What to expect when you're expecting?

In the Netherlands, early risk stratification for pregnancy complications is based on the
medical and obstetric history of pregnant women. Pregnant women who are assumed
to be at low risk for complications have their pregnancy monitored by a midwife in
primary care and those with a medium or high risk have their pregnancy monitored
by an obstetrician in secondary or tertiary care. Many pregnant women are referred
to secondary or tertiary care during pregnancy or childbirth, for example in case of
gestational diabetes (GDM) or preeclampsia (PE). Multivariable prognostic models
for the development of such pregnancy complications may be the ultimate tool to
improve early risk stratification, which may facilitate tailored and preventive obstetric
care to improve pregnancy outcome. The main aim of this thesis was to improve early
risk stratification for pregnancy complications to allow for preventive tailored obstetric
care, which may ultimately lead to a reduction of maternal and perinatal mortality and
morbidity. In this thesis, GDM and PE were addressed and were evaluated whether the
use of prognostic models for these outcomes are beneficial for clinical practice.

Conclusions
The results of the RESPECT study show that prognostic models for GDM and PE can improve
early risk stratification in pregnancy and are cost-effective compared to current
strategies, which are mainly based on single risk factors. Prognostic models for GDM and
PE are therefore ready for implementation, but evidence on the actual impact of these
models is needed to verify whether improvement of maternal and perinatal morbidity
and mortality can be achieved this way. The findings of this thesis may encourage a
similar approach of validating prognostic models for a broader range of pregnancy
complications, such as preterm birth or the birth of a small for gestational age neonate.