Elf Cohort
The Elfe study aims to gain a better understanding of the factors (environment, family background, living conditions, etc.) that may influence a child’s physical and psychological development, health, and socialization.
Elf Cohort
Gain a better understanding of the factors (environment, family environment, living conditions, etc.) that can influence a child’s physical and psychological development, health, and...
Santé publique France has been a partner since 2006. It is directly involved in several projects in the fields of infectious diseases, diabetes, trauma, the environment, respiratory diseases, alcohol, and more.
The Elfe cohort consists of a longitudinal study of children born in 2011. Nearly 18,000 children born in 2011 were initially included in the study, with their parents’ consent. Questionnaire-based interviews and sample collections are conducted at various stages of the child’s life to track their development and progress. Data were collected from pregnant women and newborns at birth, then when the child was two months old, at 1 year, 2 years, 3½ years, and so on.
Here are a few examples of the many questions to which Santé publique France is helping to provide answers through the Elfe cohort:
To what extent are pregnant women in France exposed to environmental pollutants during pregnancy? What are the modes of exposure, and what is the impact on the child’s health and development?
What is the incidence of everyday accidents among children, and how do they affect a child’s long-term development?
What are the sociodemographic characteristics that promote screening, the diagnosis of gestational diabetes, and the birth of a high-birth-weight infant?
What is the incidence of asthma in early childhood, and what factors influence its onset?
What is the impact of alcohol consumption during pregnancy on a child’s development and health?
This report presents the projects carried out by Santé publique France using data from the Elfe cohort, along with related publications. It also highlights the role of Santé publique France (formerly the Institut de veille sanitaire) in establishing (pilot phase) this cohort.
The ELFE cohort was launched in April 2011 under the leadership of a joint Inserm/INED/EFS unit, following a pilot phase conducted from 2006 to 2009 by Santé publique France and INED.
Since 2011, Santé publique France has been a partner of the ELFE cohort as a member of the steering committee, alongside approximately ten other public institutions.
Santé publique France participates in thematic working groups focused on data collected as part of the ELFE cohort.
All current projects led by Santé publique France are presented below, along with publications related to each of these projects (organized by theme)
Projects led by Santé publique France in the Elfe cohort
Biomonitoring in pregnant women
To estimate the exposure of pregnant women to various pollutants (lead, pesticides, phthalates, bisphenol A, etc.) and the associated exposure factors.
Dereumeaux C et al. The French human biomonitoring program: First lessons from the perinatal component and future needs. Int. J. Hyg. Environ. Health (2016)
Dereumeaux C, Saoudi A, Pecheux M, Berat B, de Crouy Chanel P, Zaros C et al. Biomarkers of exposure to environmental contaminants in French pregnant women from the Elfe cohort in 2011. Environ Int 2016;97:56-67.
Guldner L, Dereumeaux C, Saoudi A, Pecheux M, et al. Exposure to environmental pollutants among pregnant women and their children in utero: initial results from the perinatal component of the national biomonitoring program (mothers included in the ELFE cohort). Arch Pediatr 2015;22:35-36.
Asthma
Measurement of asthma prevalence at different ages of the child, asthma incidence, and study of the natural history of the disease.
Injuries
Description of accidents among children, monitoring of their sequelae and medium- and long-term impact: questions on trauma in the questionnaires. Santé publique France will analyze the data collected at 1 year and 2 years.
Perrine A-L, Bois C, Dufourg M-N, Charles M-A, Thélot B. Accidents in children, their determinants, and their consequences, through the Elfe cohort. Poster. French Society of Public Health (SFSP) – Tours. November 2015
Perrine AL, Bois C, Dufourg MN, Pédrono G, Ricard C, Thélot B. Unintentional injuries from birth up to two months: data from the Elfe cohort in France. Poster. Safety conference, Tampere, Finland, September 17–21, 2016.
Surveillance of Vaccine-Preventable Diseases
Estimation of mothers’ serological status regarding CMV and hepatitis B markers and evaluation of measures to prevent neonatal transmission of hepatitis B; estimation of the risk of tuberculosis and BCG vaccination at 6 weeks, as well as vaccination coverage among children at 2 years of age.
Guthmann JP, Ragot M, Ben Boutieb M, Bois C, Dufourg MN, Levy Bruhl D. Vaccination coverage and socioeconomic determinants of BCG vaccination in children under 3 months of age: results from the Elfe cohort, 2011. Rev Epidemiol Sante Publique 2016;64(4):271-80.
Study of psychomotor development in children exposed to alcohol during the prenatal period
Identification of clinical characteristics and psychomotor developmental disorders in children whose mothers report having consumed alcohol excessively (an average of at least 2 standard drinks per month or having experienced more than 2 episodes of severe acute alcohol intoxication [3 or more drinks on a single occasion]) during their pregnancy.
Gestational diabetes
To estimate the frequency of screening for gestational diabetes and its prevalence in France in 2011, following the publication of new guidelines. To describe the associations between maternal sociodemographic characteristics and screening, diagnosis of gestational diabetes, as well as the birth of a child with high birth weight for gestational age.
