G J Bonsel

Erasmus MC, Rotterdam, South Holland, Netherlands

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Publications (324)919.28 Total impact

  • [Show abstract] [Hide abstract]
    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;
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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.
    European journal of public health. 06/2014;
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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; · 1.85 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; · 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; · 2.31 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; · 1.85 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 01/2014; · 1.51 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 01/2014; 30(919):925. · 1.12 Impact Factor
  • A A Vos, G J Bonsel, E A P Steegers
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    ABSTRACT: Results from the Euro-Peristat project in 2000 and 2004 showed the Netherlands to have higher perinatal mortality rates and a slower rate of decline than in other European countries. Recent results from the 2010 Euro-Peristat project have shown a substantial decline in both foetal and neonatal mortality rates and an improved position in the European ranking. However, the comparison of the Netherlands to countries with similar population characteristics and healthcare systems puts this position in a different perspective. Continuing effort will be necessary to improve perinatal health and care in the Netherlands.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158:A7594.
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    ABSTRACT: To describe inequalities in perinatal and maternal mortality, and morbidity from an international high-income country perspective. Measures of inequalities are socioeconomic status, ethnic background, and living area. Despite decreasing overall perinatal and maternal mortality in high-income countries, perinatal and maternal health inequalities persist. Inequalities in fetal, neonatal, and maternal adverse outcome relate to specific groups of risk factors. They commonly have a background in so-called structural risk factors, that is low level of education and income, being a migrant and living in disadvantaged areas. Structural risk factors therefore drive inequalities, and simultaneously represent the common perspective to judge perinatal and maternal health gaps. The effect of risk factors is further magnified in urban areas through risk accumulation.As mother and child share their background, neonatal, and maternal adverse health outcome patterns coincide, resulting in similar inequalities and similar epidemiological trends. The structural background explains the difficulty of improving this. Inequalities in perinatal and maternal outcome persist in women from lower socioeconomic groups, from specific ethnic groups, and from those living in deprived areas. In view of the lifelong consequences, these marked social disparities pose an important challenge for the political decision makers and the healthcare system.
    Current opinion in obstetrics & gynecology 04/2013; 25(2):98-108. · 2.49 Impact Factor
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    ABSTRACT: Social deprivation is considered a key factor in adverse perinatal outcomes. Rotterdam, the second largest city in The Netherlands, has large inequalities in perinatal health and a high number of deprived neighbourhoods. Social deprivation is measured here through a composite variable: 'Social Index' (SI). We studied the impact of the SI (2008-2009; 5 categories) in terms of perinatal mortality, congenital anomalies, preterm birth, small for gestational age (SGA) and low 5-minute Apgar score as registered in The Netherlands Perinatal Registry (Rotterdam 2000-2007, n = 56,443 singleton pregnancies). We applied ethnic dichotomisation as Western (European/North-American/Australian) vs. Non-Western (all others) ethnicity was expected to interact with the impact of SI. Tests for trend and multilevel regression analysis were applied. Gradually decreasing prevalence of adverse perinatal outcomes was observed in Western women from the lowest SI category (low social quality) to the highest SI category (high social quality). In Western women the low-high SI gradient for prevalence of spontaneous preterm birth (per 1000) changed from 57.2 to 34.1, for iatrogenic preterm birth from 35.2 to 19.0, for SGA from 119.6 to 59.4, for low Apgar score from 10.9 to 8.2, and for perinatal mortality from 14.9 to 7.6. These trends were statistically confirmed by Chi2-tests for trend (p < 0.001). For non-Western women such trends were absent. These strong effects for Western women were confirmed by significant odds ratios for almost all adverse perinatal outcomes estimated from multilevel regression analysis. We conclude social deprivation to play a different role among Western vs. non-Western women. Our results suggest that improvements in social quality may improve perinatal outcomes in Western women, but alternative approaches may be necessary for non-Western groups. Suggested explanations for non-Western 'migrant' groups include the presence of 'protective' effects through knowledge systems or intrinsic resilience. Implications concern both general and targeted policies.
