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1. Associations of severe adverse perinatal outcomes among continuous birth weight percentiles on different birth weight charts: a secondary analysis of a cluster randomized trial

Author

Hester D. Kamphof, Sanne J. Gordijn, Wessel Ganzevoort, Viki Verfaille, Pien M. Offerhaus, Arie Franx, Eva Pajkrt, Ank de Jonge, and Jens Henrichs

Subjects
Birth weight standard, Birth weight reference charts, Birth weight reference curve, Fetal growth restriction, FGR, IUGR, Gynecology and obstetrics, RG1-991
Abstract

Abstract Objective To identify neonatal risk for severe adverse perinatal outcomes across birth weight centiles in two Dutch and one international birth weight chart. Background Growth restricted newborns have not reached their intrinsic growth potential in utero and are at risk of perinatal morbidity and mortality. There is no golden standard for the confirmation of the diagnosis of fetal growth restriction after birth. Estimated fetal weight and birth weight below the 10th percentile are generally used as proxy for growth restriction. The choice of birth weight chart influences the specific cut-off by which birth weight is defined as abnormal, thereby triggering clinical management. Ideally, this cut-off should discriminate appropriately between newborns at low and at high risk of severe adverse perinatal outcomes and consequently correctly inform clinical management. Methods This is a secondary analysis of the IUGR Risk Selection (IRIS) study. Newborns (n = 12 953) of women with a low-risk status at the start of pregnancy and that received primary antenatal care in the Netherlands were included. We examined the distribution of severe adverse perinatal outcomes across birth weight centiles for three birth weight charts (Visser, Hoftiezer and INTERGROWTH) by categorizing birth weight centile groups and comparing the prognostic performance for severe adverse perinatal outcomes. Severe adverse perinatal outcomes were defined as a composite of one or more of the following: perinatal death, Apgar score

Published
2022
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2. Multidisciplinary consensus on screening for, diagnosis and management of fetal growth restriction in the Netherlands

Author

Viki Verfaille, Ank de Jonge, Lidwine Mokkink, Myrte Westerneng, Henriëtte van der Horst, Petra Jellema, Arie Franx, and IRIS study group

Subjects
Intrauterine growth restriction, fetal growth restriction, Delphi technique, Practice guideline, Prenatal ultrasonography, Collaboration, Gynecology and obstetrics, RG1-991
Abstract

Abstract Background Screening for, diagnosis and management of intrauterine growth restriction (IUGR) is often performed in multidisciplinary collaboration. However, variation in screening methods, diagnosis and management of IUGR may lead to confusion. In the Netherlands two monodisciplinary guidelines on IUGR do not fully align. To facilitate effective collaboration between different professionals in perinatal care, we undertook a Delphi study with uniform recommendations as our primary result, focusing on issues that are not aligned or for which specifications are lacking in the current guidelines. Methods We conducted a Delphi study in three rounds. A purposively sampled selection of 56 panellists participated: 27 representing midwife-led care and 29 obstetrician-led care. Consensus was defined as agreement between the professional groups on the same answer and among at least 70% of the panellists within groups. Results Per round 51 or 52 (91% - 93%) panellists responded. This has led to consensus on 27 issues, leading to four consensus based recommendations on screening for IUGR in midwife-led care and eight consensus based recommendations on diagnosis and eight on management in obstetrician-led care. The multidisciplinary project group decided on four additional recommendations as no consensus was reached by the panel. No recommendations could be made about induction of labour versus expectant monitoring, nor about the choice for a primary caesarean section. Conclusions We reached consensus on recommendations for care for IUGR within a multidisciplinary panel. These will be implemented in a study on the effectiveness and cost-effectiveness of routine third trimester ultrasound for monitoring fetal growth. Research is needed to evaluate the effects of implementation of these recommendations on perinatal outcomes. Trial registration NTR4367 .

