Vulnerability during pregnancy: population-level monitoring and implications for healthcare and social support services

Background: Detecting and addressing vulnerability during pregnancy is important to optimize the first thousand days of children’s lives and prevent health inequities. In a previous study, we found 5 vulnerability-classes among pregnant women. Women in the ‘multidimensional vulnerability’-class shared multiple risk factors across domains and lacked protective factors. In this study, we aimed to gain further insight into vulnerability during pregnancy by adding data about the woman’s partner, and by studying its relation with healthcare and social support services utilization and spending.

 

Methods: This study was conducted in the Netherlands, utilizing the Data-InfrAstructure for ParEnts and ChildRen (DIAPER). Using self-reported and routinely collected data on risk and protective factors from both pregnant women and their partners, we again identified vulnerability classes with Latent Class Analysis. We then developed a model using only routinely collected data as a foundation for longitudinal monitoring at population-level.

 

Next, we studied the association between vulnerability during pregnancy and health and social care utilization (logistic regression) as well as spending (linear regression). We assessed outcomes for both pregnant women and their children over a 7-year follow-up (2016 – 2023), including medical spending in total, general practitioner visits, hospital care, medication use, mental healthcare, maternity care, dental care, youth care and participation in preschool programs.

 

Results: Five vulnerability-classes were found. Approximately 7% of the pregnant women and their partners in the Netherlands were classified as being in a multidimensional vulnerable situation. Results showed increased medical and social care spending for children from parents in the multidimensional vulnerability class compared to children in the other classes, while this group makes less use of care. Both utilization and spending were higher for pregnant women in a vulnerable situation compared to those without. [preliminary results; effect-sizes and ORs will be added]

Implications: Considering the combination of risk and protective factors to vulnerability for both parents is important. Routinely collected data could provide insight in the prevalence, trends and associated outcomes of multidimensional vulnerability at population-level. Public health strategies should focus on both medical and social care and support to improve equity and reduce differences in healthcare and social services spending and utilization.