    Social Science [?] Medicine 04/2013; 83:42-9. · 2.73 Impact Factor
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    ABSTRACT: Relatively high perinatal mortality rates in the Netherlands have required a critical assessment of the national obstetric system. Policy evaluations emphasized the need for organizational improvement, in particular closer collaboration between community midwives and obstetric caregivers in hospitals. The leveled care system that is currently in place, in which professionals in midwifery and obstetrics work autonomously, does not fully meet the needs of pregnant women, especially women with an accumulation of non-medical risk factors. This article provides an overview of the advantages of greater interdisciplinary collaboration and the current policy developments in obstetric care in the Netherlands. In line with these developments we present a model for shared care embedded in local 'obstetric collaborations'. These collaborations are formed by obstetric caregivers of a single hospital and all surrounding community midwives. Through a broad literature search, practical elements from shared care approaches in other fields of medicine that would suit the Dutch obstetric system were selected. These elements, focusing on continuity of care, patient centeredness and interprofessional teamwork form a comprehensive model for a shared care approach. By means of this overview paper and the presented model, we add direction to the current policy debate on the development of obstetrics in the Netherlands. This model will be used as a starting point for the pilot-implementation of a shared care approach in the 'obstetric collaborations', using feedback from the field to further improve it.
    Maternal and Child Health Journal 12/2012; · 2.24 Impact Factor
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    ABSTRACT: Abstract Objective: Analyses of the effects of place of residence, socio-economic status and ethnicity on perinatal mortality and morbidity in the Netherlands. Methods: Epidemiological analysis of all singleton deliveries ≥ 22 gestational weeks (871 889 live born and 5927 stillborn) from the Dutch National Perinatal Registry 2002-2006. Multiple logistic regression analysis was used to determine whether place of residence (deprived neighbourhood, or not) contributed to the adverse perinatal outcome (defined as perinatal mortality, preterm birth, small for gestational age, congenital abnormalities or Apgar score < 7, 5 minutes after birth), additional to individual pregnancy characteristics, demographic characteristics, ethnic background and socio-economic class. Results: Incidence of adverse perinatal outcome was 16.7 %. After adjustment the excess risk for perinatal mortality in deprived districts was 21%, for preterm birth 16%, for small-for-gestational age 11%, and for Apgar score < 7 after 5 minutes 11%. Conclusions: Perinatal inequalities appear impressive in both urban and non-urban areas, with a significant additive risk of living in a deprived neighbourhood. Excess risk for perinatal mortality generally outranges that for morbidity, suggesting both an etiological and prognostic pathway for neighbourhood effects. A distinct pattern exists for congenital anomalies, for which first trimester adverse selection effects may be responsible.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 10/2012; · 1.36 Impact Factor
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    ABSTRACT: OBJECTIVES: To investigate the determinants of the intention of preconception care use of women in a multi-ethnic urban population. METHODS: The ASE-model-a health behaviour model-was used as an explanatory framework. A representative sample was taken from the municipal population registers of two districts in Rotterdam, the Netherlands, 2009-2010. 3,225 women (aged 15-60 years) received a questionnaire, which was returned by 631: 133 Dutch, 157 Turkish and Moroccan, and 341 Surinamese and Antillean. Descriptive, univariate and multivariate analyses were performed. RESULTS: The multiple logistic analyses showed that intention to attend preconception care was significantly higher in women with a Turkish and Moroccan background (β 1.02, P = 0.006), a higher maternal age (β 0.04, P = 0.008) and a positive attitude (β 0.50, P < 0.001). Having no relationship (β -1.16, P = 0.004), multiparity with previous adverse perinatal outcome (β -1.32, P = 0.001), a high educational level (β -1.23, P = 0.03), having paid work (β -0.72, P = 0.01) and experienced barriers level (β -0.15, P = 0.003) were associated with less intention to use preconception care. CONCLUSIONS: Modifiable determinants as attitude and barriers can be addressed to enhance preconception care attendance.