Published
2017
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3. Cost-Effectiveness of Routine Third Trimester Ultrasound Screening for Fetal Growth Restriction Compared to Care as Usual in Low-Risk Pregnancies: A Pragmatic Nationwide Stepped-Wedge Cluster-Randomized Trial in The Netherlands (the IRIS Study)

Author

Jens, Henrichs, Ank, de Jonge, Myrte, Westerneng, Viki, Verfaille, Arie, Franx, Henriëtte E, van der Horst, Judith E, Bosmans, On Behalf Of The Iris Study Group, Midwifery Science, APH - Mental Health, APH - Quality of Care, Amsterdam Reproduction & Development (AR&D), APH - Personalized Medicine, General practice, APH - Aging & Later Life, Health Economics and Health Technology Assessment, APH - Methodology, and Obstetrics & Gynecology

Subjects
Health, Toxicology and Mutagenesis, Pregnancy Trimester, Third, Cost-Benefit Analysis, Routine third trimester ultrasonography, Ultrasonography, Prenatal, SDG 3 - Good Health and Well-being, Pregnancy, Cluster-randomized trial, Humans, Prenatal, Toxicology and Mutagenesis, routine third trimester ultrasonography, severe adverse perinatal outcome, cluster-randomized trial, economic evaluation, Netherlands, Ultrasonography, Third, Fetal Growth Retardation, Environmental and Occupational Health, Public Health, Environmental and Occupational Health, Severe adverse perinatal outcome, Pollution, Economic evaluation, Health, Female, Public Health, Pregnancy Trimester
Abstract

Routine third trimester ultrasonography is increasingly used to screen for fetal growth restriction. However, evidence regarding its cost-effectiveness is lacking. We aimed to evaluate the cost-effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes compared to usual care (selective ultrasonography). An economic evaluation alongside a stepped-wedge cluster-randomized trial was conducted. Via 60 midwifery practices 12,974 Dutch women aged ≥16 years with low-risk pregnancies were enrolled at 22.8 (SD = 2.4) weeks’ gestation. All practices provided usual care. At 3, 7, and 10 months a third of the practices were randomized to the intervention strategy providing routine ultrasonography at 28–30 and 34–36 weeks’ gestation and usual care. The primary clinical outcome was a dichotomous composite measure of 12 severe adverse perinatal outcomes (SAPO) up to one week postpartum. Information on perinatal care and societal costs was derived from Netherlands Perinatal Registry, hospital records and a survey. Cost-effectiveness analyses revealed no significant differences in SAPO and healthcare and societal costs between the intervention strategy (n = 7026) and usual care (n = 5948). Cost-effectiveness acceptability curves showed that the probability of cost-effectiveness was never higher than 0.6 for all possible ceiling ratios. Adding routine third trimester ultrasonography to usual care is not cost-effective in reducing SAPO.

Published
2022
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4. Influence of Gestational Age at Initiation of Antihypertensive Therapy: Secondary Analysis of CHIPS Trial Data (Control of Hypertension in Pregnancy Study)

