Perinatal health: an evolution "worrying" neonatal mortality

Public Health France is sounding the alarm. The agency reports a “high and stable” level of care in France but gives several warning points on the health of mothers and their newborns.

A falling birth rate, rising neonatal mortality, a stable caesarean section rate… For the first time, a report describes the state of perinatal health in France, with a “worrying” evolution of certain indicators, in ten years, particularly in Overseas France.

This document of some 160 pages, published this Tuesday by Public Health Francecompiles a series of data on the health status of pregnant women, the fetus and the newborn during the period from pregnancy to postpartum (the return of diapers), from 2010 to 2019. According to the health agency, it thus allows for the first time an overall description of the state of perinatal health in France.

If certain indicators testify to a “high and stable level of care” in France, “the report shows heterogeneous situations between the territories, with a deterioration in the overseas departments and regions”, indicated Anne Gallay, director of non-communicable diseases and trauma at Public Health France.

Declining birth rate

First observation: a declining birth rate in all regions of France, except in Guyana. The number of births decreased from 841,000 in 2010 to 734,000 in 2019.

The main reasons lie in the increase in the maternal age of childbirth and in the decrease in fertility among the youngest women. For the whole of France, the average age at childbirth fell from 29.4 years in 2010 to 30.1 years in 2019.

The precariousness of mothers seems to be worsening at the same time: slightly fewer deliveries are covered by health insurance (96.8% in 2010 against 96.0% in 2019). And there are more mothers in an irregular situation with State Medical Aid (AME, 1.6% in 2010; 2.5% in 2019) and homeless mothers (0.58% in 2015 in Ile-de-France; 2.28% in 2019).

The highest prevalence of maternal smoking in Europe

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

Certain maternal pathologies during pregnancy and postpartum are on the increase, in particular disorders related to hypertension (4.5% in 2010; 5.0% in 2019) and gestational diabetes (6.7% in 2010 13.6% in 2019).

This latter increase is partly explained by changes in screening methods and by the increase in the prevalence of risk factors, such as obesity or higher maternal age.

Increase in neonatal mortality

Another major observation: the evolutions of mortality are contrasting, “even worrying” both for the mother and the child, underlined Anne Gallay. Thus, the maternal mortality rate did not decrease significantly between 2007-2009 (9.5 deaths per 100,000 births) and 2013-2015 (8.1 per 100,000), the date of the latest data available.

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

“Work is underway to better understand the causes of this mortality,” noted Nolwenn Régnault, head of the perinatal unit of Public Health France. The situation can in any case progress, according to her, “many countries showing better results”.

In the Overseas Departments and regions, the overall picture is even more unfavorable: a maternal mortality rate 4 times higher than in mainland France, a stillbirth rate 1.5 times higher, a mortality rate neonatal 2 times higher. Guyana and Mayotte are the departments where the situation is the worst.

These findings “advocate for a strengthening of prevention and promotion of perinatal health”, “better access to rights and care, in particular in certain territories” of Overseas, concludes the report.

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