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

Abstract

Women with subfertility or recurrent miscarriage were recruited to a two-centre RCT where they were randomised to either the online lifestyle coaching platform 'Smarter Pregnancy' (intervention) or periconceptional advice provided by NHS websites (control). Participants completed a lifestyle questionnaire at baseline, 6, 12, 18 and 24 weeks; the results were used to tailor lifestyle coaching in the intervention group. At baseline, 12 and 24 weeks, composite risk scores (CRS) were calculated. A lower CRS corresponds with a healthier lifestyle. ResultsOf the 400 women recruited, 262 women were randomised (131 in each arm). At 12 weeks, there was a reduction in CRS (includes risk score for intake of folic acid, vegetables and fruits, smoking and alcohol) in the intervention vs control arms. After correcting for baseline, the difference in the CRS between intervention and control were -0.47 (95% CI -0.97, 0.02) at 12 weeks and -0.32 (95% CI -0.82, 0.15) at 24 weeks. There was a statistically significant reduction in lifestyle risk scores in women with a BMI ≥25kg/m 2 compared to those with a BMI <25kg/m 2 . The odds of being pregnant at 24 weeks was increased in the intervention vs control (OR 2.83, 95% CI 0.35, 57.76). ConclusionsThe 'Smarter Pregnancy' coaching platform is more effective in delivering lifestyle advice and modulating behaviours to support women with a history of subfertility or recurrent miscarriage than standard online NHS advice.

Machine learning algorithms as new screening approach for patients with endometriosis

“…Recently, Kleczyk et al 23 validated the role of MLAs for the diagnosis, prediction, and forecasting of endometriosis, based on a medico-economic healthcare database. However, although accurate from a statistical point of view, the clinical utility of this tool is questionable because of (1) the inclusion in the models of key features often associated with other gynecologic disorders such as pelvic inflammatory, sub-mucous myoma or genital infection, (2) the lack of a digital personalized patient-based approach 17 , 40 , and (3) the lack of external validation to assess its reproducibility. The present MLA tool is a complete patient-based screening questionnaire in accordance with the recent NHS England guidance on patient involvement in their health and care, by which they mean “supporting them to become involved, as much as they want or are able to, in decisions about their care and giving them choice and control” 40 .…”

“…However, although accurate from a statistical point of view, the clinical utility of this tool is questionable because of (1) the inclusion in the models of key features often associated with other gynecologic disorders such as pelvic inflammatory, sub-mucous myoma or genital infection, (2) the lack of a digital personalized patient-based approach 17 , 40 , and (3) the lack of external validation to assess its reproducibility. The present MLA tool is a complete patient-based screening questionnaire in accordance with the recent NHS England guidance on patient involvement in their health and care, by which they mean “supporting them to become involved, as much as they want or are able to, in decisions about their care and giving them choice and control” 40 . It supports the use of self- management approaches that reenforce patients as experts in their own health and provides support to develop understanding and confidence, improved patient experience and adherence to treatment and medication 17 , 25 , 27 , 31 , 32 , 40 .…”

“…The present MLA tool is a complete patient-based screening questionnaire in accordance with the recent NHS England guidance on patient involvement in their health and care, by which they mean “supporting them to become involved, as much as they want or are able to, in decisions about their care and giving them choice and control” 40 . It supports the use of self- management approaches that reenforce patients as experts in their own health and provides support to develop understanding and confidence, improved patient experience and adherence to treatment and medication 17 , 25 , 27 , 31 , 32 , 40 .…”

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

“…We read with interest the paper by Ng et al (Ng et al, 2021) and have the following suggestions for improvements.…”

“…Multiple imputation provides a new approach to the problem of missing data in clinical practice (He et al, 2010), in which suitable replacement values for the missing data are created and then incorportated to generate a complete database for analysis and sorting. Third, patients were divided into 2 groups according to body mass index (BMI) (<25 or ≥25 kg/m 2 ) in subgroup analyses of risk scores at 24 weeks correcting for the baseline between intervention and control arms (Figure 3, Ng et al, 2021). However, according to World Health Organization classification, people are divided into four groups (Parr et al, 2010): BMI <18.5, 18.5 to 24.9, 25.0 to 29.9, and ≥30 kg/m 2 .…”