Geographical differences in perinatal health and child welfare in the Netherlands: rationale for the healthy pregnancy 4 all-2 program

Waelput, Adja J M; Sijpkens, Meertien K.; Lagendijk, Jacqueline; Minde, M; Raat, Hein; Ernst-Smelt, Hiske E; Kroon, Marlou L. A. de; Rosman, Ageeth N.; Been, Jasper V; Bertens, Loes C. M.; Steegers, Eric A.P.

doi:10.1186/s12884-017-1425-2

Cited by 44 publications

(47 citation statements)

References 46 publications

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“…Apart from strategies to improve birth outcomes in the general population, policies targeting the most deprived sectors of the population were also made available in this period. Also, multiple intervention programmes to improve perinatal health were launched with a general focus on vulnerable populations 34 35. As found in previous studies,36 maternal smoking is an important contributor to inequalities in birth outcomes.…”

Section: Discussionmentioning

confidence: 94%

Persisting inequalities in birth outcomes related to neighbourhood deprivation

Bertens

Ochoa

Ourti

et al. 2019

J Epidemiol Community Health

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IntroductionHealth inequalities can be observed in early life as unfavourable birth outcomes. Evidence indicates that neighbourhood socioeconomic circumstances influence health. However, studies looking into temporal trends in inequalities in birth outcomes including neighbourhood socioeconomic conditions are scarce. The aim of this work was to study how inequalities in three different key birth outcomes have changed over time across different strata of neighbourhood deprivation.MethodsNationwide time trends ecological study with area-level deprivation in quintiles as exposure. The study population consisted of registered singleton births in the Netherlands 2003–2017 between 24 and 41 weeks of gestation. Outcomes used were perinatal mortality, premature birth and small for gestational age (SGA). Absolute rates for all birth outcomes were calculated per deprivation quintile. Time trends in birth outcomes were examined using logistic regression models. To investigate relative inequalities, rate ratios for all outcomes were calculated per deprivation quintile.ResultsThe prevalence of all unfavourable birth outcomes decreased over time: from 7.2 to 4.1 per 1000 births for perinatal mortality, from 61.8 to 55.6 for premature birth, and from 121.9 to 109.2 for SGA. Inequalities in all birth outcomes have decreased in absolute terms, and the decline was largest in the most deprived quintile. Time trend analyses confirmed the overall decreasing time trends for all outcomes, which were significantly steeper for the most deprived quintile. In relative terms however, inequalities remained fairly constant.ConclusionIn absolute terms, inequalities in birth outcomes by neighbourhood deprivation in the Netherlands decreased between 2003 and 2017. However, relative inequalities remained persistent.

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Section: Discussionmentioning

confidence: 94%

Persisting inequalities in birth outcomes related to neighbourhood deprivation

Bertens

Ochoa

Ourti

et al. 2019

J Epidemiol Community Health

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“…Epidemiological evidence of inequalities in adverse pregnancy outcomes is compelling enough to justify continued efforts to develop a healthcare system that can properly deal with social risk factors. It is advised to evaluate such a system when it has been brought to scale and matured sufficiently to have a discernible impact 31. The Ready for a Baby programme generated a lot of attention both locally and nationally for the relevance of social determinants of pregnancy outcomes and for the development of methods to integrate obstetric care and the social domain, which is a valuable outcome in itself.…”

Section: Discussionmentioning

confidence: 99%

Did an urban perinatal health programme in Rotterdam, the Netherlands, reduce adverse perinatal outcomes? Register-based retrospective cohort study

