Gouke J Bonsel

Erasmus MC, Rotterdam, South Holland, Netherlands

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Publications (341)1036.73 Total impact

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    ABSTRACT: Mental disorders are prevalent during pregnancy, affecting 10% of women worldwide. To improve triage of a broad spectrum of mental disorders, we investigated the decision impact validity of: 1) a short set of currently used psychiatric triage items, 2) this set with the inclusion of some more specific psychiatric items (intermediate set), 3) this new set with the addition of the 10-item Edinburgh Depression Scale (extended set), and 4) the final set with the addition of common psychosocial co-predictors (comprehensive set). This was a validation study including 330 urban pregnant women. Women completed a questionnaire including 20 psychiatric and 10 psychosocial items. Psychiatric diagnosis (gold standard) was obtained through Structured Clinical Interviews of DSM-IV axis I and II disorders (SCID-I and II). The outcome measure of our analysis was presence (yes/no) of any current mental disorder. The performance of the short, intermediate, extended, and comprehensive triage models was evaluated by multiple logistic regression analysis, by analysis of the area under the ROC curve (AUC) and through associated performance measures, including, for example, sensitivity, specificity and the number of missed cases. Diagnostic performance of the short triage model (1) was acceptable (Nagelkerke's R(2)=0.276, AUC=0.740, 48 out of 131 cases were missed). The intermediate model (2) performed better (R(2)=0.547, AUC=0.883, 22 cases were missed) including the five items: ever experienced a traumatic event, ever had feelings of a depressed mood, ever had a panic attack, current psychiatric symptoms and current severe depressive or anxious symptoms. Addition of the 10-item Edinburgh Depression Scale or the three psychosocial items unplanned pregnancy, alcohol consumption and sexual/physical abuse (models 3 and 4) further increased R(2) and AUC (>0.900), with 23 cases missed. Missed cases included pregnant women with a current eating disorder, psychotic disorder and the first onset of anxiety disorders. For a valid detection of the full spectrum of common mental disorders during pregnancy, at least the intermediate set of five psychiatric items should be implemented in routine obstetric care. For a brief yet comprehensive triage, three high impact psychosocial items should be added as independent contributors.
    BMC Pregnancy and Childbirth 12/2015; 15(1):480. DOI:10.1186/s12884-015-0480-9 · 2.15 Impact Factor
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    ABSTRACT: The incidence of severe postpartum hemorrhage (PPH) is increasing. Regional variation may be attributed to variation in provision of care, and as such contribute to this increasing incidence. We assessed reasons for regional variation in severe PPH in the Netherlands. We used the Netherlands Perinatal Registry and the Dutch Maternal Mortality Committee to study severe PPH incidences (defined as blood loss ≥ 1000 mL) across both regions and neighborhoods of cities among all deliveries between 2000 and 2008. We first calculated crude incidences. We then used logistic multilevel regression analyses, with hospital or midwife practice as second level to explore further reasons for the regional variation. We analyzed 1599867 deliveries in which the incidence of severe PPH was 4.5%. Crude incidences of severe PPH varied with factor three between regions while between neighborhoods variation was even larger. We could not explain regional variation by maternal characteristics (age, parity, ethnicity, socioeconomic status), pregnancy characteristics (singleton, gestational age, birth weight, pre-eclampsia, perinatal death), medical interventions (induction of labor, mode of delivery, perineal laceration, placental removal) and health care setting. In a nationwide study in The Netherlands, we observed wide practice variation in PPH. This variation could not be explained by maternal characteristics, pregnancy characteristics, medical interventions or health care setting. Regional variation is either unavoidable or subsequent to regional variation of a yet unregistered variable.
