51 Defining vulnerability subgroups among pregnant women Variable Definition Categories Data source* Proximity to GP office Distance (by road) between registered home address and the nearest GP’s office >3 km; <3 km SSD Liveability neighbourhood According to the Dutch Leefbaarometer16, based on various elements including housing characteristics, residents, distance to services, safety and physical environment Low-mediocre; high SSD * SSD and Perined are nationwide observational data sources, the Public Health Monitor 2016 (PHM-2016 contains self-reported data. ** The data of the PHM-2016 is collected through a combination of the regular Health Survey of Statistics Netherlands (98% of the study population) and the health surveys of the Municipal Health Services (2% of the study population). The variables indicated by the asterisks were not included in the regular Health Survey of Statistics Netherlands. *** The number of included years was based on data-availability, which varied per item. Outcomes Outcome Definition Categories Data source Preterm birth Birth occurring from 24 weeks of gestation and before 37 weeks of gestation Yes; no Perined Small for gestational age (SGA) Birth weight below 10th percentile, corrected for gestational age and fetal sex17 Yes; no Perined Preterm birth and/ or SGA Baby born prematurely and/or SGA, following definitions above Yes; no Perined Admission to neonatal intensive-care unit (NICU) Admission to the Neonatal Intensive Care Unit after birth Yes; no Perined Primary caesarean section Birth by caesarean section, decision taken before the start of birth Yes; no Perined Secondary caesarean section Birth by caesarean section, decision taken during birth Yes; no Perined Pre-eclampsia/ hypertension Having pre-eclampsia or maternal hypertension (high blood pressure), chronic or pregnancy induced Yes; no Perined Postpartum haemorrhage Heavy bleeding after birth (>1000 ml blood loss) Yes; no Perined No postpartum care (at home) Woman does not receive postpartum care at home by a maternity care assistant18 No postpartum care; postpartum care Vektis No antenatal care before week 10 Not having the first antenatal care appointment (i.e., booking visit) before the 10th week of pregnancy No antenatal care before week 10; antenatal care before week 10 Perined 16 Leidelmeijer, K., Marlet, G., Ponds, R., Schulenberg, R., van Woerkens, C., & van Ham, M. V. M. Leefbaarometer 2.0: instrumentontwikkeling. Rigo Research en Advies & Atlas voor de gemeenten. 2014 17 Hoftiezer, L., Hof, M. H., Dijs-Elsinga, J., Hogeveen, M., Hukkelhoven, C. W., & van Lingen, R. A. From population reference to national standard: new and improved birthweight charts. American journal of obstetrics and gynecology. 2019; 220(4): 383. 18 Laureij, L. T., van der Hulst, M., Lagendijk, J., Been, J. V., Ernst-Smelt, H. E., Franx, A., & Lugtenberg, M. Insight into the process of postpartum care utilization and in-home support among vulnerable women in the Netherlands: an in-depth qualitative exploration. BMJ open. 2021; 11(9): e046696. 2
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