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Did an urban perinatal health programme in Rotterdam, the Netherlands, reduce adverse perinatal outcomes? Register-based retrospective cohort study
  1. Hendrik CC de Jonge1,
  2. Jacqueline Lagendijk2,
  3. Unnati Saha1,
  4. Jasper V Been1,2,3,
  5. Alex Burdorf1
  1. 1 Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
  2. 2 Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
  3. 3 Department of Paediatrics, Erasmus University Medical Centre–Sophia Children’s Hospital, Rotterdam, The Netherlands
  1. Correspondence to Hendrik CC de Jonge; h.c.c.dejonge{at}


Objectives To study the effect of an urban perinatal health programme in Rotterdam, the Netherlands, on perinatal outcomes.

Design A retrospective cohort study with difference-in-differences analysis using individual-level perinatal outcome data from the Dutch Perinatal Registry 2003–2014 linked to Central Bureau of Statistics data of migration background and individual disposable household income.

Intervention The programme consisted of perinatal health promotion, risk selection and risk-guided pregnancy care, and a new primary care child birth centre. The programme was implemented during 2009–2012.

Primary outcome measures We compared trends in perinatal mortality, preterm delivery and small-for-gestational-age births between targeted urban neighbourhoods in Rotterdam (n=61 415) and all other urban neighbourhoods in the Netherlands (n=881 202). The effect of the programme was modelled as a change in trend of each perinatal outcome in the treatment group post intervention compared with the control population from January 2010 onwards. All analyses were adjusted for maternal age, parity, ethnicity and individual-level low socioeconomic status (SES). We also conducted a stratified analysis by SES.

Results During 2003–2014, downward trends in perinatal mortality (adjusted OR (aOR) 0.9439 per year, 95% CI 0.9362 to 0.9517), preterm birth (aOR 0.9970 per year, 95% CI 0.9944 to 0.9997) and small-for-gestational-age births (aOR 0.9809 per year, 95% CI 0.9787 to 0.9831) in the entire study population were observed. No demonstrable changes in these trends were found in the intervention group after the programme had started. The stratified analyses by SES showed no changes in trends post intervention in both strata either.

Conclusions The programme had no demonstrable effects on perinatal outcomes. The intervention may not have reached a sufficient proportion of the population or has provided too little contrast to the widespread attention for inequalities in pregnancy outcomes occurring simultaneously in the Netherlands.

  • public health
  • epidemiology
  • perinatology

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  • Contributors HCCdJ, JVB and AB were involved in the conception and design of the study. HCCdJ and JVB acquired the data from the Netherlands Perinatal Registry and Statistics the Netherlands. HCCdJ and US analysed the data and all authors were involved with the interpretation of the results. HCCdJ and JL drafted the original work and all authors were involved in revising it critically. All authors have approved the final version of the manuscript.

  • Funding JVB is supported by a personal fellowship from the Netherlands Lung Foundation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Results are based on calculations by Erasmus MC using non-public microdata from Statistics Netherlands. Under certain conditions, these microdata are accessible for statistical and scientific research. For further information: Syntax files that allow repeating the analyses in this paper from microdata at Statistics the Netherlands can be obtained from the first author.

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