APROPOS-II Study

In a stepped-wedge cluster randomized controlled trial design, a locally tailored Preconception care (PCC) approach will be implemented in six municipalities in the Netherlands. The main objective of the APROPOS-II study is: “to implement a local PCC approach using a stepped wedge cluster randomized controlled trial design and evaluate the effectiveness on the preconception health and reach of PCC among prospective parents”. At the beginning of the pregnancy, future parents living in one of the participating municipalities will be approached by their primary care midwife to complete a one-time questionnaire. The questions address the respondents’ preparation for pregnancy and their lifestyle (changes). In addition the pregnancy outcomes of the participating women will be obtained. Data will be retrieved from medical records and collected from the questionnaires before and after the introduction of the PCC-approach. Moreover, a process evaluation will gain information on the functioning, efficiency and feasibility of the approach.

Expected results:
• The development of information toolkits and training modules for general practices, pharmacies, centers for youth and family, maternity care and PCC providers.
• Insight into the experiences of local healthcare providers and prospective parents regarding PCC.
• Insight into the differences in needs and PCC-strategy for prospective parents from low-risk, high-risk and vulnerable groups.
• Insight into the effect of a locally tailored PCC approach on preconception lifestyle behaviors and other social, medical and obstetrical risk factors.
• Insight into the follow-up data on the pregnancy course and pregnancy outcomes of women before and after exposure to the PCC approach.
• Insight into the (differences in) feasibility and sustainability of implementing a PCC approach that can be tailored to specific local settings.
The APROPOS-II study introduces a unique and locally tailored PCC-approach that will contribute to evidence regarding the effectiveness of PCC. If this PCC-approach indeed has a positive effect on lifestyle changes, subsequently leading to improved pregnancy outcomes and the future health of prospective parents and their offspring, it could be expanded towards (inter)national implementation.

• Beginning of the pregnancy: the questionnaire will be distributed
• Postpartum: the pregnancy outcomes will be obtained.

The intervention is locally tailored PCC approach. The key to this PCC approach is that it is tailored to the needs of prospective parents and healthcare providers in a local setting. To accomplish this we will use a dual-track approach based on, (1) uptake of PCC: a large and professional promotional campaign directed towards couples who wish to conceive, (2) provision of PCC: a local care pathway to improve interdisciplinary collaboration between healthcare workers.