American Journal of Epidemiology Vol. 155, No. 4 : 304
Copyright © 2002 by The Johns Hopkins University School of Hygiene and Public Health
ORIGINAL CONTRIBUTIONS |
Dayan et al. Respond to "Is Preterm Labor a Valid Endpoint in Perinatal Research?"
1 Service de Psychiatrie de l'Enfant et de l'Adolescent, CHU Clemenceau, Caen, France.
2 Laboratoire d'Informatique Médicale et Épidémiologie, CHU Clemenceau, Caen, France.
3 Clinique de Gynécologie-Obstétrique et de la Reproduction Humaine, CHU Clemenceau, Caen, France.
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We agree with most of the arguments Dr. Macones (1
) very clearly put forward regarding the obstetric aspects of our study (2). However we would like to stress the following points. Apart from the medical complications mentioned by Dr. Macones, preterm labor has frequent, and often serious, psychological consequences. As already stated in our article, preterm labor increases the level of maternal anxiety and alters the quality of life during pregnancy. More specifically, prescriptions such as prolonged bed rest may increase the risk of depression.
It is very usual, in France, to have serial cervical assessments during pregnancy. In our hospital, all pregnant women have to attend a compulsory prenatal visit each month, most of them starting before the end of the first trimester. Cervicovaginal examination is systematically conducted at each of these visits.
The assumption that "the 'diagnosis' of preterm labor was presumably given only to women who had 'complaints' of contractions that necessitated a visit to the obstetrician" (1, p. 303) is not accurate. As mentioned in the article (2), preterm labor is systematically queried at each compulsory routine consultation. One of these compulsory consultations necessarily took place during the enrolment phase of our study. As a consequence, a diagnosis of preterm labor may be made quite independently from any visit motivated by complaints of contraction or other complaints.
Possible biases regarding the relation between anxiety and preterm labor cannot be applied to depression. This disorder, especially in its major form, differs from anxiety in its manifestations. Depressed women exhibit a tendency toward inhibition and withdrawal and as a result are not likely to express complaints or seek multiple visits, unlike anxious women. It is thus very unlikely that the magnitude of the strong association we found between depression and preterm labor might be falsely increased.
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Correspondence to Dr. J. Dayan, Service de Psychiatrie de l'Enfant et de l'Adolescent, CHU Clemenceau, Avenue Georges Clemenceau, 14033 Caen Cedex, France (e-mail: dayan-j{at}chu-caen.fr).
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Macones GA. Invited commentary: is preterm labor a valid endpoint in perinatal research? Am J Epidemiol 2002;155:302–3.
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Dayan J, Creveuil C, Herlicoviez M, et al. Role of anxiety and depression in the onset of spontaneous preterm labor. Am J Epidemiol 2002;155:293–301.
[Abstract/Free Full Text]
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Related articles in Am. J. Epidemiol.:
- Role of Anxiety and Depression in the Onset of Spontaneous Preterm Labor
- J. Dayan, C. Creveuil, M. Herlicoviez, C. Herbel, E. Baranger, C. Savoye, and A. Thouin
Am. J. Epidemiol. 2002 155: 293-301.[Abstract] [FREE Full Text]
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