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Perinatal and maternal morbidity/mortality is relatively high in the Netherlands, compared to other European countries. The perinatal outcomes are especially worse for pregnant women from lower socio-economic groups and from non-western origin. In the US a customized care model has been developed for these groups of women: CenteringPregnancy (CP). CP consists of consultations in group setting aimed at empowering the pregnant women by integrating three major components of care: health assessment, education, and support. Studies have shown positive effects of CP in the US: amongst others a decrease in the number of preterm births. CP is now being adapted to the Dutch primary health care and its feasibility is being studied. In the region Northern South-Holland in the Netherlands CP will be strengthened by a) involving chain partners from public health care, other primary care professionals and specialized health care, and b) the development of additional support for pregnant women with complex needs. In the present study this adapted CP is developed and its effects are evaluated. In collaboration with professionals from public health, primary health, and specialized health care, in the first half year of the project, a protocol is developed presenting the tasks and roles of the different chain partners during the group consultations of CP. In the next three years, we will use a wedged cluster randomized controlled trial to examine the effects of CP of infant outcomes, maternal outcomes, and care outcomes in 9 midwifery practices and 3 clinics. Instead of randomly allocating practices to the intervention or control condition, 9 midwifery practices are randomly allocated to the period in which they start with providing CenteringPregnancy. Data registered in the Dutch Perinatal Registration is used to monitor infant outcomes, and some of the maternal and care outcomes. Next, pregnant women will complete questionnaires three times during and one time after pregnancy. During the study the key professionals will monitor the process of prenatal care such as participation rate, uptake intervention, provided activities, and the costs of implementing group consultations. Professionals are also interviewed to assess their satisfaction with group consultations and with the integration of care. Pregnant women and their partners will be asked about their perceptions regarding the integration of care and their satisfaction with care.

The project will be imbedded in our regional obstetric consortium group in which professionals and researchers in public health, primary, and specialized care are involved. The partners of our consortium are already collaborating in several networks: like the perinatal audits, obstetrics collaboration networks (verloskundig samenwerkingsVerband; VSV), and the Academic working place Public Health.

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