PhD defence V.Y.F. (Veronique) Maas

Dissertation in short:

While the majority of antenatal care starts between 8 and 10 weeks of gestation, the foundation of most critical organs is initiated earlier, thus, preventive efforts should be initiated as early as possible, preferably prior to conception, also known as preconception care (PCC). The overall aim of this thesis to explore and evaluate 1) the implementation of a new and innovative PCC-approach within multiple municipalities and 2) its effect on preconceptional lifestyle behaviours and reach among prospective parents and healthcare providers. This thesis was based on research performed within the APROPOS-II study, a stepped wedge cluster randomised controlled trial. The intervention contained a dual-track approach and focused on both the uptake of PCC (the prospective parents) and on the provision of PCC (healthcare providers). The target population was reached through a large campaign week during which the Woke Women® campaign was launched with lots of media attention and innovative channels e.g. social media and local ambassadors This study was conducted between 2018 and 2021 within six municipalities in the Netherlands. The discussion of this thesis argues that PCC as a single component program would be a non-profitable source of efforts and resources since the business case for PCC is lacking. Yet, PCC should better be embedded within a multicomponent program focussing on improving women’s health in general, in accordance with the life course approach, resulting in improved life expectancy and preventing many long-term healthcare costs.