    BMC Pregnancy and Childbirth 12/2015; 15(1):473. DOI:10.1186/s12884-015-0473-8 · 2.15 Impact Factor
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    ABSTRACT: Growing evidence on the risk contributing role of non-medical factors on pregnancy outcomes urged for a new approach in early antenatal risk selection. The evidence invites to more integration, in particular between the clinical working area and the public health domain. We developed a non-invasive, standardized instrument for comprehensive antenatal risk assessment. The current study presents the application-oriented development of a risk screening instrument for early antenatal detection of risk factors and tailored prevention in an integrated care setting. A review of published instruments complemented with evidence from cohort studies. Selection and standardization of risk factors associated with small for gestational age, preterm birth, congenital anomalies and perinatal mortality. Risk factors were weighted to obtain a cumulative risk score. Responses were then connected to corresponding care pathways. A cumulative risk threshold was defined, which can be adapted to the population and the availability of preventive facilities. A score above the threshold implies multidisciplinary consultation between caregivers. The resulting digital score card consisted of 70 items, subdivided into four non-medical and two medical domains. Weighing of risk factors was based on existing evidence. Pilot-evidence from a cohort of 218 pregnancies in a multi-practice urban setting showed a cut-off of 16 points would imply 20% of all pregnant women to be assessed in a multidisciplinary setting. A total of 28 care pathways were defined. The resulting score card is a universal risk screening instrument which incorporates recent evidence on non-medical risk factors for adverse pregnancy outcomes and enables systematic risk management in an integrated antenatal health care setting.
    International journal of integrated care 03/2015; 15:e002. · 1.26 Impact Factor
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    ABSTRACT: Promotion of healthy pregnancies has gained high priority in the Netherlands because of relatively unfavorable perinatal outcomes. In response, a nationwide study, 'Healthy Pregnancy 4 All' (HP4ALL), has been initiated. Part of this study involves systematic and broadened antenatal risk assessment (the Risk Assessment substudy). Risk selection in current clinical practice is mainly based on medical risk factors. Despite the increasing evidence for the influence of nonmedical risk factors (social status, lifestyle or ethnicity) on perinatal outcomes, these risk factors remain highly unexposed. Systematic risk selection, combined with customized care pathways to reduce or treat detected risks, and regular and structured consultation between community midwives, gynecologists and other care providers such as social workers, is part of this study. Neighborhoods in 14 municipalities with adverse perinatal outcomes above national and municipal averages are selected for participation. The study concerns a cluster randomized controlled trial. Municipalities are randomly allocated to intervention (n = 3,500 pregnant women) and control groups (n = 3,500 pregnant women). The intervention consists of systematic risk selection with the Rotterdam Reproductive Risk Reduction (R4U) score card in pregnant women at the booking visit, and referral to corresponding care pathways. A risk score, based on weighed risk factors derived from the R4U, above a predefined threshold determines structured multidisciplinary consultation. Primary outcomes of this trial are dysmaturity (birth weight < p10), prematurity (birth <37 weeks), and efficacy of implementation. The 'HP4ALL' study introduces a systematic approach in antenatal health care that may improve perinatal outcomes and, thereby, affect future health status of a new generation in the Netherlands.Trial registration: Dutch Trial Registry (NTR-3367) on 20 March 2012.
    Trials 01/2015; 16(1):8. DOI:10.1186/1745-6215-16-8 · 2.12 Impact Factor
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    ABSTRACT: Maternity care is an integrated care process, which consists of different services, involves different professionals and covers different time windows. To measure performance of maternity care based on clients' experiences, we developed and validated a questionnaire. We used the 8-domain WHO Responsiveness model, and previous materials to develop a self-report questionnaire. A dual study design was used for development and validation. Content validity of the ReproQ-version-0 was determined through structured interviews with 11 pregnant women (≥28 weeks), 10 women who recently had given birth (≤12 weeks), and 19 maternity care professionals. Structured interviews established the domain relevance to the women; all items were separately commented on. All Responsiveness domains were judged relevant, with Dignity and Communication ranking highest. Main missing topic was the assigned expertise of the health professional. After first adaptation, construct validity of the ReproQ-version-1 was determined through a web-based survey. Respondents were approached by maternity care organizations with different levels of integration of services of midwives and obstetricians. We sent questionnaires to 605 third trimester pregnant women (response 65%), and 810 women 6 weeks after delivery (response 55%). Construct validity was based on: response patterns; exploratory factor analysis; association of the overall score with a Visual Analogue Scale (VAS), known group comparisons. Median overall ReproQ score was 3.70 (range 1-4) showing good responsiveness. The exploratory factor analysis supported the assumed domain structure and suggested several adaptations. Correlation of the VAS rating and overall ReproQ score (antepartum, postpartum) supported validity (r = 0.56; 0.59, p<0.001 Spearman's correlation coefficient). Pre-stated group comparisons confirmed the expected difference following a good vs. adverse birth outcome. Fully integrated organizations performed slightly better (median = 3.78) than less integrated organizations (median = 3.63; p<0.001). Participation rate of women with a low educational level and/or a non-western origin was low. The ReproQ appears suitable for assessing quality of maternity care from the clients' perspective. Recruitment of disadvantaged groups requires additional non-digital approaches.