et al. 2019

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ObjectivesTo study the effect of an urban perinatal health programme in Rotterdam, the Netherlands, on perinatal outcomes.DesignA retrospective cohort study with difference-in-differences analysis using individual-level perinatal outcome data from the Dutch Perinatal Registry 2003–2014 linked to Central Bureau of Statistics data of migration background and individual disposable household income.InterventionThe programme consisted of perinatal health promotion, risk selection and risk-guided pregnancy care, and a new primary care child birth centre. The programme was implemented during 2009–2012.Primary outcome measuresWe compared trends in perinatal mortality, preterm delivery and small-for-gestational-age births between targeted urban neighbourhoods in Rotterdam (n=61 415) and all other urban neighbourhoods in the Netherlands (n=881 202). The effect of the programme was modelled as a change in trend of each perinatal outcome in the treatment group post intervention compared with the control population from January 2010 onwards. All analyses were adjusted for maternal age, parity, ethnicity and individual-level low socioeconomic status (SES). We also conducted a stratified analysis by SES.ResultsDuring 2003–2014, downward trends in perinatal mortality (adjusted OR (aOR) 0.9439 per year, 95% CI 0.9362 to 0.9517), preterm birth (aOR 0.9970 per year, 95% CI 0.9944 to 0.9997) and small-for-gestational-age births (aOR 0.9809 per year, 95% CI 0.9787 to 0.9831) in the entire study population were observed. No demonstrable changes in these trends were found in the intervention group after the programme had started. The stratified analyses by SES showed no changes in trends post intervention in both strata either.ConclusionsThe programme had no demonstrable effects on perinatal outcomes. The intervention may not have reached a sufficient proportion of the population or has provided too little contrast to the widespread attention for inequalities in pregnancy outcomes occurring simultaneously in the Netherlands.

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“…The study will be executed in three municipalities in the Netherlands; Amsterdam, Rotterdam, and Dordrecht. All three are included in the ranking of high perinatal mortality, high prematurity and high SGA rates, and high frequencies of children living in deprivation (Waelput, 2017). All newborns in these municipalities, aged 0–8 weeks of age, will be eligible for inclusion in this study, during a maximum of 18 months.…”

Section: Methodsmentioning

confidence: 99%

Innovative postnatal risk assessment in preventive child health Care: A study protocol

Minde

Remmerswaal

Raat

et al. 2020

Journal of Advanced Nursing

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Aim To introduce the rationale and design of a postnatal risk assessment study, which will be embedded in Preventive Child Health Care. This study will evaluate: (a) the predictive value of an innovative postnatal risk assessment, meant to assess the risk of growth and developmental problems in young children; and (b) its effectiveness in combination with tailored care pathways. Design This study concerns a historically controlled study design and is designed as part of the Healthy Pregnancy 4 All‐2 program. We hypothesize that child growth and developmental problems will be reduced in the intervention cohort due to the postnatal risk assessment and corresponding care pathways. Methods The study was approved in August 2016. Children and their parents, visiting well‐baby clinics during regular visits, will participate in the intervention (N = 2,650). Additional data of a historical control group (N = 2,650) in the same neighbourhoods will be collected. The intervention, consisting of the risk assessment and its corresponding care pathways, will be executed in the period between birth and 2 months of (corrected) age. The predictive value of the risk assessment and its effectiveness in combination with its corresponding care pathways will be assessed by Preventive Child Health Care nurses and physicians in four Preventive Child Health Care organisations in three municipalities with adverse perinatal outcomes. A total risk score above a predefined threshold, which is based on a weighted risk score, determines structured multidisciplinary consultation. Discussion The successful implementation of this innovative postnatal risk assessment including corresponding care pathways has potential for further integration of risk assessment and a family‐centred approach in the work process of Preventive Child Health Care nurses and physicians. Impact This study introduces a systematic approach in postnatal health care which may improve growth and developmental outcomes of children and even future generations.

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Geographical differences in perinatal health and child welfare in the Netherlands: rationale for the healthy pregnancy 4 all-2 program

Cited by 44 publications

References 46 publications

Persisting inequalities in birth outcomes related to neighbourhood deprivation

Persisting inequalities in birth outcomes related to neighbourhood deprivation

Did an urban perinatal health programme in Rotterdam, the Netherlands, reduce adverse perinatal outcomes? Register-based retrospective cohort study

Innovative postnatal risk assessment in preventive child health Care: A study protocol

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