proposition de sujet de thèse

PROPOSITION DE THESE
(2 pages maximum)
SIGLE ET NOM DU LABORATOIRE : INSERM U1153, CRESS
NOM DE L’EQUIPE : Equipe EPOPé, EPidémiologie Obstétricale, Périnatale et Pédiatrique
ADRESSE : Maternité Port-Royal 53 avenue de l’observatoire, 75014 Paris
TITRE DE LA THÈSE : Association between Socioeconomic status, Body Mass Index, and Maternal Morbidity
DIRECTEUR DE THESE : Catherine Deneux-Tharaux
CO-TUTELLE: NON
CO-ENCADRANT: Elie Azria
EQUIPE : Equipe EPOPé, EPidémiologie Obstétricale, Périnatale et Pédiatrique, INSERM U1153
PRESENTATION DU SUJET
Background
Obesity, defined as a Body Mass Index (BMI) greater than or equal to 30, has been shown to be associated with low
socioeconomic status in the general population as well as among pregnant women. Prior studies examining the impact of
maternal obesity or excessive weight gain on peripartum outcomes have primarily focused on the mode of delivery and on
neonatal health, with limited emphasis on the effects of weight on maternal morbidity. Previous evidence suggests that
adverse social conditions are associated with an increased risk of maternal morbidity. However, it is currently unknown to
what extent this association is mediated by maternal obesity.
The overall aim of this thesis will be to describe the associations between socioeconomic status, maternal BMI, and
maternal morbidity. These associations will be tested in parallel using data from France and the USA, thus allowing for a
broader examination of the relationships in differing societal and health care services contexts. We anticipate that
evaluation of the research questions in contrasting contexts will allow for a more nuanced and meaningful exploration of
the interplaying socio-medical dynamics that mediate the associations. This improved understanding will potentially
allow for the development of better-targeted and more effective interventions than if the relationships were examined in a
single and limited setting alone. It will also provide enhanced guidance for future investigations both nationally and
globally.
The project will be divided into two specific objectives:
1.
To test and quantify the association between BMI and severe acute maternal morbidity (SAMM). This
relationship will be examined by considering maternal BMI in early pregnancy as both a categorical and a
continuous variable. The primary outcomes will be defined as (i) SAMM globally as a binary composite indicator
and (ii) its individual components. Similarly, the association between weight gain during pregnancy and SAMM
will also be studied. The analyses will be conducted using French data from the EPIMOMS study and the
PreCARE cohort, and vital statistics data merged with hospital discharge summaries (SPARCS) from New York
City.
2.
To test the hypothesis that maternal obesity is an intermediary in the association between socioeconomic status
and SAMM. A path analysis will be conducted to measure the part of the association between social conditions
and SAMM that is mediated by maternal obesity. The approach will focus on the global SAMM indicator and
more specifically on preeclampsia, of which both obesity and low socioeconomic status are known risk factors.
Country of origin in France and ethnicity in the USA will be evaluated as effect modification (or interaction)
factors. The analyses will be conducted using French data from the EPIMOMS study and the PreCARE cohort
and hospital discharge data (SPARCS) merged with birth certificate data from New York City.
Data sources
France: Two databases with complementary strengths will be used.
The EPIMOMS Study is a population-based study on severe maternal morbidity conducted in 6 French regions in 20122013. From a source population of 183 000 parturient women, women with SAMM were prospectively identified, n =
2541; a representative sample of women without SAMM who delivered in the same regions during the same time period
was also selected, n =3651.Detailed information on the characteristics of the women, their pregnancy and delivery, and
the course of the SAMM event was collected.
The PreCARE multicenter cohort study was designed to study the impact of maternal social deprivation on pregnancies
and neonatal outcomes. All women registered to deliver or delivered in one of the four maternity units of university
hospitals, all located in the Paris North area (France) between October 2010 and November 2011 were recruited
(n=10419). Data concerning social conditions were collected by a self-administered questionnaire at enrollment in the
cohort and after delivery. Maternal social deprivation was characterized by four binary variables measuring four
dimensions of deprivation: 1) Social isolation; 2) Poor or insecure housing condition; 3) Not work-related household
income; 4) Absence of a health care insurance. Social deprivation was also characterized by a synthetic quantitative index
built on the 2010 French National Perinatal Survey. Detailed information on other characteristics of the women, their
pregnancy and delivery, and the course of the SAMM event was prospectively collected.
USA: Data from New York city are Vital Statistics birth records linked with New York State discharge abstract data - The
Statewide Planning and Research Cooperative System (SPARCS) for all delivery hospitalizations in New York City from
2011-2014 (40 hospitals, ≈120, 000 deliveries per year). Severe maternal morbidity is defined using a published algorithm
from the Centers for Disease Prevention and Controls (CDC) based on diagnoses and procedure codes.
Sociodemographic data (maternal age, race/ethnicity, educational level, marital status) are collected on the birth
certificate, in addition to maternal height and prepregnancy weight. Data on prenatal care from the birth certificate and
insurance status from hospital discharge data.
PREREQUIS DEMANDE, FORMATION : Master 2 d’épidémiologie ou équivalent
EXISTE-T-IL UN CANDIDAT POUR CETTE THESE
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NON
NOM DU CANDIDAT : Ayesha Siddiqui
CURSUS : MD, Master of Science in Epidemiology, Columbia University, Mailman SPH, New York, USA
DEMANDE DE CONTRAT DOCTORAL DE L’ED
LE CANDIDAT SE PRESENTE-T-IL AU CONCOURS DE L’EHESP
DE LA FRM
FINANCEMENT DU SALAIRE DU DOCTORANT PAR UNE AUTRE RESSOURCE
SI OUI, LAQUELLE :
CONTACT POUR CE SUJET : Catherine Deneux-Tharaux OU Elie Azria
EMAIL : [email protected] OU [email protected]
TELEPHONE : 01 42 34 55 79
OUI
OUI
OUI
NON
NON
NON
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NON
SPECIALITE DE LA THESE
EPIDEMIOLOGIE (AVEC EVENTUELLEMENT MENTION CLINIQUE OU SOCIALE OU GENETIQUE
BIOSTATISTIQUE/BIOMATHEMATIQUE
INFORMATIQUE BIOMEDICALE (RECOUVRANT AUSSI L’IMAGERIE BIOMEDICALE ET LA BIOINFORMATIQUE)
RECHERCHE INFIRMIERE
PERFORMANCE DU SYSTEME DE SOINS
(DONT COUT-EFFICACITE)
AUTRES (PRECISER) :……………………………………………………………………………………
AIDE A LA DECISION
VISA DU DIRECTEUR DE L’UNITE
AVIS FAVORABLE
SIGNATURE