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De APROPOS-II studie implementeert een op maat gemaakte preconceptiezorgstrategie (WOKE WOMEN®) in zes gemeentes: Tilburg, Barneveld, Deventer, Zoetermeer, Amersfoort en Utrecht. De studie heeft een stepped wedge cluster randomized controlled trial design. Door middel van een wetenschappelijke evaluatie wordt onderzocht of deze strategie uiteindelijk leidt tot een betere voorbereiding op de zwangerschap en tot betere gezondheidsuitkomsten voor moeder en kind.


De interventie WOKE WOMEN® bestaat uit de implementatie van een preconceptiezorg sociale marketingstrategie op gemeenteniveau. Deze strategie heeft een tweesporen beleid en richt zich zowel op de vraagkant (aanstaande ouders) als de aanbodkant (zorgverleners uit de nulde t/m derde lijn). Voor meer informatie kunt u terecht op:


De doelstellingen zijn:

- Het bereik en gebruik van preconceptiezorg te verbeteren;

- Aanstaande ouders beter voor te bereiden op een aanstaande zwangerschap;

- De preconceptionele- en prenatale leefstijl van de aanstaande ouders te verbeteren;

- De samenwerking onder lokale zorgverleners op het gebied van preconceptiezorg te verbeteren.

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De volgende resultaten worden uit dit project verwacht:

- De ontwikkeling van een unieke sociale marketingstrategie WOKE WOMEN® om het gebruik en bereik van preconceptiezorg onder de doelgroep te verbeteren.

- De ontwikkeling van een format voor de nascholing van zorgverleners op het gebied van kinderwensconsulten aan de hand van de preconceptie indicatielijst.

- Inzicht in de ervaringen van aanstaande ouders en zorgverleners met preconceptiezorg en zwangerschapsvoorbereiding.

- Inzicht in de faal- en succesfactoren bij de implementatie van een lokaal preconceptiezorg verbetertraject in verschillende settings (perifeer vs grootstedelijk, verschillende doelgroepen).

- Inzicht in het effect van de sociale marketingstrategie WOKE WOMEN® op preconceptioneel leefstijlgedrag en andere sociale, medische en obstetrische risicofactoren.

- Inzicht in de follow-up data m.b.t. zwangerschapsuitkomsten van vrouwen vóór en na de implementatie van de sociale marketingstrategie WOKE WOMEN®.

Samenvatting van de aanvraag

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Preconception care (PCC) is an important way for capacitating prospective parents to improve unhealthy lifestyles and eliminate/reduce other risk factors prior to pregnancy. Yet, the uptake rates of PCC among prospective parents are disappointing. One of the underlying causes is that nulliparous couples with childbearing plans are very hard to reach as they usually seek out care once conception has already occurred. Moreover, there is little data from randomized clinical trials to prove the effectiveness of PCC on improving maternal and perinatal health outcomes. This evidence is necessary to substantiate the urgency to invest in a comprehensive national PCC program.


The main objective of the APROPOS-II study is:

“to implement a local PCC approach using a stepped wedge cluster randomized controlled trial design and evaluate the effectiveness on the preconception health and reach of PCC among prospective parents”.



The APROPOS-II study aims to both rigorously evaluate and implement an improved version of the PCC intervention developed in APROPOS-I, focusing on the needs and experiences of both prospective parents and healthcare providers. The study will be conducted in the region of the Geboortezorg Consortium Midden Nederland (GCMN) in 4-8 perinatal care units. A perinatal care unit is defined as a local collaboration cluster of midwives, gynecologists and maternity care. A stepped wedge cluster RCT design will be used to provide a robust body of evidence.


The intervention consists of 1) the implementation of a tailored PCC approach for primary care settings and 2) integration of the "Preconception Indication List" (PIL) for referral to secondary and tertiary care.


1) The key of the PCC approach is that it is tailored to the needs of prospective parents and healthcare providers in a local setting. The PCC approach will make use of a community toolbox which has several modules on preconception health and care (i.e. a promotional campaign, training modules, “Tupperware” group sessions, joint design and implementation of a PCC pathway, etc.). While all participating perinatal care units will implement a fixed part of the approach, they will have the opportunity to further customize the approach by selecting modules that are relevant to the local setting of the perinatal care unit. The rationale behind this method is that every unit selects an approach that suits their local conditions best and has the highest potential for sustainability after completion of the APROPOS-II study. In all participating perinatal care units, a project group is set up with local healthcare providers to guide implementation and warrant sustainability. This local project group will have a leading role in designing the tailored PCC intervention, together with the derived input from conferences with healthcare providers and focus groups with prospective parents.

2) As part of the PCC approach, each perinatal care unit will jointly design a local care pathway and set up interdisciplinary arrangements for collaboration and referral between primary, secondary and tertiary care. The PIL will be implemented in each participating perinatal care unit to operationalize referral indications and integral care within the whole perinatal care chain.


Participation in the study only requires from women to fill out an informed consent form to retrieve data from their medical record and administering one questionnaire that takes a maximum of 15 minutes to complete. During APROPOS-I, we were able to include 35 participant per month. Therefore, it is feasible to aim for inclusion of at least 23 participants in each perinatal care unit per month (2167 paticipants in total, considering that 6 units will participate), which powers the study at 80%.


We will study the effectiveness of the PCC approach on preconceptional risk factors, lifestyle behaviors and reach of prospective parents. Follow-up data on the pregnancy course and pregnancy outcomes of participants will be collected. Moreover, a process evaluation will gain information on the functioning, efficiency and feasibility of the approach.



- The development of information toolkits and training modules for general practices, pharmacies, centers for youth and family, maternity care and PCC providers.

- Insight into the experiences of local healthcare providers and prospective parents regarding PCC.

- Insight into the differences in needs and PCC-strategy for prospective parents from low-risk, high-risk and vulnerable groups.

- Insight into the effect of a locally tailored PCC approach on preconception lifestyle behaviors and other social, medical and obstetrical risk factors.

- Insight into the follow-up data on the pregnancy course and pregnancy outcomes of women before and after exposure to the PCC approach.

- Insight into the (differences in) feasibility and sustainability of implementing a PCC approach that can be tailored to specific local settings.

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