    International Journal of Public Health 08/2012; · 1.99 Impact Factor
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    ABSTRACT: In a randomized control trial, the authors tested whether short- and long-term effects of an early literacy intervention are moderated by mild perinatal adversities in accordance with differential susceptibility theory. One-hundred 5-year-old children (58% male) who scored at or below the 30th percentile on early literacy measures were randomized to a Web-based remedial early literacy program Living Letters or a treated control group. Parents gave written informed consent to access the perinatal data of their children at the Perinatal Register in the Netherlands. Twenty-one children were, at birth, small for gestational age (between the 2.5th and 10th percentiles) or late preterm (between 34 and 37 weeks, 6 days). In this group with mild perinatal adversities, intervention children outperformed the control group immediately after the intervention and after 8 months of formal reading instruction, but a similar effect of the computerized literacy program in children without mild perinatal adversities was absent. In line with the theory of differential susceptibility, children with mild perinatal adversities seem to be more open to environmental input, for better and for worse. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
    Journal of Educational Psychology 04/2012; 104(2):337-349. · 3.08 Impact Factor
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    ABSTRACT: Nitrous oxide (N(2) O) is routinely used as an analgesic in obstetrics during labour. Epidemiological studies have linked chronic occupational exposure to N(2) O to specific health problems, including reproductive risks. Occupational exposure limits (OELs) allow the use of N(2) O once appropriate preventive and safety measures have been taken. We assessed the effectiveness of a scavenger system (Anevac P-system®, Medicvent Heinen & Löwestein Benelux, Barneveld, the Netherlands) applied in N(2) O administration during labour in a midwifery-led birthing centre in the Netherlands. After informed consent, non-pregnant midwives were trained to administer N(2) O. N(2) O was delivered as a 50 : 50 mixture with oxygen and was self administered by the patient. The scavenging device, containing a double mask and a chin mask, was connected to the local evacuation system vented outside the building. Data on the 8-h time-weighted average (8-h TWA) as well as the 15-min TWA (15-min TWA) were obtained. Thirteen patients were included. Six patients were included in the first study period. In this period the 8-h TWA was not exceeded, however, in all patients, the 15-min TWA occasionally exceeded the OELs. After four additional measures, seven patients were included. After implementation of these measures, the 8-h TWA and 15-min TWA never exceeded the OELs. System leakage was not observed during both study periods. The Anevac P-scavenging system during N(2) O analgesia in labour prevents exceeding OELs in professional workers. The scavenging system appeared acceptable and effective, and can be considered in hospital settings that use N(2) O as analgesic during labour.
    Acta Anaesthesiologica Scandinavica 03/2012; 56(7):920-5. · 2.36 Impact Factor
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    ABSTRACT: Increased adverse pregnancy outcomes related to psychiatric and psychosocial problems can be observed for urban areas when compared to national averages. We developed a personal digital assistant (PDA)-based self-report screening model that produces tailored intervention advices. After having adapted the model to local care pathways, we tested the reliability, validity and feasibility of the model in routine antenatal care. Observational study among pregnant women in a Dutch urban area included women with a booking visit. Women answered questions posed by the PDA-tool while waiting for their appointment. If the tool suggested specific interventions (screen result), this was discussed during booking visit. A randomly selected subsample of participants completed the questionnaire again at a subsequent pregnancy check (retest). After the study was conducted, prenatal caregivers and assistants were interviewed for feasibility judgments. Psychometric and diagnostic performance of this approach was established. Response rate among invited pregnant women was 94% on weighted average (n=621). Internal reliability ranged 0.88-0.90, test-retest reliability ranged 0.64-1.00. Positive predictive value was 86% and negative predictive value was 97%. No interpractice psychometrical differences were observed. Migrant women more often received an intervention advice than native women (p<0.001). The approach was well accepted among prenatal caregivers for its time efficiency and patient-friendliness. Psychometric properties of our screen-and-advice tool were favorable under routine conditions, and the feasibility of this integral approach appeared good. The technical flexibility renders the model suitable for broader application. Local care pathways can easily be incorporated. We suggest implementation of this model in prenatal care in urbanized settings in order to make tailored mental healthcare broadly available.
    Journal of Psychosomatic Obstetrics & Gynecology 03/2012; 33(1):7-14. · 1.59 Impact Factor
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    ABSTRACT: To study regional differences in maternal mortality in the Netherlands. Confidential inquiry into the causes of maternal mortality. Nationwide. A total of 3 108 235 live births and 337 maternal deaths. Data analysis of all maternal deaths in the period 1993-2008. Maternal mortality. The overall national maternal mortality ratio was 10.8 per 100 000 live births. In the 12 provinces of the Netherlands, the maternal mortality ratio ranged from 6.2 in Noord Brabant to 16.3 per 100 000 live births in Zeeland. In the four largest cities, maternal mortality varied from 9.3 in Amsterdam to 21.0 in Rotterdam. At a national level, the most frequent direct cause was pre-eclampsia. Increased risks for maternal mortality were found for women living in deprived neighbourhoods (RR 1.41), women from non-Western origin (RR 1.59), and women who were 35 years or older (RR 1.61). There are significant variations in maternal mortality ratios in the Netherlands between cities, provinces, and neighbourhoods. In addition, higher maternal mortality was observed in women of non-Western origin and in women who were 35 years of age or older.