    PLoS ONE 01/2015; 10(2):e0117031. DOI:10.1371/journal.pone.0117031 · 3.53 Impact Factor
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    ABSTRACT: Background The concept of responsiveness, introduced by the World Health Organization (WHO), addresses non-clinical aspects of health service quality that are relevant regardless of provider, country, health system or health condition. Responsiveness refers to ¿aspects related to the way individuals are treated and the environment in which they are treated¿ during health system interactions. This paper assesses the psychometric properties of a newly developed responsiveness questionnaire dedicated to evaluating maternal experiences of perinatal care services, called the Responsiveness in Perinatal and Obstetric Health Care Questionnaire (ReproQ), using the eight-domain WHO concept.Methods The ReproQ was developed between October 2009 and February 2010 by adapting the WHO Responsiveness Questionnaire items to the perinatal care context. The psychometric properties of feasibility, construct validity, and discriminative validity were empirically assessed in a sample of Dutch women two weeks post partum.ResultsA total of 171 women consented to participation. Feasibility: the interviews lasted between 20 and 40 minutes and the overall missing rate was 8%. Construct validity: mean Cronbach¿s alphas for the antenatal, birth and postpartum phase were: 0.73 (range 0.57-0.82), 0.84 (range 0.66-0.92), and 0.87 (range 0.62-0.95) respectively. The item-own scale correlations within all phases were considerably higher than most of the item-other scale correlations. Within the antenatal care, birth care and post partum phases, the eight factors explained 69%, 69%, and 76% of variance respectively. Discriminative validity: overall responsiveness mean sum scores were higher for women whose children were not admitted. This confirmed the hypothesis that dissatisfaction with health outcomes is transferred to their judgement on responsiveness of the perinatal services.Conclusions The ReproQ interview-based questionnaire demonstrated satisfactory psychometric properties to describe the quality of perinatal care in the Netherlands, with the potential to discriminate between different levels of quality of care. In view of the relatively small sample, further testing and research is recommended.
    BMC Health Services Research 12/2014; 14(1):622. DOI:10.1186/s12913-014-0622-1 · 1.66 Impact Factor
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    ABSTRACT: IntroductionAntenatal screening for depressive/anxiety symptoms could be biased by worries surrounding the first ultrasound (US). Therefore, we examined the potential influence of worries surrounding the first US on systematic screening for depressive/anxiety symptoms during pregnancy.Materials and Methods We obtained data from 573 women screened consecutively in midwifery practices and hospitals in the Netherlands. Data included the Edinburgh Depression Scale (EDS), having had an US, and its perceived influence on women's worries.ResultsIn total, 18% had EDS scores ≥10 (n = 105). Among 392 women who underwent an US, currently existing worries, introduced or unaltered by the US, predicted depressive/anxiety symptoms (aOR: 3.41, P < 0.001). Among 181 women who did not undergo an US, expected continuation of existing worries after the US predicted depressive/anxiety symptoms (aOR: 18.84, P = 0.046), in contrast to worries which were expected to subside.DiscussionIn our cohort, depressive and/or anxiety symptoms were not associated with transient worries, reduced by a first US, suggesting no bias. If true, antenatal screening for anxiety/depressive symptoms should not depend on the timing of this US examination.
    Australian and New Zealand Journal of Obstetrics and Gynaecology 10/2014; 55(1). DOI:10.1111/ajo.12268 · 1.62 Impact Factor
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    ABSTRACT: Abstract Psychopathology, psychosocial problems and substance use (PPS) commonly occur in pregnant women, and can have a negative impact on the course of pregnancy and the healthy development of the child. As PPS often remains undetected and untreated during pregnancy, we developed and implemented a four-step screen-and-treat protocol in routine obstetric care, with: (i) screening including triage and subsequent confirmation, (ii) indication assessment, (iii) transfer towards care and (iv) utilization of care. Adherence to the protocol and risk factors associated with dropout were examined for 236 Dutch pregnant women in a deprived urban area. Seventy-nine percent of women accepted the screening, 21% dropped out during triage, 15% during confirmation, 3% during transfer and 8% thereafter. Provided reasons for dropout were lack of time and lack of perceived benefit. In particular, smokers, multiparous women, and women of non-Western ethnicity dropout on the way towards mental and psychosocial care. For a successful implementation of the protocol in the future, with improved adherence of pregnant women to the protocol, education of women on PPS risks, motivational skills and compulsory treatment are worth investigation.
