title: Differences in quality of antenatal care provided by midwives to low-risk pregnant dutch women in different ethnic groups.
abstract: BACKGROUND
  The objective of this study was to evaluate whether differences existed in the adherence to the Dutch national guidelines regarding basic antenatal care by Dutch midwives for low-risk women of different ethnic groups.
  
  
  METHODS
  This was an observational study using data from electronic antenatal charts of 7 midwife practices (23 midwives), participating in the Generation R Study. The Generation R Study is a multiethnic, population-based, prospective, cohort study that is investigating the growth, development, and health of urban children from fetal life until young adulthood. The study is conducted in Rotterdam, The Netherlands. The antenatal charts of 2093 low-risk pregnant women with an expected birthing date in 2002 through 2004 were used to determine the mean quality of antenatal care scores for 7 ethnic groups. These scores reflected the degree of adherence to the guidelines regarding 10 tests and examinations.
  
  
  RESULTS
  Few differences between ethnic groups were found in adherence to the guidelines that addressed the obstetric-technical quality of antenatal care. This finding applied more to nulliparous than to multiparous women. Adherence to guidelines was not always better in the antenatal care provided to native Dutch multiparous women when compared to other ethnic groups. Midwives adhered well to the guidelines regarding most tests. For all women, irrespective of ethnic background, hemoglobin was not measured as often as recommended, and this was especially the case for Moroccan, Surinamese-Creole, and Dutch-Antillean multiparous women.
  
  
  CONCLUSIONS
  The poorer adherence regarding screening for hemoglobin needs further investigation, as women with African or Mediterranean heritage are more at risk for hemoglobinopathies. However, in general, midwives adhered well to the clinical guidelines regarding most tests irrespective of the ethnic background of the pregnant women. When differences were present, these were not systematically less favorable for non-Dutch pregnant women.
authors.affiliation: Erasmus University Rotterdam, Rotterdam, The Netherlands. chote@bmg.eur.nl
authors.forename: Anushka
authors.initials: A
authors.lastname: Choté
authors.forename: Christianne
authors.initials: C
authors.lastname: de Groot
authors.forename: Ken
authors.initials: K
authors.lastname: Redekop
authors.forename: Renske
authors.initials: R
authors.lastname: Hoefman
authors.forename: Gerrit
authors.initials: G
authors.lastname: Koopmans
authors.forename: Vincent
authors.initials: V
authors.lastname: Jaddoe
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Eric
authors.initials: E
authors.lastname: Steegers
authors.forename: Margo
authors.initials: M
authors.lastname: Trappenburg
authors.forename: Johan
authors.initials: J
authors.lastname: Mackenbach
authors.forename: Marleen
authors.initials: M
authors.lastname: Foets
mesh_terms: D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008880:Midwifery / Q000592:standards*; D009426:Netherlands; D010298:Parity; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards*; D011787:Quality of Health Care
chemical_list: D006454:Hemoglobins