Antenatal non-medical risk assessment and care pathways to improve pregnancy outcomes: a cluster randomised controlled trial

Autor: Semiha Denktaş, Ewout W. Steyerberg, Jasper V Been, Loes C.M. Bertens, Eric A.P. Steegers, Jacqueline Lagendijk, Amber A. Vos, Gouke J. Bonsel
Přispěvatelé: Obstetrics and gynaecology, Obstetrics & Gynecology, Department of Social and Behavioural Sciences, Department of Psychology, Education and Child Studies, Public Health, Pediatrics
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Zdroj: European Journal of Epidemiology
Vos, AA 2018, ' Antenatal non-medical risk assessment and care pathways to improve pregnancy outcomes: a cluster randomised controlled trial. ', European Journal of Epidemiology, vol. 33, no. 6, pp. 579-589 . https://doi.org/10.1007/s10654-018-0387-7
European Journal of Epidemiology, 33(6), 579. Springer Netherlands
European Journal of Epidemiology, 33(6), 579-589. Springer Netherlands
European Journal of Epidemiology, 33(6), 579-589
ISSN: 1573-7284
0393-2990
Popis: Social deprivation negatively affects health outcomes but receives little attention in obstetric risk selection. We investigated whether a combination of (1) risk assessment focused on non-medical risk factors, lifestyle factors, and medical risk factors, with (2) subsequent institution of risk-specific care pathways, and (3) multidisciplinary consultation between care providers from the curative and the public health sector reduced adverse pregnancy outcomes among women in selected urban areas in the Netherlands. We conducted a cluster randomised controlled trial in 14 urban municipalities across the Netherlands. Prior to the randomisation, municipalities were ranked and paired according to their expected proportion of pregnant women at risk for adverse outcomes at birth. The primary outcome was delivery of a preterm and/or small for gestational age (SGA) baby, analysed with multilevel mixed-effects logistic regression analysis adjusting for clustering and individual baseline characteristics. A total of 33 community midwife practices and nine hospitals participated throughout the study. Data from 4302 participants was included in the Intention To Treat (ITT) analysis. The intervention had no demonstrable impact on the primary outcome: adjusted odds ratio (aOR) 1.17 (95% CI 0.84–1.63). Among the secondary outcomes, the intervention improved the detection of threatening preterm delivery and fetal growth restriction during pregnancy [aOR 1.27 (95% CI 1.01–1.61)]. Implementation of additional non-medical risk assessment and preventive strategies into general practices is feasible but did not decrease the incidence of preterm and/or SGA birth in the index pregnancy in deprived urban areas. Trial registration Netherlands National Trial Register (NTR-3367). Electronic supplementary material The online version of this article (10.1007/s10654-018-0387-7) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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