Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands.
BMJ Open. 2019 Oct 22;9(10):e031357. doi: 10.1136/bmjopen-2019-031357.
To study the effect of an urban perinatal health programme in Rotterdam, the Netherlands, on perinatal outcomes.
A retrospective cohort study with difference-in-differences analysis using individual-level perinatal outcome data from the Dutch Perinatal Registry 2003-2014 linked to Central Bureau of Statistics data of migration background and individual disposable household income.
The programme consisted of perinatal health promotion, risk selection and risk-guided pregnancy care, and a new primary care child birth centre. The programme was implemented during 2009-2012.
We compared trends in perinatal mortality, preterm delivery and small-for-gestational-age births between targeted urban neighbourhoods in Rotterdam (n=61 415) and all other urban neighbourhoods in the Netherlands (n=881 202). The effect of the programme was modelled as a change in trend of each perinatal outcome in the treatment group post intervention compared with the control population from January 2010 onwards. All analyses were adjusted for maternal age, parity, ethnicity and individual-level low socioeconomic status (SES). We also conducted a stratified analysis by SES.
During 2003-2014, downward trends in perinatal mortality (adjusted OR (aOR) 0.9439 per year, 95% CI 0.9362 to 0.9517), preterm birth (aOR 0.9970 per year, 95% CI 0.9944 to 0.9997) and small-for-gestational-age births (aOR 0.9809 per year, 95% CI 0.9787 to 0.9831) in the entire study population were observed. No demonstrable changes in these trends were found in the intervention group after the programme had started. The stratified analyses by SES showed no changes in trends post intervention in both strata either.
The programme had no demonstrable effects on perinatal outcomes. The intervention may not have reached a sufficient proportion of the population or has provided too little contrast to the widespread attention for inequalities in pregnancy outcomes occurring simultaneously in the Netherlands.
研究荷兰鹿特丹市一项围产期保健计划对围产期结局的影响。
一项回顾性队列研究，采用 2003-2014 年荷兰围产儿登记处的个体围产期结局数据，并与中央统计局的移民背景和个体可支配家庭收入数据进行链接，采用差异分析法进行分析。
该计划包括围产期保健促进、风险选择和风险导向的妊娠护理，以及一个新的初级保健分娩中心。该计划于 2009-2012 年实施。
我们比较了鹿特丹目标城市街区（n=61415）和荷兰所有其他城市街区（n=881202）的围产儿死亡率、早产和小于胎龄儿出生的趋势。该计划的效果模型为干预后治疗组每个围产儿结局的趋势变化与 2010 年 1 月以后的对照人群相比。所有分析均调整了母亲年龄、产次、种族和个体低社会经济地位（SES）。我们还按 SES 进行了分层分析。
在 2003-2014 年期间，整个研究人群中围产儿死亡率（调整后的比值比[aOR]每年下降 0.9439，95%可信区间[CI]0.9362 至 0.9517）、早产（aOR 每年下降 0.9970，95%CI 0.9944 至 0.9997）和小于胎龄儿（aOR 每年下降 0.9809，95%CI 0.9787 至 0.9831）呈下降趋势。在计划开始后，干预组中没有发现这些趋势的明显变化。SES 分层分析显示，干预后两个亚组的趋势也没有变化。
该计划对围产期结局没有明显影响。该干预措施可能没有覆盖足够多的人群，或者与荷兰同时发生的妊娠结局不平等现象引起的广泛关注相比，提供的反差太小。
