S.E. Buitendijk

The world's tallest nation has stopped growing taller: The height of Dutch children from 1955 to 2009

Background:Records show that mean height in The Netherlands has increased since 1858. This study looks at whether this trend in the world’s tallest nation is continuing. We consider the influence of the geographical region, and of the child and parental education, on changes in height.Methods:We compared the height of young Dutch people aged 0–21 y as determined on the basis of the growth study of 2009, with the height data from growth studies conducted in 1955, 1965, 1980, and 1997.Results:The analysis sample included 5,811 boys and 6,194 girls. Height by age was the same as in 1997. Mean final height was 183.8 cm (SD = 7.1 cm) in boys and 170.7 cm (SD = 6.3 cm) in girls. The educational levels of both children and their parents are positively correlated with mean height. Since 1997, differences between geographical regions have decreased but not vanished, with the northern population being the tallest.Conclusion:The world’s tallest population has stopped growing taller after a period of 150 y, the cause of which is unclear. The Dutch may have reached the optimal height distribution. Alternatively, growth-promoting environmental factors may have stabilized in the past decade, preventing the population from attaining its full growth potential.

Prevalence of Overweight in Dutch Children With Down Syndrome

OBJECTIVE: Prevalence of overweight in children is increasing, causing various health problems. This study aims to establish growth references for weight and to assess the prevalence rates of overweight and obesity in a nationwide sample of Dutch children with Down syndrome (DS), taking into account the influence of comorbidity. METHODS: In 2009, longitudinal growth data from Dutch children with trisomy 21 who were born after 1982 were retrospectively collected from medical records of 25 Dutch regional specialized DS centers. “Healthy” was defined as not having concomitant disorders or having only a mild congenital heart defect. Weight and BMI references were calculated by using the LMS method, and prevalence rates of overweight and obesity by using cutoff values for BMI as defined by the International Obesity Task Force. Differences in prevalence rates were tested by multilevel logistic regression analyses to adjust for gender and age. RESULTS: Growth data of 1596 children with DS were analyzed. Compared with the general Dutch population, healthy children with DS were more often overweight (25.5% vs 13.3% in boys, and 32.0% vs 14.9% in girls) and obese (4.2% vs 1.8%, and 5.1% vs 2.2%, respectively). Prevalence rates of overweight between DS children with or without concomitant disorders did not vary significantly. CONCLUSIONS: Dutch children with DS have alarmingly high prevalence rates of overweight and obesity during childhood and adolescence. Health care professionals should be aware of the risk of overweight and obesity in children with DS to prevent complications.

Maternal factors and the probability of a planned home birth

Objectives  In the Netherlands, approximately one‐third of births are planned home births, mostly supervised by a midwife. The relationship between maternal demographic factors and home births supervised by midwives was examined.

Do differences in maternal age, parity and multiple births explain variations in fetal and neonatal mortality rates in Europe?--Results from the EURO-PERISTAT project.

Perinatal mortality rates differ markedly between countries in Europe. If population characteristics, such as maternal age, parity or multiple births, contribute to these differences, standardised rates may be useful for international comparisons of health status and especially quality of care. This analysis used aggregated population-based data on fetal and neonatal mortality stratified by maternal age, parity and multiple birth from 12 countries participating in the EURO-PERISTAT project to explore this question. Adjusted odds ratios were computed for fetal and neonatal mortality and tested for inter-country heterogeneity; standardised mortality rates were calculated using a direct standardisation method. There were wide variations in fetal and neonatal mortality rates, from 3.3 to 7.1 and 2.0 to 6.0 per 1000 total and livebirths, respectively, and in the prevalence of mothers over 35 (7-22%), primiparae (41-50%) and multiple births (2-4%). These population characteristics had a significant association with mortality, although results were less consistent for primiparity. Odds ratios for older mothers and primiparae showed significant inter-country heterogeneity. The association between maternal age and fetal mortality declined as the prevalence of older mothers in the population increased. Standardised rates did not substantially change inter-country rankings and demographic characteristics did not explain the higher mortality observed in some countries. Our results do not support the use of mortality rates standardised for age, parity and multiple births for international comparisons of quality of care. Further research should explore why the negative effects of older maternal age decrease as delayed childbearing becomes more common and, in particular, whether this is due to changes in the social characteristics of older mothers or in health care provision.