    Journal of Psychosomatic Obstetrics & Gynecology 09/2014; DOI:10.3109/0167482X.2014.952278 · 1.23 Impact Factor
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    ABSTRACT: Objective: To investigate the relation between prenatal ultrasound measurements of viscero-abdominal disproportion and the expected type of postnatal surgical closure of an omphalocele. Study design: Retrospectively, 24 fetuses diagnosed with an isolated omphalocele in the 2nd trimester of pregnancy were selected (period 2003-2013). An image of the axial plane of the abdomen at the level of the defect was retrieved. The ratio of omphalocele circumference to abdominal circumference (OC/AC), and the ratio of defect diameter to abdominal diameter (DD/DA) were calculated. Prognostic outcome was primary closure. Sensitivity and specificity and the corresponding area under the ROC curve of these ratios were calculated as measurements of prognostic accuracy. Results: Primary closure was achieved in 15/24 cases. For the OC/AC-ratio a cut-off value of 0.82 successfully predicted outcome in 23/24 cases with an area under the ROC curve of 0.99. A cut-off value of 0.61 for the DD/DA-ratio successfully predicted type of closure in 20/24 cases with an area under the ROC curve of 0.88. In all cases without eviscerated liver tissue, the defect was primarily closed. Conclusion: In prenatal isolated omphalocele cases, the OC/AC-ratio is better at predicting postnatal surgical closure than the DD/DA-ratio and can be used as a prognostic tool for expected type of closure in the 2nd trimester of pregnancy.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 08/2014; 181C:294-299. DOI:10.1016/j.ejogrb.2014.08.009 · 1.63 Impact Factor
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    ABSTRACT: Objective Depressive symptoms during pregnancy are associated with preterm birth (PTB) and small for gestational age (SGA). Depressive symptoms and PTB and SGA, however, share similar demographic and psychosocial risk factors. Therefore, we investigated whether depressive symptomatology is an independent risk factor, or a mediator in the pathway of demographic and psychosocial risks to PTB and SGA. Design Multicentre follow-up study. Participants and setting Pregnant women (n=1013) from midwifery practices, secondary hospitals and a tertiary hospital in three urban areas in the Netherlands. Measurements Initial risk factors and depressive symptoms were assessed with the Mind2Care instrument, including Edinburgh Depression Scale (EDS) during early pregnancy. Pregnancy outcomes were extracted from medical records. A formal mediation analysis was conducted to investigate the role of depressive symptoms in the pathway to PTB and SGA. Findings A univariate association between depressive symptoms and PTB (OR:1.04; 95% CI:1.00–1.08) was observed. After adjusting for the risk factors educational level and smoking in the mediation analysis, this association disappeared. One educational aspect remained associated: low education OR: 1.06; 95%CI: 1.02-1.10. Key Conclusions Depressive symptomatology appeared no mediator in the pathway of demographic and psychosocial risks to PTB or SGA. The presumed association between depressive symptoms and PTB seems spurious and may be explained by demographic and psychosocial risk factors. Implications for practice For the prevention of PTB and SGA, interventions directed at demographic and psychosocial risk factors are likely to be of primary concern for clinicians and public health initiatives. As depressive symptoms and PTB and SGA share similar risk factors, both will profit.
    Midwifery 08/2014; 30(919):925. DOI:10.1016/j.midw.2014.03.008 · 1.71 Impact Factor
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    ABSTRACT: Objective To study in routine care the feasibility and inter-rater reliability of the Rotterdam Reproductive Risk Reduction risk score card (R4U), a new semi-quantitative score card for use during the antenatal booking visit. The R4U covers clinical and non-clinical psychosocial factors and identifies overall high risk pregnancies, qualifying for intensified antenatal care. Design A population-based cross-sectional study (feasibility) and a cohort study (inter-rater reliability). Setting Feasibility was studied in six midwifery practices and two hospitals; the reliability study was performed in one midwifery practice. Participants 1096 pregnant women in the feasibility study and a subsample of 133 participants in the inter-rater reliability study. Measurements Feasibility was expressed as a) time needed to complete the R4U and b) the missing rate at the item and client level. For inter-rater reliability (IRR) an independent, blinded, caregiver completed a re-test R4U during a second visit; inter-rater agreement for each item and all domain sum scores were computed. Findings Completion of the R4U took 5 minutes or less in 63%; and between 5 and 10 minutes in another 33%. On the participant level 0.2% of women had >20% missing values (below 4% threshold, P<0.001). One of 77 items had a >10% missing rate. The per item IRR was 100% in 20% of the items, and below the predefined 80% threshold in 13% of the items (n=9). The domain sum scores universally differed less than the predetermined +/−15% margin. Key conclusion The R4U risk score card is a feasible and reliable instrument. Implication for practice The R4U is suitable for the assessment of clinical and non-clinical risks during the antenatal booking visit in a heterogeneous urban setting in routine practice.
