BackgroundValue-based health care aims to optimize the balance of patient outcomes and health care costs. To improve value in perinatal care using this strategy, standard outcomes must first be defined. The objective of this work was to define a minimum, internationally appropriate set of outcome measures for evaluating and improving perinatal care with a focus on outcomes that matter to women and their families.MethodsAn interdisciplinary and international Working Group was assembled. Existing literature and current measurement initiatives were reviewed. Serial guided discussions and validation surveys provided consumer input. A series of nine teleconferences, incorporating a modified Delphi process, were held to reach consensus on the proposed Standard Set.ResultsThe Working Group selected 24 outcome measures to evaluate care during pregnancy and up to 6 months postpartum. These include clinical outcomes such as maternal and neonatal mortality and morbidity, stillbirth, preterm birth, birth injury and patient-reported outcome measures (PROMs) that assess health-related quality of life (HRQoL), mental health, mother-infant bonding, confidence and success with breastfeeding, incontinence, and satisfaction with care and birth experience. To support analysis of these outcome measures, pertinent baseline characteristics and risk factor metrics were also defined.ConclusionsWe propose a set of outcome measures for evaluating the care that women and infants receive during pregnancy and the postpartum period. While validation and refinement via pilot implementation projects are needed, we view this as an important initial step towards value-based improvements in care.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3732-3) contains supplementary material, which is available to authorized users.

Objective To examine the contribution of preterm birth and size-for-gestational age in stillbirths using six "newborn types". Design Population-based multi-country analyses. Setting Births collected through routine data systems in 12 countries. Sample 119,644,788 total births from 22+0 to 44+6 weeks gestation identified from 2000 to 2020. Methods We included 605,557 stillbirths from 22+0 weeks gestation from 12 countries. We classified all births, including stillbirths, by six "newborn types" based on gestational age information (preterm, PT, <37+0 weeks vs term, T, ≥37+0 weeks) and size-for-gestational age defined as small (SGA, <10th centile), appropriate (AGA, 10th-90th centiles), or large (LGA, >90th centile) for gestational age, according to the international newborn size for gestational age and sex INTERGROWTH-21st standards. Main Outcome Measures Distribution of stillbirths, stillbirth rates and rate ratios according to six newborn types. Results 605,557 (0.50%) of the 119,644,788 total births resulted in stillbirth after 22+0 weeks. Most stillbirths (74.3%) were preterm. Around 21.0% were SGA types (PT+SGA (16.0%), T+SGA (5.0%)) and 14.3% were LGA types (PT+LGA (10.1%), T+LGA (4.2%)). The median rate ratio (RR) for stillbirth was highest in PT+SGA babies (RR=78.8, interquartile range (IQR), 68.2, 111.5) followed by PT+AGA (RR=24.5, IQR, 19.3, 29.4), PT+LGA (RR=23.0, IQR,13.7, 29.0) and T+SGA (RR=5.5, IQR, 5.0, 6.0) compared with T+AGA. Stillbirth rate ratios were similar for T+LGA vs T+AGA (RR=0.7, IQR, 0.7, 1.1). At the population level, 21.5% of stillbirths were attributable to small-for-gestational-age. Conclusions In these high-quality data from high/middle income countries, almost three quarters of stillbirths were born preterm and a fifth were small-for-gestational age, with the highest stillbirth rates associated with the coexistence of preterm and SGA. Further analyses are needed to better understand patterns of gestation-specific risk in these populations, and also patterns in lower-income contexts, especially those with higher rates of intrapartum stillbirth and SGA. Funding The Childrens Investment Fund Foundation, 1803-02535 Keywords newborn, stillbirths, premature birth, preterm, pregnancy, gestational age TWEETABLE ABSTRACT OF 110 CHARACTERS Word count 3,482

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Introduction: Maternal obesity presents significant health risks to mothers and their fetuses. This study aimed to determine the proportion, associated factors and outcomes of maternal obesity among pregnant women in Klang Valley, Malaysia. Methods: A retrospective cross-sectional study was conducted between January 2018 and March 2018 using secondary data from the Malaysian National Obstetric Registry (NOR) for the year 2015. All pregnant women with first-trimester booking at 12 weeks and below that were registered with the NOR and met the inclusion and exclusion criteria were included in the study. Descriptive statistics and multiple logistic regression analysis were used. Data were analysed using SPSS version 22.0. A total of 2113 respondents were included in this study to determine the proportion, associated factors and outcomes of maternal obesity. Regarding the univariate and multivariate analyses, respondents were classified into two groups: normal and obese. The obese group comprised overweight and obese mothers. The underweight group was excluded in the subsequent analysis. Results: Out of the 2113 respondents, 7.1% were underweight, 41.7% were of normal weight, 28.6% were overweight, 15.9% were in obese class I, 4.6% were in obese class II, and 2.1% were in obese class III according to the WHO (1995) reference. However, when the MOH (2003) cutoff point was used, there was a marked increase in the proportion of respondents in the overweight categories by 2.7% and obesity class I by 12.8%. The Indian (AdjOR 2.06, 95% CI: 1.11, 3.83, p=0.021) and Malay (AdjOR 1.75, 95% CI: 1.02, 3.00, p=0.040) ethnicities, as well as both multiparity (AdjOR 1.46, 95% CI: 1.23, 1.73, p <0.001) and grand multiparity (AdjOR 2.41, 95% CI: 1.78, 3.26, p <0.001), were significantly associated with maternal obesity. There were significant association between maternal obesity with hypertensive disorder in pregnancy (p=0.025), caesarean section delivery (p=0.002) and macrosomic infant (p <0.001). Conclusion: The identification of risk factors for maternal obesity is important to facilitate intervention programmes focused on improving the pregnancy outcomes for a high-risk group of women.

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