38 CHAPTER 2 feeling lonely (0.78) and an owner-occupied house (0.90). Based on the dominant features, Class 2 was named ‘high care utilization’. Class 3 (n = 395; 9.5%) was characterized in particular by high proportions of socioeconomic risk factors. Women in this class were likely to receive social benefits or have no income prior to pregnancy (0.87). They frequently lived in a rented house (0.58), had a non-Dutch background (0.56) and a low (0.30) or moderate (0.39) educational level. The probability of living in a neighbourhood with a low liveability score was highest in this class (0.22). When considering protective factors, these women were often married (0.70), had a positive perception of health (0.90) and low healthcare expenditures (0.83). Class 3 was named ‘socioeconomic vulnerability’. Class 4 (n = 1005; 24%) was characterized by psychosocial health issues. The majority had a moderate to high risk of depression or anxiety disorders prior to pregnancy (0.71). These women were likely to feel lonely (0.57) and nullipara were overrepresented (0.55). Regarding protective factors, the majority had a full-time contract (0.69), an owneroccupied house (0.64) and no high healthcare expenditures (0.95). Class 4 was named ‘psychosocial vulnerability’. Class 5 (n = 2040; 48.9%) was characterized by women with low probabilities of all risk factors to vulnerability before pregnancy. Instead, in general, these women had a positively perceived health (1.00), did not feel lonely (0.86), had a high educational level (0.70) and paid work (0.98). Women in Class 5 had the highest probability to experience high control over life (0.37). Class 5 was named ‘healthy and socioeconomically stable’. The analyses in the two additional study populations (women who gave birth before and all women aged 19-44 years) showed similar results. The five-class model was preferred and classes could be interpreted similarly. Figure 2 shows associations between classes and adverse outcomes. Class 5 (healthy and socioeconomically stable) was the reference-category. Women classified in Class 1 (multidimensional vulnerability) were more likely to have babies who were born prematurely, SGA or admitted to a NICU. These women were also more likely to have a caesarean section. There were no significant associations found for other maternal health outcomes including hypertension/pre-eclampsia and postpartum haemorrhage. Compared to Class 5 (healthy and socioeconomical stable), all other classes except Class 4 (psychosocial vulnerability) were more likely to not receive postpartum care (at home) and to not receive antenatal care on time. Adverse outcomes were quite similar in Class 2 (socioeconomic vulnerability) and Class 5 (healthy and socioeconomically stable), except from the odds of planned caesarean section. Appendix 4 shows prevalences of outcomes for each class.
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