    Midwifery 08/2014; 31(1). DOI:10.1016/j.midw.2014.08.002 · 1.71 Impact Factor
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    ABSTRACT: Promotion 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) a 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/design: A 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.
    BMC Pregnancy and Childbirth 07/2014; 14(1):253. DOI:10.1186/1471-2393-14-253 · 2.15 Impact Factor
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    ABSTRACT: In this hypothetical analysis with retrospective cohort data (1,160,708 hospital births) we estimated outcome of centralisation of acute obstetric care, i.e., closure of 10 hospitals (out of 99) in The Netherlands. The main outcome was predicted intrapartum and first-week mortality (further referred to as neonatal mortality) for several subgroups of patients affected by two centralisation scenarios: (1) closure of the 10 smallest hospitals; (2) closure of the 10 smallest hospitals, but avoiding adjacent closures. Predictions followed from regression coefficients from a multilevel logistic regression model. Scenario 1 resulted in doubled travel time, and 10% increased mortality (210 [0.34%] to 231 [0.38%] cases). Scenario 2 showed less effect on mortality (268 [0.33%] to 259 [0.32%] cases) and travel time. Heterogeneity in hospital organisational features caused simultaneous improvement and deterioration of predicted neonatal mortality. Consequences vary for subgroups. We demonstrate that (in The Netherlands) centralisation of acute obstetric care according to the ‘closure-of-the-smallest-rule’ yields suboptimal outcomes. In order to develop an optimal strategy one would need to consider all positive and negative effects, e.g., organisational heterogeneity of closing and surviving hospitals, differential effects for patient subgroups, increased travel time, and financial aspects. The provided framework may be beneficial for other countries considering centralisation of acute obstetric care.
    Health Policy 07/2014; 117(1). DOI:10.1016/j.healthpol.2014.03.009 · 1.73 Impact Factor
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    ABSTRACT: The main objective of this study was to estimate the contributing role of maternal, child, and organizational risk factors in perinatal mortality by calculating their population attributable risks (PAR). The primary dataset comprised 1,020,749 singleton hospital births from ≥22 weeks' gestation (The Netherlands Perinatal Registry 2000-2008). PARs for single and grouped risk factors were estimated in four stages: (1) creating a duplicate dataset for each PAR analysis in which risk factors of interest were set to the most favorable value (e.g., all women assigned 'Western' for PAR calculation of ethnicity); (2) in the primary dataset an elaborate multilevel logistic regression model was fitted from which (3) the obtained coefficients were used to predict perinatal mortality in each duplicate dataset; (4) PARs were then estimated as the proportional change of predicted- compared to observed perinatal mortality. Additionally, PARs for grouped risk factors were estimated by using sequential values in two orders: after PAR estimation of grouped maternal risk factors, the resulting PARs for grouped child, and grouped organizational factors were estimated, and vice versa. The combined PAR of maternal, child and organizational factors is 94.4 %, i.e., when all factors are set to the most favorable value perinatal mortality is expected to be reduced with 94.4 %. Depending on the order of analysis, the PAR of maternal risk factors varies from 1.4 to 13.1 %, and for child- and organizational factors 58.7-74.0 and 7.3-34.3 %, respectively. In conclusion, the PAR of maternal-, child- and organizational factors combined is 94.4 %. Optimization of organizational factors may achieve a 34.3 % decrease in perinatal mortality.
    Maternal and Child Health Journal 07/2014; 19(4). DOI:10.1007/s10995-014-1562-4 · 2.24 Impact Factor
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    ABSTRACT: Urban residence contributes to disparities in preterm birth (PTB) and birth weight. As urban and rural pregnant populations differ in individual psychopathological, psychosocial and substance use (PPS) risks, we examined the extent to which PTB and birth weight depend on the (accumulative) effect of PPS risk factors and on demographic variation.
