06.1979. Cases and Methods:From November 2007 to October 2008, 440 women have been convoked for the assessment of reproductive and metabolic repercussions during menacme. Among them, 355 appeared (268 AGA and 87 SGA), with 137 AGAs and 38 SGAs being excluded from the study due to the use of a hormonal contraceptive (98) and to the presence of pregnancy or breast-feeding (77). The medical history of all women was taken, including age, characteristics of the menstrual cycle and of signs and symptoms of hyperandrogenism, height, and body mass index. We performed hormone determination (FSH, LH, prolactin, testosterone, DHEAS, 17-OH progesterone), biochemical evaluation (lipid profile, glycemia and 75 g oral glucose tolerance test), and pelvic ultrasound for the definition of the diagnosis of POS. Blood was collected between the third and fourth day ofthe menstrual cycle after a 12 hour fast. Results:The prevalence of POS was higher in the SGA group (32%) than in the AGA group (13.8%), with relative risk of 2,02 (IC 95%: 1,27- 3,21, p=0,0097). Regarding the criteria for a diagnosis of POS, chronic anovulation (SGA:51% vs AGA: 25,4%, p = 0.0012) and clinical hyperandrogenism (SGA: 41.2% vs AGA: 22.3%, p = 0.01) were more elevated in SGA patients. In contrast, ulrasonography and the biochemical and hormonal exams did not show significant differences between groups. Conclusion:Women who were SGA at birth represent a risk group for the development of POS during menacme. Following studies this women should be performed to assess the relation to birth weight with the prevalence of cardiovascular and metabolic diseases during of life.

Objectives. Identify risk factors for at-term small for gestational age newborns. Materials and methods. Retrospective cohort study using data from the Maternal Perinatal Information System of the Maria Auxiliadora Hospital of Lima, from the period 2000-2010. Maternal age, parity, education level, marital status, pregestational body mass index, number of prenatal care visits, presence of conditions such as preeclampsia, eclampsia, urinary tract infection and gestational diabetes as risk factors in small for gestational age newborns were evaluated. The weight for gestational age was calculated based on Peruvian percentiles. Crude relative risk (RR) and adjusted (ARR) were calculated with confidence intervals of 95% using log-binomial generalized linear models. Results. 64,670 pregnant women were included. The incidence for small for gestational age was 7.2%. Preeclampsia (ARR 2.0, 95% CI: 1.86 to 2.15), eclampsia (ARR 3.22, 95% CI: 2.38 to 4.35), low maternal weight (ARR 1.38; 95% CI: 1.23 to 1.54), nulliparity (ARR 1.32, 95% CI: 1.23 to 1.42), age ≥35 years (ARR 1.16, 95% CI: 1.04 -1.29), having prenatal care visits from 0 to 2 (ARR 1.43, 95% CI: 1.32 to 1.55) and 3 to 5 (ARR 1.22, 95% CI: 1.14 to 1.32) were risk factors for small for gestational age. Conclusions. It is necessary to identify pregnant women with risk factors such as those found to decrease the condition of small for gestational age. Actions should emphasize modifiable factors, such as the frequency of prenatal care visits. / Objetivos. Identificar factores de riesgo para neonatos a término pequeños para la edad gestacional. Materiales y métodos. Cohorte retrospectiva que utilizó datos del Sistema Informático Materno Perinatal del Hospital María Auxiliadora de Lima, del período 2000 a 2010. Se evaluó la edad materna, paridad, nivel educativo, estado civil, índice de masa corporal pregestacional, número de controles prenatales, presencia de patologías como preeclampsia, eclampsia, infección urinaria y diabetes gestacional como factores de riesgo en pequeños para edad gestacional. El peso para la edad gestacional fue calculado sobre la base de percentiles peruanos. Se calcularon los riesgos relativos crudos (RR) y ajustados (RRa) con sus intervalos de confianza al 95% usando modelos lineales generalizados log binomial. Resultados. Se incluyeron 64 670 gestantes. La incidencia de pequeños para la edad gestacional fue 7,2%. La preeclampsia (RRa 2,0; IC 95%: 1,86-2,15), eclampsia (RRa 3,22; IC 95%: 2,38-4,35), bajo peso materno (RRa 1,38; IC 95%: 1,23-1,54), nuliparidad (RRa 1,32; IC 95%: 1,23-1,42), edad ≥35 años (RRa 1,16; IC 95%: 1,04-1,29), tener controles prenatales de 0 a 2 (RRa 1,43; IC 95%: 1,32-1,55) y 3 a 5 (RRa 1,22; IC 95%: 1,14-1,32) fueron factores de riesgo para ser pequeños para la edad gestacional. Conclusiones. Es necesario identificar a las gestantes con factores de riesgo como los encontrados para disminuir la condición de pequeños para la edad gestacional. Se debe actuar poniendo énfasis en factores modificables, tales como la frecuencia de sus controles prenatales

