Defining vulnerability subgroups among pregnant women using pre-pregnancy information: a latent class analysis

Joyce Molenaar*, Lindsey van der Meer, L.C.M. Bertens, Eline de Vries, Adja Waelput, Marian Knight, Eric Steegers, JC Kiefte-de Jong, JN (Jeroen) Struijs

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Downloads (Pure)


Early detection of vulnerability during or before pregnancy can contribute to optimizing the first 1000 days, a crucial period for children’s development and health. We aimed to identify classes of vulnerability among pregnant women in the Netherlands using pre-pregnancy data on a wide range of social risk and protective factors, and validate these classes against the risk of adverse outcomes.

We conducted a latent class analysis based on 42 variables derived from nationwide observational data sources and self-reported data. Variables included individual, socioeconomic, lifestyle, psychosocial and household characteristics, self-reported health, healthcare utilization, life-events and living conditions. We compared classes in relation to adverse outcomes using logistic regression analyses.

In the study population of 4172 women, we identified five latent classes. The largest ‘healthy and socioeconomically stable’-class [n = 2040 (48.9%)] mostly shared protective factors, such as paid work and positively perceived health. The classes ‘high care utilization’ [n = 485 (11.6%)], ‘socioeconomic vulnerability’ [n = 395 (9.5%)] and ‘psychosocial vulnerability’ [n = 1005 (24.0%)] were characterized by risk factors limited to one specific domain and protective factors in others. Women classified into the ‘multidimensional vulnerability’-class [n = 250 (6.0%)] shared multiple risk factors in different domains (psychosocial, medical and socioeconomic risk factors). Multidimensional vulnerability was associated with adverse outcomes, such as premature birth and caesarean section.

Co-existence of multiple risk factors in various domains is associated with adverse outcomes for mother and child. Early detection of vulnerability and strategies to improve parental health and well-being might benefit from focussing on different domains and combining medical and social care and support.
Original languageEnglish
Pages (from-to)25-34
JournalEuropean Journal of Public Health
Issue number1
Publication statusPublished - Feb 2023

Bibliographical note

This study was supported by funding. The Dutch Ministry of Health,
Welfare and Sport funded the monitor of the Dutch Solid Startprogramme that was conducted by the National Institute for
Public Health and the Environment (J.M.M., E.F.d.V. and J.N.S.,
project numbers V/010038/01 and V/060438/22). The Bernard van
Leer Foundation provided funding for different projects on the topic
of vulnerability before, during and after pregnancy for Erasmus MC
(L.v.d.M., L.C.M.B., A.J.M.W. and E.A.P.S., grant number NET2017-096). J.C.K.d.J. received subsidy from the Netherlands
Organization of Health Research and Development to study vulnerable and unintended pregnancies (grant number 554002006). The
funders of the study had no role in study design, data collection,
data analysis, data interpretation, writing the manuscript and submission of the article for publication.


Dive into the research topics of 'Defining vulnerability subgroups among pregnant women using pre-pregnancy information: a latent class analysis'. Together they form a unique fingerprint.

Cite this