Neighborhood Deprivation and the Effectiveness of Mobile Health Coaching to Improve Periconceptional Nutrition and Lifestyle in Women: Survey in a Large Urban Municipality in the Netherlands

Abstract

Background In 2011, we launched the Smarter Pregnancy mobile health (mHealth) coaching program, which has shown to effectively improve inadequate nutrition and lifestyle behaviors in women before and during pregnancy. It is known that in deprived neighborhoods, risk factors for adverse pregnancy outcomes like inadequate nutrition and lifestyle behaviors accumulate. However, it has not yet been investigated whether the Smarter Pregnancy program is equally effective in women living in deprived neighborhoods. Objective This paper aimed to study the associations between neighborhood deprivation and improvement of inadequate nutrition and lifestyle behaviors of women who were either contemplating pregnancy or already pregnant and subscribed to the Smarter Pregnancy program. Methods We performed an additional analysis on data from women who used the Smarter Pregnancy program from 2011 to 2016. The program comprised 24 weeks of coaching on 5 nutrition and lifestyle behaviors, of which adequate intakes or lifestyle behaviors were defined as an intake of 200 grams or above of vegetables, 2 pieces of fruit, daily folic acid supplement use of 400 µg per day, and no smoking or alcohol consumption. Neighborhood deprivation was determined according to the status scores of the Netherlands Institute for Social Research. Logistic regression analyses and generalized estimating equation models were used to assess the associations between the neighborhood status score (NSS) and the improvement of inadequate nutrition and lifestyle behaviors, taking into account the behaviors at baseline. We adjusted the analyses for maternal age, body mass index, geographic origin, pregnancy status, and participation as a couple. Results Of the 2554 women included, 521 participated with their male partner. Overall, daily vegetable intake was most frequently inadequate at the start of the program (77.72, 1985/2554). Women with a higher NSS (ie, nondeprived neighborhood) smoked less often (adjusted odds ratio [OR] 0.85; 95% CI 0.77-0.93), consumed alcohol more often (adjusted OR 1.14, 95% CI 1.04-1.24), and were less likely to complete the 24 weeks of coaching (OR 0.91, 95% CI 0.88-0.95) compared with women who lived in a neighborhood with a low NSS (ie, deprived). In the total group, the relative improvement of inadequate nutrition and lifestyle behaviors after 24 weeks of coaching was between 26% and 64%. NSS was negatively associated with this improvement, indicating that women with a higher NSS were less likely to improve inadequate nutrition and lifestyle behaviors, especially vegetable intake (adjusted OR 0.89, 95% CI 0.82-0.97). Conclusions The Smarter Pregnancy mHealth coaching program empowers women to improve inadequate nutrition and lifestyle behaviors. Unexpectedly, the program seemed more effective in women living in deprived neighborhoods. It is important to unravel differences in needs and behaviors of spe...

Impact of a Blended Periconception Lifestyle Care Approach on Lifestyle Behaviors: Before-and-After Study

“…The online coaching program Smarter Pregnancy has been proven to be effective for improving lifestyle behaviors [ 18 , 20 , 27 ]. However, the mechanism by which this intervention affects lifestyle behaviors and the elements that contribute the most are unclear and represent a “black box.” Opening this black box is even more relevant for the current blended care approach.…”

“…The Erasmus University Medical Center (Erasmus MC) developed and tested the outpatient lifestyle counseling clinic “Achieving a Healthy Pregnancy,” and this intervention was demonstrated to decrease the prevalence of unhealthy lifestyle components in a sample of 419 mostly subfertile couples [ 17 ]. Additionally, the Erasmus MC developed and evaluated the eHealth coaching program “Smarter Pregnancy” in a large survey including both a general population cohort and a subfertile (in vitro fertilization/intracytoplasmic sperm injection) cohort [ 18 - 20 ].…”

Smartphone-based lifestyle coaching modifies behaviours in women with subfertility or recurrent miscarriage: a randomized controlled trial

“…They are considered to represent an easily accessible and low cost method of self-management for health care (Donker et al, 2013;Fanning et al, 2012;Free et al, 2013;Okorodudu et al, 2015). Within reproductive medicine, the use of an online, smartphone accessed lifestyle coaching application (Smarter Pregnancy (www.smarterpregnancy.co.uk)), has been reported to improve periconceptional behaviours in the general population and women and men who are undergoing IVF ( Van Dijk et al, 2016), especially within obese women (van Dijk et al, 2017a) and in the cohort with lower socioeconomic status (Gootjes et al, 2019). The aim of this study was to assess the effectiveness of the online lifestyle coaching platform 'Smarter Pregnancy' in modifying periconceptional behaviours in women referred to a subfertility or recurrent miscarriage clinic.…”

Pre-Conception Interventions for Subfertile Couples Undergoing Assisted Reproductive Technology Treatment: Modeling Analysis

“…We do not yet know if various lifestyle modifications such as smoking, alcohol, and nutrition have different effects that depend on the socioeconomic status, educational level, or social background of the couple trying to conceive. Recent analysis of Smarter Pregnancy suggests that the program has been more effective in women living in nondeprived neighborhoods, who were, however, less likely to complete the 24 weeks of coaching than women who lived in deprived neighborhoods [42]. Although subfertile couples seeking fertility treatment are often intrinsically motivated to make positive lifestyle changes to improve the likelihood of a successful pregnancy, the socioeconomic status of couples may impact lifestyle as well as their ability to change lifestyle habits.…”