    The European Journal of Public Health 06/2014; DOI:10.1093/eurpub/cku063 · 2.46 Impact Factor
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    ABSTRACT: Objective This study aims to summarize evidence on the relation between neighborhood deprivation and the risks for preterm birth, small-for-gestational age, and stillbirth.DesignSystematic review and meta-analysis.Main outcome measuresStudies that directly compared the risk of living in the most deprived neighborhood quintile with least deprived quintile for at least one perinatal outcome of interest (preterm delivery, small-for-gestational age and stillbirth).Methods Study selection was based on a search of Medline, Embase and Web of Science for articles published up to April 2012, reference list screening, and email contact with authors. Data on study characteristics, outcome measures, and quality were extracted by two independent investigators. Random-effects meta-analysis was preformed to estimate unadjusted and adjusted summary odds ratios (ORs) with the associated 95% confidence intervals.ResultsWe identified 2863 articles of which 24 were included in a systematic review. A meta-analysis (n = 7 studies, including 2 579 032 pregnancies) assessed the risk of adverse perinatal outcomes by comparing the most deprived neighborhood quintile with the least deprived quintile. Compared to the least deprived quintile, ORs for adverse perinatal outcomes in the most deprived neighborhood quintile were significantly increased for preterm delivery (OR 1.23, 95%CI: 1.18-1.28), small-for-gestational age (OR 1.31, 95%CI: 1.28-1.34), and stillbirth (OR 1.33, 95%CI: 1.21-1.45).Conclusion Living in a deprived neighborhood is associated with preterm birth, small-for-gestational age and stillbirth.This article is protected by copyright. All rights reserved.
    Acta Obstetricia Et Gynecologica Scandinavica 05/2014; 93(8). DOI:10.1111/aogs.12430 · 1.99 Impact Factor
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    ABSTRACT: To identify Psychopathology, Psychosocial problems and substance use (PPS) as predictors of adverse pregnancy outcomes, two screen-and-advice instruments were developed: Mind2Care (M2C, self-report) and Rotterdam Reproductive Risk Reduction (R4U, professional's checklist). To decide on the best clinical approach of these risks, the performance of both instruments was compared. Observational study of 164 pregnant women who booked at two midwifery practices in Rotterdam. Women were consecutively screened with M2C and R4U. For referral to tailored care based on specific PPS risks, inter-test agreement of single risks was performed in terms of overall accuracy and positive accuracy (risk present according to both instruments). With univariate regression analysis we explored determinants of poor agreement (<90 %). For triage based on risk accumulation and for detecting women-at-risk for adverse birth outcomes, M2C and R4U sum scores were compared. Overall accuracy of single risks was high (mean 93 %). Positive accuracy was lower (mean 46 %) with poorest accuracy for current psychiatric symptoms. Educational level and ethnicity partly explained poor accuracy (p < 0.05). Overall low PPS prevalence decreased the statistical power. For triage, M2C and R4U sum scores were interchangeable from sum scores of five or more (difference <1 %). The probability of adverse birth outcomes similarly increased with risk accumulation for both instruments, identifying 55-75 % of women-at-risk. The self-report M2C and the professional's R4U checklist seem interchangeable for triage of women-at-risk for PPS or adverse birth outcomes. However, the instruments seem to provide complementary information if used as a guidance to tailored risk-specific care.
    Maternal and Child Health Journal 03/2014; 18(9). DOI:10.1007/s10995-014-1456-5 · 2.24 Impact Factor
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    ABSTRACT: The aim was to determine the diagnostic performance of 3-dimensional virtual reality ultrasound (3D_VR_US) and conventional 2- and 3-dimensional ultrasound (2D/3D_US) for first-trimester detection of structural abnormalities. Forty-eight first trimester cases (gold standard available, 22 normal, 26 abnormal) were evaluated offline using both techniques by 5 experienced, blinded sonographers. In each case, we analyzed whether each organ category was correctly indicated as normal or abnormal and whether the specific diagnosis was correctly made. Sensitivity in terms of normal or abnormal was comparable for both techniques (P = .24). The general sensitivity for specific diagnoses was 62.6% using 3D_VR_US and 52.2% using 2D/3D_US (P = .075). The 3D_VR_US more often correctly diagnosed skeleton/limb malformations (36.7% vs 10%; P = .013). Mean evaluation time in 3D_VR_US was 4:24 minutes and in 2D/3D_US 2:53 minutes (P < .001). General diagnostic performance of 3D_VR_US and 2D/3D_US apparently is comparable. Malformations of skeleton and limbs are more often detected using 3D_VR_US. Evaluation time is longer in 3D_VR_US.
