Lionel Carbillon’s research while affiliated with Sorbonne Nouvelle University and other places

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Publications (274)


Flow chart. PPH, postpartum hemorrhage.
A History of Cesarean Birth as a Risk Factor for Postpartum Hemorrhage Even After Successful Planned Vaginal Birth
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  • Publisher preview available

November 2024

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7 Reads

Birth

J. Boujenah

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M. Belabbas

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A. Tigaizin

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[...]

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L. Carbillon

Background It is unclear if a history of cesarean birth (CB) is a risk factor for postpartum hemorrhage (PPH) even after a successful planned vaginal birth. Methods A historical retrospective cohort study from all deliveries (42,456) between 2004 and 2019. Inclusion criteria were as follows: (i) women with only one previous CB; (ii) liveborn cephalic singleton pregnancy and term spontaneous labor; (iii) successful planned vaginal birth; (iv) no operative vaginal delivery; and (v) no history of PPH. Women who experienced intrapartum uterine rupture leading to CB were excluded. Those who experienced uterine rupture diagnosed after vaginal birth were not excluded. The labor after cesarean (LAC) group (109 women with previous CB and current vaginal birth) were compared with 2 control groups to consider the parity: control group 1 (1633 nulliparous women) and control group 2 (4197 parous women). The main outcome was the rate of PPH (> 500 mL). Multivariate analysis was performed to investigate whether previous CB was an independent risk factor for PPH. Bivariate analysis and causal framework was used to determine the relation between variables of clinical interest. Results The PPH rates in the LAC group, control group 1, and control group 2 were 12.8%, 5.3%, and 6.4%, respectively. Irrespective of the group control (1 or 2), a history of CB was associated with an increased risk of PPH: adjusted odds ratio (aOR) 2.38 [95% confidence interval (CI) 1.28–4.44] (adjusted with maternal age, overweight, hyperthermia, and use of oxytocin) and aOR 2.16 [95% CI 1.20–3.87] (adjusted with maternal age and overweight) for Groups 1 (parous) and 2 (nulliparous), respectively. Conclusion A history of cesarean birth could be a risk factor for PPH even after successful planned vaginal delivery.

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Hyperglycaemia in Pregnancy Is Less Frequent in Smokers: A French Observational Study of 15,801 Women

August 2024

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6 Reads

Background: We aimed to explore the still-debated association between smoking and hyperglycaemia in pregnancy (HIP). Methods: A multiethnic prospective study of 15,801 women who delivered at Jean Verdier University Hospital between 2012 and 2018. Of these, 13,943 (88.2%) were non-smokers, 624 (4.5%) former smokers, and 1234 (7.8%) current smokers. Universal HIP screening was proposed to the entire sample (IADPSG/WHO criteria). Results: A total of 13,958 women were screened for HIP. Uptake differed between non-smokers, former smokers, and current smokers (89.5%, 88.3%, and 75.7%, respectively, p < 0.0001). HIP prevalence in these groups was 19.9%, 15.4%, and 12.3%, respectively (p < 0.0001). After adjusting for age, body mass index, family history of diabetes, history of HIP, history of macrosomic baby, and ethnicity, current (odds ratio 0.790 [95% confidence interval 0.636–0.981], p < 0.05) but not former (1.017 [0.792–1.306]) smokers were less likely to have HIP than non-smokers. Furthermore, 1 h and 2 h oral plasma glucose test values were lower in current smokers than in non-smokers (p < 0.01). To exclude potential selection bias, we compared risk factors for HIP and HIP-related adverse pregnancy outcomes in current smokers according to HIP screening status. Compared with screened current smokers (n = 934), their unscreened counterparts (n = 300) were younger, less frequently employed, and more likely to be of non-European origin. Moreover, infant birthweight was lower in this group, and preterm deliveries and perinatal deaths were more likely (all p < 0.01). Conclusions: Smoking during pregnancy was independently associated with lower HIP prevalence. The low HIP screening rate in current smokers did not explain this finding.




Prevalence and association of placental lesions with obstetrical features and outcome: data from French prospective study