Author

Anouk Pels, Ben Willem J. Mol, Joel Singer, Terry Lee, Peter von Dadelszen, Wessel Ganzevoort, Elizabeth Asztalos, Laura A. Magee, Amiram Gafni, Andrée Gruslin, Michael Helewa, Eileen Hutton, Shoo Lee, Alexander Logan, Jennifer Menzies, Jean-Marie Moutquin, Kellie Murphy, Evelyne Rey, Sue Ross, Johanna Sanchez, Jim G. Thornton, Ross Welch, Trinh Hoac, Joanne Kirton, Katherine Trigiani, Ainy Zahid, Michael B. Bracken, Patricia Crowley, Lelia Duley, Richard Ehrenkranz, Kevin Thorpe, Sunny Chan, Michael Shi, Shelley Yu, Raquel de Lourdes Martin, Maria Florencia Bassi, Mirta Clara Caruso, Valeria Lagunas, Fernando Vera, Maria Mohedano de Duhalde, Alicia Beatriz Roque, Patricia Roldan, Esteban Marcos Duhalde, Viviana Dip, Jesus Daniel Aguirre, Elba Mirta Alicia Morales, Griselda Itati Abreo, Teresa De Sagastizabal, Carolina Gomez, Nadia Rizzi, Carlos Arias, Ricardo Antonio Bruno, Kassam Mahomed, Alison Drew, Ann Green, Jane Hoare, Bill Hague, Suzette Coat, Caroline Crowther, Peter Muller, Sophie Trenowden, Barry Walters, Claire Parker, Dorothy Graham, Craig Pennell, Eileen Sung, Angela Makris, Gaksoo Lee, Charlene Thornton, Annemarie Hennessy, Louise Farrell, Nelson Sass, Henri Korkes, Dayana Couto Ferreira, Renato Augusto Moreira de Sa, Monique Schmidt Marques Abreu, Rita Guerios Bornia, Nancy Ribeiro da Silva, Fernanda Freitas Oliveira Cardoso, Caio Coelho Marques, Jorge Hornos, Ricardo Leal Davdt, Letícia Germany Paula, Pedro Luis Zanella, Gabrielle Inglis, Ruth Dillon, Ashley Docherty, Anna Hutfield, Keith Still, Sayrin Lalji, Tamara Van Tent, Chris Hotz, Tracy Messmer, Joel G. Ray, Howard Berger, Leanne De Souza, Andrea Lausman, Tatiana Freire-Lizama, Kate Besel, Paul Gibson, Greta Ellsworth, Leslie Miller, T. Lee-Ann Hawkins, Michelle Hladunewich, Anna Rogowsky, Dini Hui, Virginia Collins, Isabelle Delisle, Cora Fanning, Nestor Demianczuk, Rshmi Khurana, Winnie Sia, Catherine Marnoch, Carmen Young, Cheryl Lux, Sophie Perreault, Valerie Tremblay, Sophie Desindes, Anne-Marie Côté, Veronique Dagenais, Heather Clark, Elaine O’Shea, Ruth Rennicks White, Shital Gandhi, Mary-Jean Martin, Cheryl Brush, Gareth Seaward, Jill Newstead-Angel, Judy Brandt, Jocelyne Martel, Kristine Mytopher, Elise Buschau, Erin Keely, Patti Waddell, Svetlana Shachkina, Alan Karovitch, Robert Anderson, Nicole Koenig, Theresa Yong, Marie Vasiliou, Peri Johnson, Beth Allan, Renato Natale, Laura Kennedy, Lucie Opatrny, Lorraine Lavigne, George Carson, Sheila Kelly, Joan Crane, Donna Hutchens, Juan Pedro Kusanovic, Christian Figueroa, Karla Silva Neculman, Juan Andres Ortiz, Paula Vargas, Pedro Ferrand, Jorge Carrillo, Rodrigo Cifuentes Borrero, Dahiana Marcela Gallo, Luisa Fernanda Moreno, Fred Kirss, Kristiina Rull, Anne Kirss, Tamas Major, Andrea Fodor, Tunde Bartha, Mordechai Hallak, Nardin Aslih, Saja Anabousi-Murra, Ester Pri-Or, Linda Harel, Sima Siev, Marwan Hakim, Christina Simona Khoury, Najla Hamati, Mazen El-Zibdeh, Lama Yousef, Ruth Hughes, Di Leishman, Barbra Pullar, Matthew Farrant, Malgorzata Swiatkowska-Freund, Krzysztof Preis, Anette Aleksandra Traczyk-Los, Anna Partyka, Joanna Preis-Orlikowska, Mariusz Lukaszuk, Grzegorz Krasomski, Michael Krekora, Anna Kedzierska-Markowicz, Katarzyna Zych-Krekora, Grzegorz H. Breborowicz, Anna Dera-Szymanowska, Jannet Bakker, Joost Akkermans, Eline van den Akker, Sabine Logtenberg, Steven Koenen, Maartje de Reus, David Borman, Martijn A. Oudijk, Annemiek Bolte, Viki Verfaille, Bart Graaf, Martina Porath, Corine Verhoeven, Maureen T.M. Franssen, Lida Ulkeman, Ineke Hamming, Jose H.M. Keurentjes, Ina van der Wal, S.W.A. Nij Bijvank, A.A. Lutjes, Henricus Visser, Hubertina Catharina Johanna Scheepers, Erik van Beek, Coby van Dam, Kathy van den Berg-Swart, Paula Pernet, Birgit van der Goes, Nico Schuitemaker, Gunilla Kleiverda, Marcel van Alphen, Ageeth Rosman, Ingrid Gaugler-Senden, Marieke Linders, Catherine Nelson-Piercy, Annette Briley, May Ching Soh, Kate Harding, Hayley Tarft, David Churchill, Katherine Cheshire, Julia Icke, Mausumi Ghosh, James Thornton, Yvonne Toomassi, Karen Barker, Joanne Fisher, Nicky Grace, Amanda Green, Joanne Gower, Anna Molnar, Shobhana Parameshwaran, Andrew Simm, George Bugg, Yvette Davis, Ruta Desphande, Yvette Gunn, Mohammed Houda, Nia Jones, Jason Waugh, Carly Allan, Gareth Waring, Steve A. Walkinshaw, Angela Pascall, Mark Clement-Jones, Michelle Dower, Gillian Houghton, Heather Longworth, Tej Purewal, Derek Tuffnell, Diane Farrar, Jennifer Syson, Gillian Butterfield, Vicky Jones, Rebecca Palethorpe, Tracey Germaine, Marwan Habiba, Debbie Lee, Olufemi Eniola, Lynne Blake, Jane Khan, Helen M. Cameron, Kim Hinshaw, Amanda Bargh, Eileen Walton, Olanrewaju Sorinola, Anna Guy, Zoe D’Souza, Rhiannon Gabriel, Jo Williams, Heidi Hollands, Olujimi Jibodu, Sara Collier, Pauline Tottie, Claire Oxby, James Dwyer, Franz Majoko, Helen Goldring, Sharon Jones, Janet Cresswell, Louise Underwood, Mary Kelly-Baxter, Rebecca Robinson, Dilly Anumba, Anne Chamberlain, Clare Pye, Clare Tower, Sue Woods, Lisa Horrocks, Fiona Prichard, Lynsey Moorhead, Sarah Lee, Louise Stephens, Cara Taylor, Suzanne Thomas, Melissa Whitworth, Jenny Myers, Ellen Knox, Katie Freitas, Mark Kilby, Amanda Cotterill, Khalil Abdo, Katrina Rigby, Julie Butler, Fiona Crosfill, Sean Hughes, Sanjeev Prashar, Fatimah Soydemir, Janet Ashworth, Lorraine Mycock, Jill Smith, Amaju Ikomi, Kerry Goodsell, Jean Byrne, Maxwell Masuku, Alice Pilcher, Meena Khandelwal, Gunda Simpkins, Michelle Iavicoli, Yon Sook Kim, Richard Fischer, Robin Perry, Eugene Y. Chang, Tamara D. Saunders, Betty W. Oswald, Kristin D. Zaks, Sarosh Rana, Dawn McCullough, Anna Sfakianaki, Cheryl Danton, Erin Kustan, Luisa Coraluzzi, Helen How, Christina Waldon, Jeffrey Livingston, Sherry Jackson, Lisa Greene, Dinesh Shah, Jorge E. Tolosa, Monica Rincon, Leonardo Pereira, Amy E. Lawrence, Janice E. Snyder, D. Michael Armstrong, Teresa Blue, Austin Hester, Kathryn Salisbury, Obstetrics and gynaecology, APH - Quality of Care, Amsterdam Reproduction & Development (AR&D), Midwifery Science, Graduate School, Obstetrics and Gynaecology, and APH - Digital Health