Dow C, Fosse-Edorh S, Perrine A-L, Charles M-A, Barry Y, Vambergue A, Cosson E, Regnault N. Screening, prevalence, and prognosis of gestational diabetes in France in 2011: the ELFE study. Poster. Francophone Diabetes Society (SFD) – Lyon. March 2016
In March 2006, a scientific interest group (GIS) was established, bringing together multiple partners: INED, Santé publique France, Inserm, the National Institute of Statistics and Economic Studies (INSEE), the Directorate for Evaluation, Forecasting, and Performance (DEPP), the Directorate for Research, Studies, Evaluation, and Statistics (Drees), the General Directorate of Health (DGS), and the National Family Allowance Fund. INED hosted the project team, which included several Santé publique France staff members.
Given the multidisciplinary nature of the Elfe project and the number and diversity of partners, it was essential to test acceptability among all stakeholders, assess the requirements for effective coordination, and evaluate the project’s feasibility.
Thus, a pilot cohort of 571 families, established by Santé publique France and INED, was the subject of pilot studies aimed, on the one hand, at testing the logistical feasibility of sample collection and the quality of the samples, and, on the other hand, at conducting assays for infectious and environmental biomarkers.
Biological Sample Collection and Biobank Quality
The objective was to evaluate, under real-world conditions, the logistical organization, acceptability, and feasibility of data collection and biological sample collection (cord blood, maternal urine and hair, breast milk).
Biomarker Assays
The objective was to validate the methodological choices and to estimate the validity of the detection thresholds for infectious markers and biomarkers of exposure to certain pollutants.
Infectious markers: two infectious markers were studied in cord blood:
Cytomegalovirus (CMV) - Objective: to verify the quality of samples for CMV detection via PCR. This testing was successfully performed even in the presence of blood clots. No cases of congenital CMV infection were detected across all assays conducted by both laboratories.
Toxoplasmosis - Objective: to verify the concordance between the women’s medical records and the toxoplasmosis antibody levels in the cord blood. These results were concordant in 94% of cases. Nearly one-third of the women were seropositive.
Environmental biomarkers: Testing for these markers provides information on maternal exposure to certain pollutants and helps prioritize the biomarkers and exposures to be considered in the national biomonitoring program, of which the Elfe cohort constitutes the perinatal component.
Lead (cord blood): no elevated blood lead levels or cases of lead poisoning were observed following the measurements, which was not unexpected given the prevalence of lead poisoning in the general population and the sample size.
Bisphenol A and phthalates (maternal urine): the measured levels are similar to those reported in the international literature and show high interindividual variability, suggesting different potential sources (Elfe – Key results for bisphenol A and phthalates). Contamination from medical devices has been identified and will be avoided in the national Elfe study.
All publications (excluding posters) related to projects led by Santé publique France as part of the Elfe cohort are listed below (in chronological order):
2016
Dereumeaux C et al. The French human biomonitoring program: First lessons from the perinatal component and future needs. Int. J. Hyg. Environ. Health (2016)
Dereumeaux C, Saoudi A, Pecheux M, Berat B, de Crouy Chanel P, Zaros C et al. Biomarkers of exposure to environmental contaminants in French pregnant women from the Elfe cohort in 2011. Environ Int 2016;97:56-67.
Guthmann JP, Ragot M, Ben Boutieb M, Bois C, Dufourg MN, Levy Bruhl D. Vaccination coverage and socioeconomic determinants of BCG vaccination in children under 3 months of age: results from the Elfe cohort, 2011. Rev Epidemiol Sante Publique 2016;64(4):271-80.
2015
Guldner L, Dereumeaux C, Saoudi A, Pecheux M, et al. Exposure to environmental pollutants among pregnant women and their children in utero: initial results from the perinatal component of the national biomonitoring program (mothers included in the ELFE cohort). Arch Pediatr 2015;22:35-36.
Richaud Eyraud E, Brouard C, Antona D, La Ruche G, Tourdjman M, Dufourg MN, et al. Screening for infectious diseases during pregnancy: results of the ELFE survey in maternity wards, metropolitan France, 2011. Special Issue. Screening during pregnancy and at birth: recent epidemiological data. Bull Epidemiol Hebd 2015;(15-16):254-63.
Wagner S, Kersuzan C, Gojard S, Tichit C, Nicklaus S, Geay B, et al. Duration of breastfeeding in France according to parental and birth characteristics. Results of the French longitudinal Elfe study, 2011. Weekly Epidemiological Bulletin 2015;(29):522-32.
2014
Kersuzan C, Gojard S, Tichit C, Thierry X, Wagner S, Nicklaus S, et al. Prevalence of breastfeeding at the maternity ward according to parental characteristics and delivery conditions. Results from the Elfe Maternity Survey, mainland France, 2011. Bull Epidemiol Hebd 2014;(27):440-9.
2013
Antignac A, Veyrand B, Kadar H, Marchand P, Oleko A, Le Bizec B, et al. Occurrence of perfluorinated alkylated substances in breast milk of French women and relation with socio-demographic and clinical parameters: results of the ELFE pilot study. Chemosphere 2013;91(6):802-8.
Bois C, Dufourg MN, Charles MA, Guthmann JP, Thelot B, Levy Bruhl D. Box. The ELFE cohort: a tool for exploring the determinants of vaccination coverage. Special issue. New tools to improve the measurement of vaccination coverage in France. Bull Epidemiol Hebd 2013;(8-9):86-7.
2011
Oleko A, Betsou F, Sarter H, Gerdil C, Desbois I, Charles MA, et al. A pilot study of the ELFE longitudinal cohort: feasibility and preliminary evaluation of biological collection. Biopreserv Biobank 2011;9(3):223-7.
