{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:42:57Z","timestamp":1788871377668,"version":"build-2803163510"},"reference-count":43,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2014,3,12]],"date-time":"2014-03-12T00:00:00Z","timestamp":1394582400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Faculty of Midwifery Education and Studiesat Zuyd University, Maastricht (The Netherlands)."}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2014,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the impact of obesity on the likelihood of remaining in midwife\u2010led care throughout pregnancy and childbirth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Secondary analysis of data from a prospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Dutch midwife\u2010led practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>A cohort of 1369 women eligible for midwife\u2010led care after their first antenatal visit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      First\u2010trimester body mass index (\n                      <jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content>\n                      ) was calculated as weight measured at booking divided by height squared. Obstetric data were retrieved from medical records. Multiple logistic regressions were performed to examine the effects of\n                      <jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content>\n                      classification on midwife\u2010led pregnancies and childbirths.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Percentages of women remaining in midwife\u2010led care throughout pregnancy and throughout childbirth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of women in obesity classes\n                      <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content>\n                      and\n                      <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>\n                      , 55% remained in midwife\u2010led care throughout pregnancy and 30% remained in midwife\u2010led care throughout birth. Compared with women of normal weight, women in obesity classes\n                      <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content>\n                      and\n                      <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>\n                      had fewer midwife\u2010led pregnancies (\n                      <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                      0.38, 95%\u00a0\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      0.21\u20130.69), and women who were overweight or in obesity class\u00a0I had fewer midwife\u2010led childbirths (\n                      <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                      0.63, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      0.44\u20130.90;\n                      <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                      0.49, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      0.29\u20130.84, respectively). Compared with women of normal weight, women who were obese had higher referral rates for hypertensive disorders (4 versus 14%), prolonged labour (4.6 versus 10.4%), and intrapartum pain relief (4 versus 10.4%). The women who were eligible for midwife\u2010led birth and who were overweight or obese, had no more urgent referrals than women of normal weight. Women who were obese and who completed a midwife\u2010led birth had no more adverse outcomes than women of normal weight, with the exception of higher rates of large for gestational age (\n                      <jats:styled-content style=\"fixed-case\">LGA<\/jats:styled-content>\n                      ) babies (&gt;97.7 centile; 12.1%, versus 1.9% in normal weight and versus 3.3% in overweight women).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although fewer women who were obese remain in midwife\u2010led care during pregnancy and childbirth, there was no increased risk of unfavourable birth outcomes for women who were obese and eligible for a midwife\u2010led birth when compared with women of normal weight. This indicates that when primary care midwives use a risk assessment tool throughout pregnancy and childbirth they are able to safely assign women who are obese to either midwife\u2010led or obstetrician\u2010led care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.12684","type":"journal-article","created":{"date-parts":[[2014,3,12]],"date-time":"2014-03-12T03:24:20Z","timestamp":1394594660000},"page":"1403-1414","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["The impact of obesity on outcomes of midwife\u2010led pregnancy and childbirth in a primary care population: a prospective cohort study"],"prefix":"10.1111","volume":"121","author":[{"given":"DOA","family":"Daemers","sequence":"first","affiliation":[{"name":"Faculty of Midwifery Education and Studies Maastricht Research Centre for Midwifery Science Zuyd University Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"HAA","family":"Wijnen","sequence":"additional","affiliation":[{"name":"Faculty of Midwifery Education and Studies Maastricht Research Centre for Midwifery Science Zuyd University Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"EBM","family":"van Limbeek","sequence":"additional","affiliation":[{"name":"Faculty of Midwifery Education and Studies Maastricht Research Centre for Midwifery Science Zuyd University Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"LM","family":"Bud\u00e9","sequence":"additional","affiliation":[{"name":"Faculty of Midwifery Education and Studies Maastricht Research Centre for Midwifery Science Zuyd University Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MJ","family":"Nieuwenhuijze","sequence":"additional","affiliation":[{"name":"Faculty of Midwifery Education and Studies Maastricht Research Centre for Midwifery Science Zuyd University Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MEA","family":"Spaanderman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University Hospital Maastricht Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RG","family":"de Vries","sequence":"additional","affiliation":[{"name":"Faculty of Midwifery Education and Studies Maastricht Research Centre for Midwifery Science Zuyd University Maastricht the Netherlands"},{"name":"Caphri School for Public Health and Primary Care Maastricht University Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,3,12]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-789X.2007.00464.x"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.113"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.04.021"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-789X.2008.00541.x"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.EDE.0000059921.71494.D1"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)62233-7"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-789X.2008.00511.x"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-789X.2007.00397.x"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-789X.2008.00537.x"},{"key":"e_1_2_11_11_1","volume-title":"Verloskundig Vademecum 2003","author":"Commissie Verloskunde","year":"2003"},{"key":"e_1_2_11_12_1","unstructured":"NVOG.Pregnancy and obesity.2009. 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