Subjects
Gestational hypertension, medicine.medical_specialty, Randomization, Hypertension in Pregnancy, Birth weight, artikel tijdschrift, Preeclampsia, fetal growth restriction, preeclampsia, 03 medical and health sciences, 0302 clinical medicine, Internal Medicine, medicine, hypertension pregnancy-induced, 030212 general & internal medicine, humans, Pregnancy, 030219 obstetrics & reproductive medicine, pregnancy outcome, Obstetrics, business.industry, Gestational age, blood pressure, medicine.disease, 3. Good health, Blood pressure, business
Abstract

For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data based on the Akaike information criterion. Randomization before (but not after) 24 weeks to less-tight (versus tight) control was associated with fewer babies with birth weight P interaction =0.005), but more preterm birth ( P interaction =0.043), and no effect on perinatal death or high-level neonatal care >48 hours ( P interaction =0.354). For the mother, less-tight (versus tight) control was associated with more severe hypertension at all gestational ages but particularly so before 28 weeks ( P interaction =0.076). In women with nonsevere, chronic, or gestational hypertension, there seems to be no gestational age at which less-tight (versus tight) control is the preferred management strategy to optimize maternal or perinatal outcomes. Clinical Trial Registration— URL: https://www.isrctn.com . Unique identifier: ISRCTN71416914.

Published
2018
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