July 2024

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11 Reads

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1 Citation

AJOG Global Reports

Purpose Since the Consensus Statement diffused by the Amsterdam Placental Workshop Group, knowledge of the meaning of placental vascular malperfusion has become essential in the unavoidable analysis of obstetrical history in a patient followed for autoimmune disease or any other maternal comorbidity. We aimed to analyse the prevalence of various placental lesions from a 6-months prospective observational study and to correlate the various placental profiles to obstetrical outcome, maternal diseases and pregnancy treatments. The frequency of foetal vascular malperfusion lesion could be estimated at 8.7%, in our population and to understand its neonatal associations. Methods The study groups consisted of 208 consecutive women which ended the pregnancy and have placental analysis during the period of the study. Results From December 2015 to October 2017, from overall 4398 delivered pregnancies in university obstetrical department, 208 (4.7%) placental analysis have been done and included in the study. The placental analysis have been done for vascular obstetrical complications during the pregnancy (n = 106; 51%), unexplained abnormal foetal heart rate tracings (n = 59; 28,3%), suspicion of intra-amniotic infection (n = 12; 5,7%%), term new-borns Apgar score <7 or arterial cord blood pH ≤ 7 (n = 7; 3,5%), spontaneous preterm delivery (n = 19; 9,1%), intrahepatic cholestasis of pregnancy (n = 5; 2,4%). An adverse obstetrical event was noted in 87 cases (42%): preeclampsia or HELLP syndrome (n = 15; 7%), FGR (n = 59; 28%), gestational diabetes (n = 33; 16%) and gestational hypertension (n = 19; 9%). Placental histological analysis showed abnormal vascular features in 159 cases (76%), inflammatory features in 16 placentas (8%), vascular and inflammatory features in 10 cases (4%), chorioamnionitis in 38 cases (18%) and absence of any abnormality in 43 cases (21%). A cluster analysis of histological features allowed distinguishing three placental patterns: a normal pattern characterised by the absence of any placental lesions, an inflammatory pattern characterised by the presence of villitis and/or chronic intervillositis; a vascular pattern with the presence of thrombosis, maternal floor infarct with massive perivillous fibrin deposition, infarction and chronic villositis hypoxia. Women with inflammatory placental profile have significantly increased frequencies of tobacco use (50% vs. 9%; P = 0.03), pathological vascular Doppler (50% vs. 5%; P = 0.001), FGR (100% vs. 14%; P = 0.0001) and oligohydramnios (67% vs. 5%; P = 0.0001) than those with normal placentas. A higher rate of vascular or inflammatory lesion were observed in women with Hypertensive disorder of pregnancy, where as those with inflammatory pattern have significantly more frequent FGR (100% vs 34%; P = 0.02) and oligohydramnios (67% vs 5%; P = 0.0002). Conclusion The placenta analysis is important to understand the origin of adverse obstetrical outcome and the risk for subsequent pregnancy.


Population-based study of eclampsia: Lessons learnt to improve maternity care

May 2024

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27 Reads

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1 Citation

Background Among hypertensive disorders of pregnancy (HDP), eclampsia is a rare but serious event, often considered avoidable. Detailed assessment of the adequacy of care for the women who have eclampsia can help identify opportunities for improvement and for prevention of the associated adverse maternal and neonatal outcomes. Objective 1/ To estimate the incidence and describe the characteristics of women with eclampsia and to compare them with those of women with non-eclamptic hypertensive disorders of pregnancy (HDP)-related severe maternal morbidity (SMM) and of control women without SMM 2/ To analyse the quality of management in women who had eclampsia, at various stages of their care pathway. Methods It was a planned ancillary analysis of the EPIMOMS population-based study, conducted in six French regions in 2012–2013. Among the 182,309 maternities of the source population, all women with eclampsia (n = 51), with non-eclamptic HDP-related SMM (n = 351) and a 2% representative sample of women without SMM (n = 3,651) were included. Main outcome was the quality of care for eclampsia assessed by an independent expert panel at three different stages of management: antenatal care, care for pre-eclampsia and care for eclampsia. Results The eclampsia incidence was 2.8 per 10,000 (95%CI 2.0–4.0). Antenatal care was considered completely inadequate or substandard in 39% of women, as was pre-eclampsia care in 76%. Care for eclampsia was judged completely inadequate or substandard in 50% (21/42), mainly due to inadequate use of magnesium sulphate. Conclusion The high proportion of inadequate quality of care underlines the need for an evidence-based standardisation of care for HDP.


Risk factors for placenta accreta spectrum disorders in women with any prior cesarean and a placenta previa or low lying: a prospective population-based study

March 2024

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60 Reads

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8 Citations

This study aimed to identify the risk factors for placenta accreta spectrum (PAS) in women who had at least one previous cesarean delivery and a placenta previa or low-lying. The PACCRETA prospective population-based study took place in 12 regional perinatal networks from 2013 through 2015. All women with one or more prior cesareans and a placenta previa or low lying were included. Placenta accreta spectrum (PAS) was diagnosed at delivery according to standardized clinical and histological criteria. Of the 520,114 deliveries, 396 fulfilled inclusion criteria; 108 were classified with PAS at delivery. Combining the number of prior cesareans and the placental location yielded a rate ranging from 5% for one prior cesarean combined with a posterior low-lying placenta to 63% for three or more prior cesareans combined with placenta previa. The factors independently associated with PAS disorders were BMI ≥ 30, previous uterine surgery, previous postpartum hemorrhage, a higher number of prior cesareans, and a placenta previa. Finally, in this high-risk population, the rate of PAS disorders varies greatly, not only with the number of prior cesareans but also with the exact placental location and some of the women's individual characteristics. Risk stratification is thus possible in this population.



