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An instrument for broadened risk assessment in antenatal health care including non-medical issues
Amber A Vos1, Mieke J van Veen2, Erwin Birnie3
1Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Insights
This study developed a new risk screening tool to identify non-medical factors affecting pregnancy outcomes. The instrument enables early detection and tailored prevention strategies in integrated antenatal care settings.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Health Services Research
Background:
- Non-medical factors significantly impact pregnancy outcomes, necessitating improved antenatal risk assessment.
- Integration between clinical practice and public health is crucial for effective prenatal care.
- Existing risk assessment tools require enhancement to incorporate broader risk factors.
Purpose of the Study:
- To develop a non-invasive, standardized instrument for comprehensive antenatal risk assessment.
- To create a risk screening tool for early detection of risk factors and tailored prevention.
- To facilitate integrated care settings for improved pregnancy outcomes.
Main Methods:
- Systematic review of published instruments and cohort study evidence.
- Selection and standardization of risk factors for adverse pregnancy outcomes (e.g., small for gestational age, preterm birth).
- Development of a cumulative risk score, threshold definition, and linked care pathways.
Main Results:
- A digital scorecard with 70 items across six domains (four non-medical, two medical) was created.
- Pilot data indicated a threshold of 16 points would direct 20% of pregnancies to multidisciplinary assessment.
- Twenty-eight distinct care pathways were defined based on risk scores.
Conclusions:
- The developed scorecard is a universal screening instrument for adverse pregnancy outcomes.
- It integrates recent evidence on non-medical risk factors into antenatal care.
- Enables systematic risk management within integrated antenatal healthcare settings.
Introduction:
Growing evidence on the risk contributing role of non-medical factors on pregnancy outcomes urged for a new approach in early antenatal risk selection. The evidence invites to more integration, in particular between the clinical working area and the public health domain. We developed a non-invasive, standardized instrument for comprehensive antenatal risk assessment. The current study presents the application-oriented development of a risk screening instrument for early antenatal detection of risk factors and tailored prevention in an integrated care setting.
Methods:
A review of published instruments complemented with evidence from cohort studies. Selection and standardization of risk factors associated with small for gestational age, preterm birth, congenital anomalies and perinatal mortality. Risk factors were weighted to obtain a cumulative risk score. Responses were then connected to corresponding care pathways. A cumulative risk threshold was defined, which can be adapted to the population and the availability of preventive facilities. A score above the threshold implies multidisciplinary consultation between caregivers.
Results:
The resulting digital score card consisted of 70 items, subdivided into four non-medical and two medical domains. Weighing of risk factors was based on existing evidence. Pilot-evidence from a cohort of 218 pregnancies in a multi-practice urban setting showed a cut-off of 16 points would imply 20% of all pregnant women to be assessed in a multidisciplinary setting. A total of 28 care pathways were defined.
Conclusion:
The resulting score card is a universal risk screening instrument which incorporates recent evidence on non-medical risk factors for adverse pregnancy outcomes and enables systematic risk management in an integrated antenatal health care setting.
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