The effect of a locally tailored intervention on the uptake of preconception care in the Netherlands: a stepped-wedge cluster randomized trial (APROPOS-II study)

Abstract

Background The preconception period provides a window of opportunity for interventions aiming to reduce unhealthy lifestyle behaviours and their negative effect on pregnancy outcomes. This study aimed to assess the effectiveness of a locally tailored preconception care (PCC) intervention in a hybrid-II effectiveness implementation design. Methods A stepped-wedge cluster randomized controlled trial was performed in four Dutch municipalities. The intervention contained a social marketing strategy aiming to improve the uptake (prospective parents) and the provision (healthcare providers) of PCC. Prospective parents participated by administering a questionnaire in early pregnancy recalling their preconceptional behaviours. Experiences of healthcare providers were also evaluated through questionnaires. The composite primary outcome was adherence to at least three out of four preconceptional lifestyle recommendations (early initiation of folic acid supplements, healthy nutrition, no smoking or alcohol use). Secondary outcomes were preconceptional lifestyle behaviour change, (online) reach of the intervention and improved knowledge among healthcare providers. Results A total of 850 women and 154 men participated in the control phase and 213 women and 39 men in the intervention phase. The composite primary outcome significantly improved among women participating in the municipality where the reach of the intervention was highest (Relative Risk (RR) 1.57 (95% Confidence Interval (CI) 1.11–2.22). Among women, vegetable intake had significantly improved in the intervention phase (RR 1.82 (95%CI 1.14–2.91)). The aimed online reach- and engagement rate of the intervention was achieved most of the time. Also, after the intervention, more healthcare providers were aware of PCC-risk factors (54.5% vs. 47.7%; p = 0.040) and more healthcare providers considered it easier to start a conversation about PCC (75.0% vs. 47.9%; p = 0.030). Conclusion The intervention showed some tentative positive effects on lifestyle behaviours among prospective parents. Primarily on vegetable intake and the knowledge and competence of healthcare providers. The results of this study contribute to the evidence regarding successfully implementing PCC-interventions to optimize the health of prospective parents and future generations. Trial registration Dutch Trial Register: NL7784 (Registered 06/06/2019).

Digital preconception interventions targeting weight, diet and physical activity: A systematic review

“…Nine of the included studies were RCTs, [30][31][32][33][34][35][36][37] and one was a cohort study adopting a pre-post-test analysis. 38 Publication ranged from July 2010 to November 2022 with five studies undertaken in the Netherlands, 30,31,35,37,39 three in the United States of America (USA) 32,36,38 and one each from Australia 34 and Malaysia. 33 The study populations consisted of non-pregnant women aged between 18 and 44 years.…”

“…Three studies also reported on behaviours in men, which was outside the scope of this review. 35,37,39 Four studies specifically included women who had an overweight or obese BMI, 30,31,34,38 the rest did not specify a BMI range. One study included women with polycystic ovary syndrome.…”

“…38 T A B L E 1 Characteristics of included studies that evaluated women's health outcomes in response to intervention during the preconception period, 1990-2022. The included interventions are a public health campaign, 35 an interactive culturally appropriate online 'conversational agent', 36 a tailored mobile application with face to face and phone sessions, 33 weekly emails and informational webpage, 32 face to face and five face to face group sessions supported by eight web-based educational sessions and online community support, 38 twenty 2.5-h group sessions with or without short message service (SMS) support 40 or ten 30-min tailored sessions face-face or via phone. Two studies describe the same intervention in two different study populations and provided tailored coaching with three SMS and emails per week.…”

“…It was delivered combining faceto-face delivery with (1) mobile phone SMS, 31 (2) online diet-diary and telephone interviews, 30 (3) social media (Facebook) and web-delivered nutrition education, 38 (4) digital consultations and an online forum, 34 (5) specifically made app and telephone counselling 33 or ( 6) mixed methods including posters, word of mouth, social media, flyers, etc. 35 Three studies were delivered digitally, via email, 31,32,37 SMS delivered nutrition education (n = 2) 32,37 or via an online virtual conversational agent referred to as 'Gabby' (n = 1). 36 Eight studies compared the intervention to a control group, two of which were standard care.…”

“…31 Face to face group sessions and web-based digital education resulted in a modest group mean loss (À1.3 kg, SD 4.4 kg) 38 and less weight was gained in the intervention group compared with control (0.83 vs. 1.6 kg, p = 0.025) when face to face was combined with an application and phone calls. 33 Six studies examined preconception dietary factors including folic acid supplementation, 32,35,37 fruit and vegetable intake 33,38,39,41,42 and caffeine intake. 35 One study examined adherence to preconception lifestyle recommendations, which included early initiation of folic acid, healthy nutrition, smoking and alcohol use.…”