The Prognosis of Glutamic Acid Decarboxylase Antibodies in Women With Hyperglycemia in Pregnancy

October 2023

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28 Reads

The Journal of Clinical Endocrinology and Metabolism

Context We recently reported that the presence of glutamic acid decarboxylase antibodies (GADA) was not associated with large-for-gestational-age infants in women with hyperglycemia in pregnancy (HIP). Objective We explored the association between the presence of GADA and other HIP-related adverse pregnancy outcomes. Methods This observational prospective study, conducted at a university hospital in a suburb of Paris, France, included 1182 consecutive women with HIP measured for GADA at HIP care initiation between 2012 and 2017. Post hoc analyses for outcomes included gestational weight gain, insulin therapy, cesarean delivery, hypertensive disorders, small-for-gestational-age infant, prematurity, and neonatal hypoglycemia. Results Of the 1182 women studied, 87 (7.4%) had positive (≥ 1 IU/mL) GADA. Although socioeconomic, clinical, and biological characteristics were similar across women in the positive and negative GADA groups, higher fasting plasma glucose values during early HIP screening were observed in the former (5.5 ± 1.5 vs 5.2 ± 0.7 mmol/L respectively, P < .001). At HIP care initiation, fructosamine levels were higher in women with positive GADA (208 ± 23 vs 200 ± 18 µmol/L; P < .05). In the homeostatic model assessment, insulin resistance (HOMA-IR) and beta secretion (HOMA-B) rates were similar in both groups. Gestational weight gain and the rates of all adverse outcomes were similar in both groups except for cesarean delivery (18.4 and 27.3% for positive and negative GADA, respectively; adjusted odds ratio 0.49 [95% CI, 0.26-0.92], P = .026). Conclusion Universal measurement of GADA in women with HIP highlighted that 7.4% had positive GADA. No association was observed between GADA and HIP-related adverse pregnancy outcomes, except a lower risk of cesarean delivery.


Flow chart
Fetal growth according to the number of socioeconomic vulnerabilities Legend: Vulnerabilities were psychosocial deprivation, food insecurity, and poor French language proficiency
Impact of experiencing multiple vulnerabilities on fetal growth and complications in women with hyperglycemia in pregnancy

October 2023

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24 Reads

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3 Citations

BMC Pregnancy and Childbirth

Background In women with hyperglycemia in pregnancy living in France, psychosocial deprivation is associated with both earlier and greater exposure to the condition, as well as poorer maternofetal prognosis. We explored the impact of this and two other socioeconomic vulnerability indicators—food insecurity and poor language proficiency—on adherence to prenatal care and maternal and fetal outcomes. Methods In a socially deprived suburb of Paris, we selected women who delivered between 01/01/2012 and 31/12/2018 and received care (nurse, dietician, diabetologist evaluation, advice, regular follow-up to adjust insulin doses if requested) for hyperglycemia in pregnancy. We analyzed the associations between individual psychosocial deprivation, food insecurity, French language proficiency (variables assessed by individual questionnaires) and fetal growth (main outcome), as well as other core maternal and fetal outcomes. Results Among the 1,168 women included (multiethnic cohort, 19.3% of whom were Europeans), 56%, 17.9%, and 27.5% had psychosocial deprivation, food insecurity, and poor French language proficiency, respectively. Forty-three percent were prescribed insulin therapy. Women with more than one vulnerability had more consultations for diabetes. The rates for small (SGA), appropriate (AGA), and large-for-gestational-age (LGA) infant were 11.4%, 76.5% and 12.2%, respectively. These rates were similar in women with and without psychosocial deprivation, and in those with and without food insecurity. Interestingly, women with poor French language proficiency had a higher odds ratio of delivering a small- or large-for-gestational age infant than those with good proficiency. Conclusion We found similar pregnancy outcomes for women with hyperglycemia in pregnancy living in France, irrespective of whether or not they had psychosocial deprivation or food insecurity. Optimized single-center care with specialized follow-up could contribute to reduce inequalities in maternal and fetal outcomes in women with hyperglycemia in pregnancy.


Citations (55)


... In total, 10 studies were chosen for the meta-analysis out of a possible 1965 (between 1999 and 2014) met the requirements for inclusion and were added to the study [6][7][8][9][15][16][17][18][19][20]. ...

Reference:

A Meta-Analysis to Assess the Probable Association of Hypertension During Pregnancy and Placenta Accreta
Risk factors for placenta accreta spectrum disorders in women with any prior cesarean and a placenta previa or low lying: a prospective population-based study

... On the other hand, to date, very few works have explored the host genetic factors possibly associated with persistent OD [18]. Our study aims to fill this knowledge gap by applying an approach that has recently proven powerful in the identification of genes associated with the host response to COVID-19 [19][20][21], namely the analysis of the genetic landscape of rare and common variants. In particular, our study focuses on the identification of rare and common biallelic variants in genes involved in the antiviral response regulation pathway, taking advantage of Whole Genome Sequencing (WGS) data of a cohort of deeply characterized Italian patients who suffered from COVID-19 presenting with long-lasting OD. ...

