Design and outline of the Healthy Pregnancy 4 All study

Abstract

BackgroundPromotion of healthy pregnancies has gained high priority in the Netherlands because of the relatively unfavourable perinatal health outcomes. In response a nationwide study Healthy Pregnancy 4 All was initiated. This study combines public health and epidemiologic research to evaluate the effectiveness of two obstetric interventions before and during pregnancy: (1) programmatic preconception care (PCC) and (2) systematic antenatal risk assessment (including both medical and non-medical risk factors) followed by patient-tailored multidisciplinary care pathways. In this paper we present an overview of the study setting and outlines. We describe the selection of geographical areas and introduce the design and outline of the preconception care and the antenatal risk assessment studies.Methods/designA thorough analysis was performed to identify geographical areas in which adverse perinatal outcomes were high. These areas were regarded as eligible for either or both sub-studies as we hypothesised studies to have maximal effect there. This selection of municipalities was based on multiple criteria relevant to either the preconception care intervention or the antenatal risk assessment intervention, or to both. The preconception care intervention was designed as a prospective community-based cohort study. The antenatal risk assessment intervention was designed as a cluster randomised controlled trial – where municipalities are randomly allocated to intervention and control.DiscussionOptimal linkage is sought between curative and preventive care, public health, government, and social welfare organisations. To our knowledge, this is the first study in which these elements are combined.

Current practice of preconception care by primary caregivers in the Netherlands

“…The municipality selection process is described elsewhere. [18] The municipalities were categorised into 14 intervention municipalities and 36 non-intervention municipalities. The survey was carried out as described below.…”

Societal Valorisation of New Knowledge to Improve Perinatal Health: Time to Act

“…Local and national governmental bodies can also direct valorisation processes by determining the content and by subsidising them. In the Netherlands, the municipality of Rotterdam finances the local programme ‘Ready for a Baby’ and the Ministry of Health, Welfare, and Sport funded the national programme ‘Healthy Pregnancy for All’ in 14 other Dutch cities . Analysis of public health data by academics had illuminated large differences in perinatal health between neighbourhoods in the cities involved.…”

“…In the Netherlands, the municipality of Rotterdam finances the local programme 'Ready for a Baby' and the Ministry of Health, Welfare, and Sport funded the national programme 'Healthy Pregnancy for All' in 14 other Dutch cities. 12 Analysis of public health data by academics had illuminated large differences in perinatal health between neighbourhoods in the cities involved. Sharing this new information with policy makers in a number of different ways, using city maps showing the distribution of perinatal health outcomes, was sufficient to convince them that action was needed.…”

Bright light therapy in pregnant women with major depressive disorder: study protocol for a randomized, double-blind, controlled clinical trial

“…Rotterdam is the second largest city in the Netherlands with more than 620.000 inhabitants [50]. It has a high number of deprived neighbourhoods, defined as 10 % of pregnant women having a low socio-economic status (<20 th percentile) [51]. …”