    Reproductive sciences (Thousand Oaks, Calif.) 01/2014; 21(8). DOI:10.1177/1933719113519172 · 2.18 Impact Factor
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    ABSTRACT: To compare perinatal singleton and multiple outcomes in a large Dutch in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) population and within risk subgroups. Newborns were assigned to a risk category based on gestational age, birthweight, Apgar score and congenital malformation. Register-based retrospective cohort study. Netherlands Perinatal Registry data. 3041 singletons and 1788 multiple children born from IVF/ICSI in 2003-2005. Student's t-test or Mann-Whitney U-test was used to analyze continuous data, χ²-analyses were used for categorical data. Multivariate logistic and linear regression analysis was performed to analyze whether the risk stratification criteria were associated with neonatal hospital admission and length of stay. Start of labor, mode of delivery, gestational age, birthweight, Apgar score, congenital malformation, neonatal hospital admission, neonatal intensive care unit admission and mortality. IVF/ICSI conceived multiples had considerably poorer outcomes than singletons in terms of cesarean section rate, preterm birth, birthweight, being small-for-gestational age, Apgar score, neonatal hospital admission, neonatal intensive care unit admission and neonatal mortality. As opposed to the results found in the total study population and the low- and moderate-risk population, high-risk multiples showed better outcomes than high-risk singletons regarding cesarean section rate, birthweight and Apgar score. All risk stratification variables were associated with being hospitalized after birth. Length of stay was associated with all risk stratification criteria except Apgar score. Perinatal outcomes in IVF/ICSI conceived multiples are considerably poorer than in singletons. This finding mainly pertains to low-risk children. High-risk multiples had significantly better perinatal outcomes than high-risk singletons. This article is protected by copyright. All rights reserved.
    Acta Obstetricia Et Gynecologica Scandinavica 01/2014; DOI:10.1111/aogs.12328 · 1.99 Impact Factor
  • American Journal of Obstetrics and Gynecology 01/2014; 210(1):S203-S204. DOI:10.1016/j.ajog.2013.10.435 · 3.97 Impact Factor

Publication Stats

9k Citations
1,036.73 Total Impact Points

Institutions

  • 2007–2015
    • Erasmus MC
      • Department of Obstetrics and Gynaecology
      Rotterdam, South Holland, Netherlands
  • 1990–2015
    • Erasmus Universiteit Rotterdam
      • • Department of Obstetrics and Gynaecology
      • • Department of Public Health (MGZ)
      • • Institute of Health Policy & Management (iBMG)
      • • Institute for Medical Technology Assessment (iMTA)
      Rotterdam, South Holland, Netherlands
  • 2013
    • Hogeschool Rotterdam
      Rotterdam, South Holland, Netherlands
  • 1996–2011
    • Academisch Medisch Centrum Universiteit van Amsterdam
      • • Department of Clinical Genetics
      • • Department of Social Medicine
      • • Epidemiology and public health
      • • Department of Obstetrics & Gynecology
      • • Department of Clinical Epidemiology and Biostatistics
      Amsterdam, North Holland, Netherlands
  • 2009
    • Rotterdam School of Management
      Rotterdam, South Holland, Netherlands
  • 2007–2009
    • Academic Medical Center (AMC)
      Amsterdamo, North Holland, Netherlands
  • 1997–2009
    • University of Amsterdam
      • • Department of Public Health
      • • Faculty of Medicine AMC
      • • Department of Obstetrics and Gynaecology
      • • Department of Clinical Epidemiology and Biostatistics
      Amsterdamo, North Holland, Netherlands
  • 2008
    • GGD Amsterdam
      Amsterdamo, North Holland, Netherlands
  • 2004–2006
    • VU University Amsterdam
      • Department of Obstetrics and Gynaecology
      Amsterdamo, North Holland, Netherlands
    • Medisch Centrum Alkmaar
      • Department of Obstetrics and Gynecology
      Alkmaar, North Holland, Netherlands
  • 2005
    • Gemeentelijke Geneeskundige en Gezondheidsdienst
      Utrecht, Utrecht, Netherlands
  • 1994–1996
    • Canisius-Wilhelmina Ziekenhuis
      Nymegen, Gelderland, Netherlands