Correction: Rare predicted loss-of-function variants of type I IFN immunity genes are associated with life-threatening COVID-19

Genome Medicine

... Three studies reported associations between food insecurity and cesarean delivery, and all were pooled in a meta-analysis (Fig 3). This included 2 high-quality studies [50,51] and 1 medium quality [48] with a pooled sample size of 1,256 women. Pooled analysis showed no association between food insecurity and cesarean section (OR 1.42, 95% CI [0.78, 2.60], I 2 56.35%) (Fig 3). ...

Impact of experiencing multiple vulnerabilities on fetal growth and complications in women with hyperglycemia in pregnancy

BMC Pregnancy and Childbirth

... Health Our research showed that the results of post-load glucose testing and fasting blood sugar provide valuable information concerning the outcomes of pregnancy. In a recent study of women screened for hyperglycemia after 22 weeks of gestation, a higher fasting blood sugar was associated with LGA and higher post-load hyperglycemia was associated with preterm delivery and neonatal intensive care unit admission 33 . Another recent study indicated that elevations in some glucose test values were linearly and some others were non-linearly associated with an increased risk of preterm birth 34 This dynamic test reflects the immediate effects of insulin resistance, a key factor in adverse pregnancy outcomes such as gestational diabetes. ...

Glycemic status during pregnancy according to fasting and post-load glucose values: The association with adverse pregnancy outcomes. An observational study
  • Citing Article
  • August 2023

Diabetes & Metabolism

... There is increasing evidence that genetic variants in immune pathways may contribute to dysregulated responses to infections including SARS-CoV-2 (22)(23)(24)(25)(26). We identified an association between COVID-sHLH and the SNARE complex pathway above. ...

Rare predicted loss-of-function variants of type I IFN immunity genes are associated with life-threatening COVID-19

Genome Medicine

... The aberrant adhesion/invasion of the trophoblast to the uterine muscle, which causes incomplete or complete retention of the placenta upon delivery, is referred to as a placenta accreta spectrum (PAS) [1] . Severe hemorrhage following delivery (PPH), shock, CS hysterectomy, multiple organ dysfunction, disseminated intravascular coagulation (DIC), and up to death are among the severe maternal complications that can result from PAS, one of the most fatal conditions during pregnancy [2,3,4,5] . ...

Conservative Management or Cesarean Hysterectomy for Placenta Accreta Spectrum: The PACCRETA Prospective Study
  • Citing Article
  • February 2023

Obstetric Anesthesia Digest

... For pregnant individuals, this was expected, since mortality following listeriosis in pregnancy is rare [9]. Among neonates, case fatality rates range from 0.65% to 21% [8,9,10]; given the small number of cases in this study, it is not surprising that there were no infant deaths. Furthermore, while we could not link parents and neonates and therefore did not have data on all neonates of the mothers with listeriosis in this study, we found there were no death records in which listeriosis was listed as the cause of death for infants. ...

Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study
  • Citing Article
  • May 2017

... One of the most important is that three out of five included studies are from countries in East Asia (China, Taiwan, Korea). That means the results of these three studies are likely to be influenced by the characteristics of this particular racial/ethnic group regarding the increased risk of perinatal complications such as preterm birth and small-for-gestational-age neonates [26]. In addition, no studies from countries in Europe and Africa were identified. ...

Effects of race and ethnicity on perinatal outcomes in high-income and upper-middle-income countries: an individual participant data meta-analysis of 2 198 655 pregnancies

The Lancet

... However, we find it problematic to translate results from high-risk pregnancies into the clinical scenario of SGA diagnosed very early in pregnancy. Indeed, in the series by Li et al. 1 (which Carbillon et al. 2 refer to as support) it is stated that 'only 20% of the fetuses ended up with a birthweight below the 10th centile. In contrast, in our series, 87% of the babies were born small for gestational age. 3 Another problematic issue is equating association with prediction (which was the aim of our study). ...

A combination of clinical Doppler ultrasound and angiogenic biomarker assessment is currently the best approach for the evaluation of periviable fetal growth restriction

BJOG An International Journal of Obstetrics & Gynaecology

... Maternal characteristics included: age in years (< 25; [25][26][27][28][29][30]; [30][31][32][33][34][35]; ≥ 35), BMI in kg/m2 (<18.5; [18.5-25]; [25][26][27][28][29][30] ...

Evaluating the quality of care for postpartum hemorrhage with a new quantitative tool: a population-based study