Defining vulnerability subgroups among pregnant women using pre-pregnancy information: a latent class analysis

Abstract

Background Early detection of vulnerability during or before pregnancy can contribute to optimizing the first 1000 days, a crucial period for children’s development and health. We aimed to identify classes of vulnerability among pregnant women in the Netherlands using pre-pregnancy data on a wide range of social risk and protective factors, and validate these classes against the risk of adverse outcomes. Methods We conducted a latent class analysis based on 42 variables derived from nationwide observational data sources and self-reported data. Variables included individual, socioeconomic, lifestyle, psychosocial and household characteristics, self-reported health, healthcare utilization, life-events and living conditions. We compared classes in relation to adverse outcomes using logistic regression analyses. Results In the study population of 4172 women, we identified five latent classes. The largest ‘healthy and socioeconomically stable’-class [n = 2040 (48.9%)] mostly shared protective factors, such as paid work and positively perceived health. The classes ‘high care utilization’ [n = 485 (11.6%)], ‘socioeconomic vulnerability’ [n = 395 (9.5%)] and ‘psychosocial vulnerability’ [n = 1005 (24.0%)] were characterized by risk factors limited to one specific domain and protective factors in others. Women classified into the ‘multidimensional vulnerability’-class [n = 250 (6.0%)] shared multiple risk factors in different domains (psychosocial, medical and socioeconomic risk factors). Multidimensional vulnerability was associated with adverse outcomes, such as premature birth and caesarean section. Conclusions Co-existence of multiple risk factors in various domains is associated with adverse outcomes for mother and child. Early detection of vulnerability and strategies to improve parental health and well-being might benefit from focussing on different domains and combining medical and social care and support.

Multiple Risk in Pregnancy- Prenatal Risk Constellations and Mother-Infant Interactions, Parenting Stress, and Child Externalizing and Internalizing Behaviors: A Prospective Longitudinal Cohort Study from Pregnancy to 18 Months Postpartum

“…This highlights how specific risks cluster, providing information on typical risk patterns during pregnancy. It also aligns with previous studies on prenatal risk patterns reporting patterns of sociodemographic, and psychosocial/ mental health risks (Hendryx et al, 2020 ; Molenaar et al, 2023 ). In contrast to these studies, we did not find support for additional risk groups in our sample.…”

“…This allows for investigation of typical combinations of risk factors during pregnancy, as well as providing more domain-specific knowledge on risk-outcome pathways. A few studies have investigated risk constellations using LCAs on samples of pregnant women, typically identifying 3–5 risk patterns (Hemady et al, 2022 ; Hendryx et al, 2020 ; Loomans et al, 2013 ; Molenaar et al, 2023 ; Mukherjee et al, 2017 ; Tian et al, 2018 ). In community samples this approach usually entails a larger low-risk group and several smaller groups characterized by elevated risk.…”

“…However, some of these studies have narrowly defined exposure variables, restricting the risk constellations to domains such as life stress (Mukherjee et al, 2017 ), social mobility (Tian et al, 2018 ), or adverse childhood experiences (Hemady et al, 2022 ); others have included a lower number of risk indicators (Loomans et al, 2013 ). Some studies comprise more broadly measured prenatal vulnerabilities (Hendryx et al, 2020 ; Molenaar et al, 2023 ), but restrict related outcomes to pregnancy complications or birth-related outcomes. There is a lack of research on the longer-term outcomes of prenatal risk constellations.…”