    BJOG An International Journal of Obstetrics & Gynaecology 02/2012; 119(5):582-8. · 3.76 Impact Factor
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    ABSTRACT: The primary goal of the Rotterdam-based health programme 'Ready for a baby' is an improvement in perinatal results via improved, risk-directed care shared across disciplines. After 2 years we conclude that many women who are or who will become pregnant lack knowledge about perinatal risk factors. They are, however, positive about preconception care. High-risk groups can best be accessed via group-based education; results of individual preconceptual care consultations are still limited. We developed and tested a new risk-screening instrument to screen pregnant women during the first antenatal consultation. We directed more attention to non-medical risks, which are often poverty-related. The experiences from our Rotterdam-based programme provide the incentive to experiment with programme-based preconception care, new risk selection during pregnancy and accessing high-risk groups in other communities in the Netherlands.
    Nederlands tijdschrift voor geneeskunde 01/2012; 156(29):A4289.
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    ABSTRACT: In 2009 the Minister of Health, Welfare and Sport ordered several measures to reduce the high perinatal mortality in the Netherlands. One of these was the carrying out of a descriptive study into pregnancy and birth in which the systematic consultation of experts played an important role. The main aims were to produce a list of subjects to study and to prioritize scientific research. In addition, representatives of the scientific committees of the professional groups involved and the heads of perinatology centres were also consulted. The 25 most important resulting research themes pertained to (a) early detection of risks during the preconceptional period, pregnancy and parturition, (b) recognition and tackling of societal, psychosocial, social and socio-economic risk factors, and (c) a more extensive and risk-led collaboration between all healthcare workers within the Dutch obstetric healthcare system. This study contributed to the study agenda of the Netherlands Organization for Health Research and Development (ZonMw) which resulted in a widely supported, specialty transcending research programme on all aspects of pregnancy and birth.
    Nederlands tijdschrift voor geneeskunde 01/2012; 155(31):A4499.

Publication Stats

6k Citations
919.28 Total Impact Points


  • 2007–2014
    • Erasmus MC
      • • Department of Obstetrics and Gynaecology
      • • Research Group for Public Health
      Rotterdam, South Holland, Netherlands
    • Academic Medical Center (AMC)
      Amsterdamo, North Holland, Netherlands
  • 1990–2014
    • Erasmus Universiteit Rotterdam
      • • Department of Obstetrics and Gynaecology
      • • Department of Public Health (MGZ)
      • • Institute of Health Policy & Management (iBMG)
      Rotterdam, South Holland, Netherlands
  • 2008–2012
    • Onze Lieve Vrouwe Gasthuis
      Amsterdamo, North Holland, Netherlands
    • World Health Organization WHO
      Genève, Geneva, Switzerland
  • 2009–2011
    • University Medical Center Utrecht
      • Julius Center for Health Sciences and Primary Care
      Utrecht, Provincie Utrecht, Netherlands
    • National Institute for Public Health and the Environment (RIVM)
      • Centre for Infectious Disease Control (CIb)
      Utrecht, Provincie Utrecht, Netherlands
  • 2008–2011
    • Gezond Amsterdam
      Amsterdamo, North Holland, Netherlands
  • 1997–2010
    • University of Amsterdam
      • Faculty of Medicine AMC
      Amsterdam, North Holland, Netherlands
  • 1996–2010
    • Academisch Medisch Centrum Universiteit van Amsterdam
      • • Academic Medical Center
      • • Department of Obstetrics & Gynecology
      • • Department of Social Medicine
      • • Department of Clinical Epidemiology and Biostatistics
      Amsterdam, North Holland, Netherlands
  • 2008–2009
    • GGD Amsterdam
      Amsterdamo, North Holland, Netherlands
  • 2006
    • Maastricht University
      Maestricht, Limburg, Netherlands
  • 2005
    • VU University Medical Center
      • Department of Obstetrics and Gynecology
      Amsterdam, North Holland, Netherlands
  • 2004
    • Medisch Centrum Alkmaar
      • Department of Obstetrics and Gynecology
      Alkmaar, North Holland, Netherlands
  • 1998
    • University of Groningen
      Groningen, Groningen, Netherlands
  • 1994–1996
    • Canisius-Wilhelmina Ziekenhuis
      Nymegen, Gelderland, Netherlands