Joyce Molenaar

42 CHAPTER 2 research is needed to identify if vulnerability classes can be identified using solely routinely collected population data, without using self-reported data. Additionally, more research is necessary regarding the role of the father or woman’s partner in relation to vulnerability. In conclusion, there is growing attention for early detection of vulnerability and implementing effective strategies to improve health and well-being of current and next generations. Results of this data-driven study suggest that several vulnerability classes can be distinguished among pregnant women in the Netherlands. The co-existence of risk factors in multiple domains leads to more adverse outcomes for mother and child. Effective strategies, starting preconceptionally, should include both medical and social care and support. Funding This study was supported by funding. The Dutch Ministry of Health, Welfare and Sport funded the monitor of the Dutch Solid Start programme that was conducted by the National Institute for Public Health and the Environment (J.M.M., E.F.d.V. and J.N.S., project numbers V/010038/01 and V/060438/22). The Bernard van Leer Foundation provided funding for different projects on the topic of vulnerability before, during and after pregnancy for Erasmus MC (L.v.d.M., L.C.M.B., A.J.M.W. and E.A.P.S., grant number NET-2017-096). J.C.K.d.J. received subsidy from the Netherlands Organization of Health Research and Development to study vulnerable and unintended pregnancies (grant number 554002006). The funders of the study had no role in study design, data collection, data analysis, data interpretation, writing the manuscript and submission of the article for publication. Conflicts of interests: None declared Data availability We are unable to share the individual data used for this study as data linkage and analysis was conducted within the highly safeguarded Remote Access (RA) platform of Statistics Netherlands (23). All data within this platform are pseudonymised to ensure data safety and confidentiality. Access to the data from Perined, Vektis, Statistics Netherlands and the Public Health Monitor 2016 can be requested from the relevant parties. Acknowledgements We acknowledge Perined, Vektis, Statistics Netherlands and the Community Health Services (GGD) for providing us the data. Results were based on calculations by the National Institute for Public Health and the Environment using non-public microdata from Statistics Netherlands. We would like to thank Dr Maarten Schipper for statistical advice in applying the latent class analysis. This manuscript expresses the views of the authors and not necessarily those of the funders or the parties that provided the data for this study.

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