De effecten van CenteringPregnancy™ in Nederland

Perinatal and maternal morbidity/mortality is relatively high in the Netherlands, compared to other European countries. The perinatal outcomes are especially worse for pregnant women from lower socio-economic groups and from non-western origin. In the US a customized care model has been developed for these groups of women: CenteringPregnancy™ (CP). CP consists of consultations in group setting aimed at empowering the pregnant women by integrating three major components of care: health assessment, education, and support. Studies have shown positive effects of CP in the US: amongst others a decrease in the number of preterm births. CP is now being adapted to the Dutch primary health care and its feasibility is being studied. In the region Northern South-Holland in the Netherlands CP will be strengthened by a) involving chain partners from public health care, other primary care professionals and specialized health care, and b) the development of additional support for pregnant women with complex needs.
We will use a wedged cluster randomized controlled trial to examine the effects of CP of infant outcomes, maternal outcomes, and care outcomes in 11 midwifery practices and 3 clinics. Instead of randomly allocating practices to the intervention or control condition, the midwifery practices and clinics are randomly allocated to the period in which they start with providing CenteringPregnancy™. Data registered in the Dutch Perinatal Registration is used to monitor infant outcomes, and some of the maternal and care outcomes. Next, pregnant women will complete questionnaires three times during and one time after pregnancy. During the study the key professionals will monitor the process of prenatal care such as participation rate, uptake intervention, provided activities, and the costs of implementing group consultations. Professionals are also questioned (using a six monthly questionnaire) to assess their satisfaction with individual and group consultations and with the integration of care. Pregnant women and their partners will be asked about their satisfaction with care.
The project will be imbedded in our regional obstetric consortium group in which professionals and researchers in public health, primary, and specialized care are involved. The partners of our consortium are already collaborating in several networks: like the perinatal audits, obstetrics collaboration networks (verloskundig samenwerkingsVerband; VSV), and the Academic working place Public Health.

Perinatal and maternal morbidity/mortality is relatively high in the Netherlands, compared to other European Countries. The perinatal outcomes are especially worse for pregnant women from lower socio-economic groups and from non-western origin. In the US a customized care model has been developed for these groups of women: CenteringPregnancy™ (CP), which consists of consultations in group setting aimed at empowering the pregnant women by integrating three major components of care: health assessment, education, and support. Studies have shown positive effects of CP in the US: amongst others a decrease in the
number of preterm births. CP is now being adapted to the Dutch primary health care and its feasibility is being studied. In the region Northern South-Holland in the Netherlands CP will be strengthened by a) involving chain partners from public health care, other primary care professionals and specialized health care, and b) the development of additional support for pregnant women with complex needs. In the present study this adapted CP is developed and its effects are evaluated.

Mental health: Edinburg Postpartum Depression Scale, by Cox et al (28 weeks GA, 6 weeks postpartum)

Sociale Steun Lijst (Social Support), by van Eijk, van Sonderen (12 and 36 weeks GA)
Prenatal Distress Questionnaire, by Lobel et al (12 and 36 weeks GA)

Cambridge Worry Scale, by Green et al (12 and 36 weeks GA)
Parent Expectations Survey, by Reece et al (6 weeks postpartum)

Patient Participation and Satisfaction Questionnaire, by Littlefield and Adam (36 weeks GA)

Birth preparation: readiness for labor-delivery and infant scales, by Ickovics et al (36 weeks GA)

Health literacy: questionnaire measuring pre, peri and postnatal knowledge, based on Ickovics et al (12 and 36 weeks GA)
Adequacy of care: Kotelchuck index (36 weeks GA and 6 weeks pp, PRN)

Labor Agentry Scale, by Hodnett et al. (6 weeks postpartum)

The intervention studied is group prenatal care according to the CenteringPregnancy™- model (https://www.centeringhealthcare.org/). The effect of the intervention will be studied performing a stepped-wedge clustered randomized controlled trial. Subsequently each cluster contributes some months of control data and some months of intervention data. The intervention is compared to usual (individual) prenatal care, provided during the control months.