Abstract：
BACKGROUND: This study was carried out to assess the effects of participating in CenteringPregnancy (CP) on maternal, birth, and neonatal outcomes among low-risk pregnant women in the Netherlands.
METHODS: A total of 2124 pregnant women in primary care were included in the study. Data were derived from the Dutch national database, Perined, complemented with data from questionnaires completed by pregnant women. A stepwise-wedge design was employed; multilevel intention-to-treat analyses and propensity score matching were the main analytic approaches. Propensity score matching resulted in sample sizes of 305 nulliparous women in both the individual care (IC) and the matched control group (control-IC) and 267 in the CP and control-CP groups. For multiparous women, 354 matches were found for IC and control-IC groups and 152 for CP and control-CP groups. Main outcome measures were maternal, birth, and neonatal outcomes.
RESULTS: Compared with the control-CP group receiving standard antenatal care, nulliparous women participating in CP had a lower risk of maternal hypertensive disorders (odds ratio [OR], 0.53; 95% CI, 0.30-0.93) and for the composite adverse maternal outcome (OR, 0.52; 95% CI, 0.33-0.82). Breastfeeding initiation rates were higher amongst nulliparous (OR, 2.23; 95% CI, 134-3.69) and multiparous women (OR, 1.62; 95% CI, 1.00-2.62) participating in CP compared with women in the control-CP group.
CONCLUSIONS: Nulliparous women in CP were at lower risk of developing hypertensive disorders during pregnancy and, consequently, at lower risk of having adverse maternal outcomes. The results confirmed our hypothesis that both nulliparous and multiparous women who participated in CP would have higher breastfeeding rates compared with women receiving standard antenatal care.
METHODS: A total of 2124 pregnant women in primary care were included in the study. Data were derived from the Dutch national database, Perined, complemented with data from questionnaires completed by pregnant women. A stepwise-wedge design was employed; multilevel intention-to-treat analyses and propensity score matching were the main analytic approaches. Propensity score matching resulted in sample sizes of 305 nulliparous women in both the individual care (IC) and the matched control group (control-IC) and 267 in the CP and control-CP groups. For multiparous women, 354 matches were found for IC and control-IC groups and 152 for CP and control-CP groups. Main outcome measures were maternal, birth, and neonatal outcomes.
RESULTS: Compared with the control-CP group receiving standard antenatal care, nulliparous women participating in CP had a lower risk of maternal hypertensive disorders (odds ratio [OR], 0.53; 95% CI, 0.30-0.93) and for the composite adverse maternal outcome (OR, 0.52; 95% CI, 0.33-0.82). Breastfeeding initiation rates were higher amongst nulliparous (OR, 2.23; 95% CI, 134-3.69) and multiparous women (OR, 1.62; 95% CI, 1.00-2.62) participating in CP compared with women in the control-CP group.
CONCLUSIONS: Nulliparous women in CP were at lower risk of developing hypertensive disorders during pregnancy and, consequently, at lower risk of having adverse maternal outcomes. The results confirmed our hypothesis that both nulliparous and multiparous women who participated in CP would have higher breastfeeding rates compared with women receiving standard antenatal care.
摘要：
背景：这项研究是为了评估参与合并妊娠（CP）对产妇的影响，出生,荷兰低危孕妇的新生儿结局。
方法：共有2124名初级保健孕妇被纳入研究。数据来自荷兰国家数据库，Perined,补充了孕妇完成的问卷数据。采用逐步楔形设计；多级意向治疗分析和倾向评分匹配是主要的分析方法。倾向评分匹配在个人护理（IC）和匹配的对照组（control-IC）中都有305名未产妇女的样本量，在CP和对照CP组中有267名。对于多胎妇女来说，IC和对照IC组发现354个匹配，CP和对照CP组发现152个匹配。主要结局指标是孕产妇，出生,和新生儿结局。
结果：与接受标准产前护理的对照组相比，参加CP的未产妇女患母体高血压疾病的风险较低（比值比[OR]，0.53；95%CI，0.30-0.93）和复合不良产妇结局（OR，0.52；95%CI，0.33-0.82）。未产者的母乳喂养起始率较高(OR，2.23；95%CI，134-3.69)和多胎女性(OR，1.62；95％CI，1.00-2.62）与对照组的女性相比，参与CP。
结论：未产女性在妊娠期间患高血压疾病的风险较低，因此,具有不良产妇结局的风险较低。结果证实了我们的假设，即与接受标准产前护理的妇女相比，参加CP的未产和多产妇女的母乳喂养率都较高。
方法：共有2124名初级保健孕妇被纳入研究。数据来自荷兰国家数据库，Perined,补充了孕妇完成的问卷数据。采用逐步楔形设计；多级意向治疗分析和倾向评分匹配是主要的分析方法。倾向评分匹配在个人护理（IC）和匹配的对照组（control-IC）中都有305名未产妇女的样本量，在CP和对照CP组中有267名。对于多胎妇女来说，IC和对照IC组发现354个匹配，CP和对照CP组发现152个匹配。主要结局指标是孕产妇，出生,和新生儿结局。
结果：与接受标准产前护理的对照组相比，参加CP的未产妇女患母体高血压疾病的风险较低（比值比[OR]，0.53；95%CI，0.30-0.93）和复合不良产妇结局（OR，0.52；95%CI，0.33-0.82）。未产者的母乳喂养起始率较高(OR，2.23；95%CI，134-3.69)和多胎女性(OR，1.62；95％CI，1.00-2.62）与对照组的女性相比，参与CP。
结论：未产女性在妊娠期间患高血压疾病的风险较低，因此,具有不良产妇结局的风险较低。结果证实了我们的假设，即与接受标准产前护理的妇女相比，参加CP的未产和多产妇女的母乳喂养率都较高。