Increasing awareness of and behaviour towards periconceptional folic acid consumption in The Netherlands from 1994 to 1995

AbstractObjective: In November 1993, Dutch health authorities advised that women planning a pregnancy should take folic acid in the periconceptional period to reduce the risk of fetal neural tube defects. In the autumn of 1995 a national campaign was organized to inform women and health care professionals in a systematic way. Methods: We assessed the awareness and behaviour of women at their first or second antenatal visit in two surveys in the spring of 1994 and the autumn of 1995, in order to evaluate the impact of non-systematic information during that period, and to collect baseline data to evaluate the effect of the national folic acid campaign. The two surveys were carried out in the north and the west of The Netherlands. Results: The proportion of women who had heard of folic acid increased from 28% to 78%. The proportion that used folic acid during any period in pregnancy increased from 7.8% to 26%. The proportion that took folic acid tablets during the whole of the recommended period increased from 0.8 to 4.4%. In the group of women who did not take folic acid, the proportion who did “not like to use anything during pregnancy” decreased, as did the proportion who did “not think it is useful”. Conclusion: In The Netherlands, non-systematic information about periconceptional folic acid use has already led to significant changes in awareness and behaviour before the start of the national folic acid campaign.

Women's motives for not participating in preconception counseling: qualitative study

Aims: Information about risk factors and preventive measures given before conception is estimated to prevent 15–35% of adverse pregnancy outcomes. We aimed to identify women’s motives for not responding to an invitation for preconception counseling (PCC) from their general practitioner. Methods: A purposive sample of 11 women who did not respond to an invitation for PCC and who became pregnant within 1 year was interviewed. Results: Three key themes influencing nonresponse emerged from the data: perceived knowledge, perceived lack of risk and a misunderstanding of the aim of PCC. Conclusion: For successful future implementation of PCC, a more tailored approach may be necessary for certain (groups of) women, addressing the reasons why women do not consider themselves part of the target group for PCC.

GP-initiated preconception counselling in a randomised controlled trial does not induce anxiety

BackgroundPreconception counselling (PCC) can reduce adverse pregnancy outcome by addressing risk factors prior to pregnancy. This study explores whether anxiety is induced in women either by the offer of PCC or by participation with GP-initiated PCC.MethodsRandomised trial of usual care versus GP-initiated PCC for women aged 18–40, in 54 GP practices in the Netherlands. Women completed the six-item Spielberger State Trait Anxiety Inventory (STAI) before PCC (STAI-1) and after (STAI-2). After pregnancy women completed a STAI focusing on the first trimester of pregnancy (STAI-3).ResultsThe mean STAI-1-score (n = 466) was 36.4 (95% CI 35.4 – 37.3). Following PCC there was an average decrease of 3.6 points in anxiety-levels (95% CI, 2.4 – 4.8). Mean scores of the STAI-3 were 38.5 (95% CI 37.7 – 39.3) in the control group (n = 1090) and 38.7 (95% CI 37.9 – 39.5) in the intervention group (n = 1186).ConclusionPCC from ones own GP reduced anxiety after participation, without leading to an increase in anxiety among the intervention group during pregnancy. We therefore conclude that GPs can offer PCC to the general population without fear of causing anxiety.Trial Registration: ISRCTN53942912

The LENTE Study: The Effectiveness of Prophylactic Intramuscular Oxytocin in the Third Stage of Labor Among Low-Risk Women in Primary Care Midwifery Practice: A Randomized Controlled Trial

PURPOSE: To test third stage management of labor for low-risk women comparing routine prophylactic intramuscular oxytocin management versus modified expectant management. STUDY DESIGN: Randomized controlled multicenter trial in primary care midwifery practice. MAJOR FINDINGS: 32.4% of women in the prophylactic intramuscular oxytocin management group had blood loss of 500 mL or more versus 44.2% in the modified expectant management group, relative risk (RR) 0.61, 95% confidence interval (CI) [0.50, 0.74]. The percentage of women experiencing postpartum hemorrhage (PPH) defined as more than 1,000 mL blood loss was 6.3% in the prophylactic intramuscular oxytocin management group versus 11.9% in the modified expectant management group (RR 0.50, 95% CI [0.36, 0.71]). The type of management showed no significant differences between the two groups in clinically relevant indicators of women’s short-term health such as the number of referrals, treatment given, hemoglobin level 36 hours postpartum, and breastfeeding rates after 1 week. Medium-term health such as hemoglobin level at 6 weeks postpartum, women’s perceptions of tiredness, and breastfeeding rates at 3 months after birth also showed no differences between the two groups. CONCLUSION: Third stage management by means of routine prophylactic intramuscular oxytocin reduced the risk of postpartum hemorrhage in a group of childbearing women at low risk of complications in primary midwifery care compared to modified expectant third stage management, but there was no evidence this was associated with a reduction in clinically relevant adverse health outcomes.

Unchanged prevalence of Down syndrome in the Netherlands

This study aims to evaluate trends in prevalence of Down syndrome (DS) births in the Netherlands over an 11‐year period and how they have been affected by maternal age and introduction of prenatal screening.

Unchanged prevalence of Down syndrome in the Netherlands: results from an 11-year nationwide birth cohort: Unchanged prevalence of Down syndrome in the Netherlands

This study aims to evaluate trends in prevalence of Down syndrome (DS) births in the Netherlands over an 11‐year period and how they have been affected by maternal age and introduction of prenatal screening.