ObjectiveWork-related activities can be a risk factor for pregnancy complications such as preterm birth. This study evaluates the effectiveness of a blended care programme, Pregnancy and Work, that provides pregnant workers and their obstetrical caregivers with advice on work adjustment.MethodsWomen less than 20 weeks of gestation, in paid employment or self-employed, in the care of four participating hospitals and their referring midwifery practices in the Netherlands received either the blended care programme (n=119), consisting of a training for professionals and a mobile health application, or care as usual (n=122) in a controlled intervention study with a follow-up in intervention and control populations. All participants completed three questionnaires concerning health and working conditions at 16, 24 and 32 weeks of pregnancy. Primary outcome was the percentage of women who received advice from their obstetrical caregiver about work adjustment. Secondary outcomes were work status, realised work adjustment and working conditions. Groups were compared using univariate and multivariate regression analyses.ResultsA total of 188 (78%) completed all three questionnaires. In the blended care group, women received more advice from obstetrical caregivers to adjust their work than in the control group, 41 (39%) vs 21 (18%) (adjusted relative risk (aRR) 2.2, 95% CI 1.4 to 3.4), but less from their employer 8 (8%) vs 31 (28%) (aRR 0.29, 95% CI 0.14 to 0.61). There were no significant differences in realised work adjustments. At 24 weeks, 30% of the pregnant women in both groups continued to work in hazardous workplaces.ConclusionAmong working pregnant women, the blended care intervention increases advice on work adjustment given by midwives and obstetricians, but does not lead to more work adjustments.
Background: Women suffering from chronic diseases should preferably receive specialized individual preconception care (PCC) by an obstetrician before becoming pregnant. For most chronic diseases it is important that the disease is in remission or under control before conception, aiming for optimal pregnancy outcome. Especially, amongst other considerations, medication use should be monitored for toxicity before starting a pregnancy. Specific case findings followed by a referral to an obstetrician for specialized individual PCC by a general practitioner (GP) could be a solution to improve the uptake of PCC. The aim of this study was to explore patients’ views on PCC organized by general practitioners (GP) for women suffering from a chronic disease.Methods: We recruited participants via a public Facebook message. We asked women suffering from a chronic medical condition, aged 18-42 years, living in the Netherlands and planning to become pregnant to contact the researcher by a personal message. Once contacted, women received additional information about the aim of the study. After reading the study information, women were asked for participation and a digital informed consent was sent. Thereafter, an appointment for a semi-structured interview by telephone, the study intervention, was made. The interviews were audio-taped, transcribed verbatim and member checked. The transcripts were coded and analysed on facilitators and barriers for preconception care by GP’s, using NVivo 10.Results: 45 women replied to the public Facebook message. All women were contacted by the researcher. Finally, 23 women consented to participate in a semi-structured interview by telephone. This resulted in a heterogeneous study population. The participants indicated a range of facilitators and barriers for organizing PCC via the GP. The GP was viewed to be trustworthy, to have knowledge about their medical history and to have a coordinating role but limited knowledge about pregnancy. Patients preferred a referral from the GP to an obstetrician to have a face-to-face preconception consultation together with their medical specialist. Conclusions: According to women suffering from a chronic disease, PCC is ideally given by an obstetrician and medical specialist in a face-to-face consultation whereby the GP has a coordinating role.Trial registration: not applicable.
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