Social supports are linked in public health research to improved birth outcomes. This study explored the relationship of social supports, stress and birth outcomes among pregnant Latinas in Pinellas County, Florida. A sample of 411 Healthy Start women at risk of poor birth outcomes participated in this study (99 Latinas, 142 Black, and 158 White). Study methods included ANOVA, Principal Component Analysis, multivariable regression, logistic regression, and structural equation modeling to identify significant associations between social support scores, stress scores, demographics and health risk factors with infant birth weight, preterm and small for gestational age by ethnic group. Study findings indicated there was a direct association between social support and stress across all ethnic groups. However, many confounding variables did not have an effect in the study sample. Latina study participants exhibited significantly lower mean social support scores compared to White and Black participants (p=0.000). Latinas also presented higher stress scores that were significantly different from White and Black participants (p=0.000). The study also found ethnic differences in stress level perceptions using the Perceived Stress Scale. Recommendations for public health included conducting additional studies to assess if the study variables have an impact on a different population, exploring different ethnic interpretations of stress, using repeated measures to assess stress in high risk populations and considering using alternate stress measures such as biological markers and stress life event scales to assess social support, stress and birth outcomes.

Le retard de croissance intra-utérin (RCIU) est une complication responsable d’une importante mortalité et morbidité périnatales. Son dépistage représente un enjeu important de la surveillance prénatale. Les objectifs de la thèse étaient d’évaluer la performance du dépistage anténatal du RCIU, d’identifier ses déterminants et de mesurer son impact sur les issues périnatales. Dans une première partie, nous avons utilisé les données de l’Enquête Nationale Périnatale de 2010 (N=14 100 enfants uniques) : 21,7% des enfants de poids <10ème percentile étaient suspectés avec un RCIU en anténatal tandis que la moitié des enfants suspectés avait un poids normal à la naissance (faux positifs). Le risque de naissance induite était élevé en cas de suspicion, indépendamment de l’existence d’un faible poids, suggérant des interventions iatrogènes. Les issues néonatales n’étaient pas différentes selon la suspicion. Dans une seconde partie, nous avons utilisé les données d’une cohorte nationale d’enfants nés avant 32 SA en 2011, EPIPAGE 2 (N=3698 enfants uniques sans anomalie congénitale). La prise en charge active pour indication fœtale en cas de RCIU était initiée à partir de 26 SA. Pour 14% des enfants, il existait une discordance entre la suspicion d’un RCIU en anténatal et un faible poids à la naissance. En cas de discordance, le poids de naissance était le paramètre le plus important pour évaluer le pronostic néonatal. Nos travaux soulèvent des questions sur l’efficacité du dépistage du RCIU en France. Ils montrent la nécessité de développer de nouvelles stratégies de dépistage et de poursuivre les recherches pour mesurer leur impact sur les décisions médicales et sur la santé. / Fetal growth restriction (FGR) is a pregnancy complication that is responsible for significant perinatal mortality and morbidity. Screening for FGR is a key component of prenatal care. The objectives of this thesis were to evaluate the performance of prenatal screening for FGR, to identify the determinants of antenatal suspicion of FGR and to measure its impact on perinatal outcomes. For the first part of the thesis, we used data from the nationally representative French National Perinatal Survey of births (N=14,100 singleton pregnancies): 21.7% of infants with a low birthweight <10th percentile were suspected with FGR during pregnancy and half of infants suspected with FGR had a normal birthweight (false positives). The risk of indicated delivery was higher when FGR was suspected, regardless of the existence of low birthweight, suggesting possible iatrogenic effects. Outcomes were not different for suspected versus unsuspected low birthweight infants. In the second part of the thesis, we used data from the EPIPAGE 2 national cohort of children born before 32 weeks of GA in 2011 (N=3698 singleton non-anomalous infants). Active management for fetal indications in cases of suspected FGR was initiated at 26 weeks. Antenatal and postnatal assessments of FGR were discordant for 14% of infants. When assessments were discordant, birthweight was a better predictor of adverse neonatal outcome. Our results raise questions about the effectiveness of screening strategies for FGR in France. New strategies for the detection of FGR are needed as well as research to measure the impact of screening on medical decisions and health.