DOI: 10.1002/pd.4564
ORIGINAL ARTICLE
Determinants of first trimester combined test participation within the central region of the Netherlands Neeltje M. T. H. Crombag1*, Peter C. J. I. Schielen2, Chantal W. Hukkelhoven3, Rita Iedema1, Jozien M. Bensing4,5, Gerard H. A. Visser1, Philip Stoutenbeek6 and Maria P. H. Koster1,6 1
Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands Centre for Infectious Disease Research, Diagnostics and Screening, National Institute for Public Health and the Environment, Bilthoven, The Netherlands 3 Netherlands Perinatal Registry, Utrecht, The Netherlands 4 Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands 5 Netherlands Institute for Health Services Research, Utrecht, The Netherlands 6 Foundation for Prenatal Screening Region of Utrecht, Utrecht, The Netherlands *Correspondence to: Neeltje M. T. H. Crombag. E-mail: [email protected] 2
ABSTRACT Objective Our objective is to study the association between potentially influential determinants and first-trimester combined test (FCT) uptake rates in the central region of the Netherlands. Methods Data were extracted from the national prenatal screening database Peridos and the Netherlands Perinatal Registry and compared at the level of the health care provider. Univariable and multivariable linear regression analysis was used to determine the effect of determinants (maternal age, parity, socio-economic status (SES), mode of conception, ethnicity and urbanisation) on uptake. Results Prenatal screening data were available for 24 657 women and overall uptake rate was 25.7%. The strongest association with FCT uptake was found for advanced maternal age (β 2.2; 95% CI [1.7, 2.8]). Grand multiparity had a significantly negative association with FCT uptake (β 4.3; 95% CI [ 5.9, 2.7]). Positive associations were found for very high urbanisation (β 0.3; 95% CI [0.1, 0.4]) and high SES (β 0.2; 95% CI [0.0, 0.3]).
Conclusion Advanced maternal age is strongly associated with participation in prenatal testing. The role of age related risk perception should be incorporated in future policy making to support women in informed and autonomous decision making. The negative association of grand multiparity and FCT might be religion based but requires further research. © 2015 John Wiley & Sons, Ltd.
Funding sources: This research was funded by grants from the Friends of the UMC Utrecht Foundation, the Royal Dutch Organisation of Midwives and the Foundation for Prenatal Screening Region of Utrecht (SPSRU). Conflicts of interest: None declared
INTRODUCTION In maternity care in the Netherlands, a distinction is made between women at low risk or high risk of pregnancy complications. The majority of women start their pregnancy with a low risk and enter the system at the primary care level (82.9%). Primary care is mainly delivered by an independently practising midwife and rarely by a general practitioner (0.5%).1 In case of any pathology, women are referred to secondary or tertiary care, carried out by an obstetrician. Since 2007, all pregnant women in the Netherlands are informed about first trimester combined testing (FCT). FCT is performed by maternal serum screening and an ultrasound measurement of the fetal nuchal translucency. Its aim is to inform prospective parents on the risk of trisomy 21, trisomy 13 and trisomy 18 in the ongoing pregnancy, to provide them with timely options, including invasive diagnostic procedures Prenatal Diagnosis 2015, 35, 486–492
in case of an increased risk, and, if diagnosed for any of the tested conditions, preparation for a disabled child or termination of pregnancy.2 For women ≥36 years of age, the test is reimbursed by their insurance, but for women
ORIGINAL ARTICLE
Determinants of first trimester combined test participation within the central region of the Netherlands Neeltje M. T. H. Crombag1*, Peter C. J. I. Schielen2, Chantal W. Hukkelhoven3, Rita Iedema1, Jozien M. Bensing4,5, Gerard H. A. Visser1, Philip Stoutenbeek6 and Maria P. H. Koster1,6 1
Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands Centre for Infectious Disease Research, Diagnostics and Screening, National Institute for Public Health and the Environment, Bilthoven, The Netherlands 3 Netherlands Perinatal Registry, Utrecht, The Netherlands 4 Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands 5 Netherlands Institute for Health Services Research, Utrecht, The Netherlands 6 Foundation for Prenatal Screening Region of Utrecht, Utrecht, The Netherlands *Correspondence to: Neeltje M. T. H. Crombag. E-mail: [email protected] 2
ABSTRACT Objective Our objective is to study the association between potentially influential determinants and first-trimester combined test (FCT) uptake rates in the central region of the Netherlands. Methods Data were extracted from the national prenatal screening database Peridos and the Netherlands Perinatal Registry and compared at the level of the health care provider. Univariable and multivariable linear regression analysis was used to determine the effect of determinants (maternal age, parity, socio-economic status (SES), mode of conception, ethnicity and urbanisation) on uptake. Results Prenatal screening data were available for 24 657 women and overall uptake rate was 25.7%. The strongest association with FCT uptake was found for advanced maternal age (β 2.2; 95% CI [1.7, 2.8]). Grand multiparity had a significantly negative association with FCT uptake (β 4.3; 95% CI [ 5.9, 2.7]). Positive associations were found for very high urbanisation (β 0.3; 95% CI [0.1, 0.4]) and high SES (β 0.2; 95% CI [0.0, 0.3]).
Conclusion Advanced maternal age is strongly associated with participation in prenatal testing. The role of age related risk perception should be incorporated in future policy making to support women in informed and autonomous decision making. The negative association of grand multiparity and FCT might be religion based but requires further research. © 2015 John Wiley & Sons, Ltd.
Funding sources: This research was funded by grants from the Friends of the UMC Utrecht Foundation, the Royal Dutch Organisation of Midwives and the Foundation for Prenatal Screening Region of Utrecht (SPSRU). Conflicts of interest: None declared
INTRODUCTION In maternity care in the Netherlands, a distinction is made between women at low risk or high risk of pregnancy complications. The majority of women start their pregnancy with a low risk and enter the system at the primary care level (82.9%). Primary care is mainly delivered by an independently practising midwife and rarely by a general practitioner (0.5%).1 In case of any pathology, women are referred to secondary or tertiary care, carried out by an obstetrician. Since 2007, all pregnant women in the Netherlands are informed about first trimester combined testing (FCT). FCT is performed by maternal serum screening and an ultrasound measurement of the fetal nuchal translucency. Its aim is to inform prospective parents on the risk of trisomy 21, trisomy 13 and trisomy 18 in the ongoing pregnancy, to provide them with timely options, including invasive diagnostic procedures Prenatal Diagnosis 2015, 35, 486–492
in case of an increased risk, and, if diagnosed for any of the tested conditions, preparation for a disabled child or termination of pregnancy.2 For women ≥36 years of age, the test is reimbursed by their insurance, but for women
