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In the Netherlands, many children are born with a suboptimal start in life. 16% of children are born prematurely or are small for gestational age. Experiences during the first 1000 days after conception and during childhood have long-lasting and even transgenerational implications, with people growing up in an extremely unfavorable environment on average dying twenty years earlier. An unfavorable intra-uterine and early childhood developmental environment is associated with a wide range of non-communicable disease, such as diabetes, cardiovascular disease, schizophrenia and obesity. A vital and productive society with a prosperous and sustainable future is built on a foundation of healthy child development. Hence, there is a strong need for early detection and prevention of unfavorable developmental conditions, both because of the impact at the individual level, but also for bringing forward society as a whole and reducing avoidable loss of health and developmental potential.

 

The Netherlands has one of the most accessible and well-developed health care systems in the world[5], with universal health insurance coverage[8] and the highest patient satisfaction in Europe. Preventive care during gestation and the first years of life is nearly universal, free to parents and their children, and highly standardized in terms of provision and registration.

The standardized collection of data on pregnancies, pregnancy outcomes, and the health and development of all Dutch children offers exceptional opportunities to personalize preventive and curative health care in the first thousand days after conception, and to give children a healthy start in life. Prenatal and early childhood investments have been shown to be among the most effective and efficient ways to spend public funds, a finding which has been described as the Heckman curve.

 

However, the Dutch system is currently missing out on important opportunities to “personalize” obstetrics, midwifery and preventive youth health care (PYHC, Jeugdgezondheidszorg in Dutch). Personalizing health care can offer budget-neutral improvements by ensuring that care reaches those who need it and who benefit most, and can be scaled up or down according to need. We have identified two opportunities to improve personalization of universal, selective, and indicated prevention. First, the data which are collected in health care practice are currently not used to their full potential to support medical professionals in their decision-making process. Second, even in the Dutch system, where obstetrics, midwifery and preventive youth health care is universally and pro-actively provided, a set of (future) parents cannot or choose not to use parts of these services, limiting the system’s early detection and prevention capabilities.

 

This project aims to remove these barriers to personalized, effective, and efficient care during the first thousand days after conception. In co-creation with (future) parents and obstetrics, midwifery and preventive youth health care professionals, we will harness rich but underused data sources to build a data-driven support tool to guide professionals in shared decision-making with (future) parents. Next, we will evaluate whether those tools will improve decision-making, targeting, and uptake of care activities. Furthermore, we will clean and document novel PYHC data, to make these data reusable for other researchers through the remote access environment of Statistics Netherlands (CBS). Finally, we will inform the public discourse about the legal and practical measures that are in place to protect the privacy of Dutch citizens.

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