BACKGROUND: Prenatal healthcare is likely to prevent adverse outcomes, but an adequate review of utilization and its determinants is lacking.OBJECTIVE: To review systematically the evidence for the determinants of prenatal healthcare utilization in high-income countries.METHOD: Search of publications in EMBASE, CINAHL and PubMed (1992-2010). Studies that attempted to study determinants of prenatal healthcare utilization in high-income countries were included. Two reviewers independently assessed the eligibility and methodological quality of the studies. Only high-quality studies were included. Data on inadequate use (i.e. late initiation, low-use, inadequate use or non-use) were categorized as individual, contextual and health behaviour-related determinants. Due to the heterogeneity of the studies, a quantitative meta-analysis was not possible.RESULTS: Ultimately eight high-quality studies were included. Low maternal age, low educational level, non-marital status, ethnic minority, planned pattern of prenatal care, hospital type, unplanned place of delivery, uninsured status, high parity, no previous premature birth and late recognition of pregnancy were identified as individual determinants of inadequate use. Contextual determinants included living in distressed neighbourhoods. Living in neighbourhoods with higher rates of unemployment, single parent families, medium-average family incomes, low-educated residents, and women reporting Canadian Aboriginal status were associated with inadequate use or entering care after 6 months. Regarding health behaviour, inadequate use was more likely among women who smoked during pregnancy.CONCLUSION: Evidence for determinants of prenatal care utilization is limited. More studies are needed to ensure adequate prenatal care for pregnant women at risk.
Lector Marco Snoek heeft een belangrijke bijdrage geleverd aan de publicatie ‘Shaping career-long perspectives on teaching’. Deze ‘Guide on policies to improve initial teacher education’ is onlangs gepubliceerd door de Europese Commissie. De guide omvat handreikingen die het resultaat zijn van het werk van de Working Group Schools van de Europese Commissie. De publicatie gaat in op de rol van leraren en hoe leraren in die rol ondersteund kunnen worden door een structuur voor het beroep, die gericht is op een leven lang leren en op samenwerkend leren. Het realiseren van een dergelijke structuur vraagt een nauwe samenwerking van de verschillende stakeholders: ministeries, leraren en schoolleiders. In de Working Group Schools bogen vertegenwoordigers van de verschillende lidstaten zich over de vraag hoe beleid van overheden het continuum van het beroep (de samenhang tussen de lerarenopleiding, de eerste fase van de beroepsuitoefening en de verdere loopbaan van leraren) kan versterken, welke bijdrage leeromgevingen die gericht zijn op samenwerkend leren tussen professionals daar aan kunnen leveren en wat dit vraagt van beleid en van de samenwerking tussen stakeholders bij het ontwikkelen van dit beleid. Marco Snoek vertegenwoordigde daarbij het Nederlandse Ministerie van Onderwijs. De verschillende inzichten die ontstonden op basis van uitwisseling van beleidsaanpakken in verschillende landen zijn vertaald naar aanbevelingen voor beleid. In een TEDlike talk die Marco Snoek op het Europese Education, Training and Youth Forum in Brussels op maandag 19 oktober verzorgde, gaat hij in op de hoofdpunten van de publicatie. Zie: www.vimeo.com/144635675
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At the beginning of the twenty first century obesity entered Dutch maternity care as a ‘new illness’ challenging maternity care professionals in providing optimal care for women with higher BMI’s. International research revealed that obese women had more perinatal problems than normal weight women. However, the effect of higher BMIs on perinatal outcomes had never been studied in women eligible for midwife-led primary care at the outset of their pregnancy. In the context of the Dutch maternity care system, it was not clear if obesity should be treated as a high-risk situation always requiring obstetrician-led care or as a condition that may lead to problems that could be detected in a timely manner in midwife-led care using the usual risk assessment tools. With the increased attention on obesity in maternity care there was also increased interest in GWG. Regarding GWG in the Netherlands, the effect of insufficient or excessive GWG on perinatal outcomes had never been studied and there were no validated guidelines for GWG. A midwife’s care for the individual woman in the context of the Dutch maternity care system - characterised by ‘midwife-led care if possible, obstetrician-led care if needed’ - is hampered by the lack of national multidisciplinary consensus regarding obesity and weight gain. Obesity has not yet been included in the OIL and local protocols contain varying recommendations. To enable sound clinical decisions and to offer optimal individual care for pregnant women in the Netherlands more insights in weight and weight gain in relation to perinatal outcomes are required. With this thesis the author intends to contribute to the body of knowledge on weight and weight gain to enhance optimal midwife-led primary care for the individual woman and to guide midwives’ clinical decision-making.
