What to expect when you're expecting?

Abstract

In the Netherlands, early risk stratification for pregnancy complications is based on the medical and obstetric history of pregnant women. Pregnant women who are assumed to be at low risk for complications have their pregnancy monitored by a midwife in primary care and those with a medium or high risk have their pregnancy monitored by an obstetrician in secondary or tertiary care. Many pregnant women are referred to secondary or tertiary care during pregnancy or childbirth, for example in case of gestational diabetes (GDM) or preeclampsia (PE). Multivariable prognostic models for the development of such pregnancy complications may be the ultimate tool to improve early risk stratification, which may facilitate tailored and preventive obstetric care to improve pregnancy outcome. The main aim of this thesis was to improve early risk stratification for pregnancy complications to allow for preventive tailored obstetric care, which may ultimately lead to a reduction of maternal and perinatal mortality and morbidity. In this thesis, GDM and PE were addressed and were evaluated whether the use of prognostic models for these outcomes are beneficial for clinical practice. Conclusions The results of the RESPECT study show that prognostic models for GDM and PE can improve early risk stratification in pregnancy and are cost-effective compared to current strategies, which are mainly based on single risk factors. Prognostic models for GDM and PE are therefore ready for implementation, but evidence on the actual impact of these models is needed to verify whether improvement of maternal and perinatal morbidity and mortality can be achieved this way. The findings of this thesis may encourage a similar approach of validating prognostic models for a broader range of pregnancy complications, such as preterm birth or the birth of a small for gestational age neonate.