A cohort study of a tailored web intervention for preconception care

Abstract

BackgroundPreconception care may be an efficacious tool to reduce risk factors for adverse pregnancy outcomes that are associated with lifestyles and health status before pregnancy. We conducted a web-based cohort study in Italian women planning a pregnancy to assess whether a tailored web intervention may change knowledge and behaviours associated with risks for adverse pregnancy outcomes.MethodsThe study was entirely conducted on the web on a cohort of Italian women of childbearing age. Data collected at baseline on health status, lifestyles and knowledge of risk factors for adverse pregnancy outcomes were used for generating a tailored document including recommendations for folic acid supplementation, obesity and underweight, smoking, alcohol consumption, vaccinations, chronic and genetic diseases, exposure to medications. Prevalence of risk factors and knowledge was assessed 6 months after the intervention. Logistic regression models were used to explore the factors associated with risk factors after the intervention.ResultsOf the 508 enrolled women, 282 (55.5%) completed the study after 6 months since the delivery of tailored recommendations. At baseline, 48% of the participants took folic acid supplementation (95% CI 43.2; 51.9) and 69% consumed alcohol (95% CI 64.7; 72.9). At the follow up 71% of the participants had a preconception visit with a physician. Moreover we observed a decrease of alcohol consumption (−46.5% 95% CI −53.28; −38.75) and of the proportion of women not taking folic acid supplementation (−23.4% 95% CI −31.0; 15.36). We observed an improvement in knowledge of the information about the preconception behaviours to prevent adverse pregnancy outcomes (20.9% 95% CI 14.6%; 27.1%). Having a preconception visit during follow up was significally associated to an increase in folic acid supplementation (OR 2.53 95% CI 1.40; 4.60).ConclusionsOur results suggest that a tailored web intervention may improve general preconception health in women planning a pregnancy. A web preconception intervention may be integrated with classic preconception care by health professionals. Clinical trials should be conducted to confirm these findings.

Preconception health interventions delivered in public health and community settings: A systematic review

“…Most of the studies (n = 9, 75%) examined individuals' knowledge of preconception health. [24][25][26][27]29,30,[33][34][35] These studies varied in the type of intervention as well as the topics selected to assess knowledge increase. Examples of knowledge tested include general preconception health, folic acid intake and its effects, types of foods enriched with folate, and risks of smoking and alcohol exposures.…”

“…In total, 12 studies met the inclusion criteria for our search. [24][25][26][27][28][29][30][31][32][33][34][35] (See the Supplementary file, in the ARTICLE TOOLS section on the journal site.) No additional studies were identified through hand searches of these studies.…”

“…A majority of studies (n = 8, 67%) were conducted in the United States, 25,[27][28][29][30][31][32][33] three in Australia, 26,34,35 and one in Italy. 24 Study designs included randomized controlled trials (n = 5, 42%), 25,28,31,32,34 quasiexperimental studies (n = 1, 8%), 30 pre-post studies (n = 5, 42%), 24,26,27,29,33 and interrupted time series (n = 1, 8%). 35 In total, four studies (33%) had sample sizes greater than 500 subjects.…”

“…28,30,34,35 Only four studies (33%) provided participation rates, which ranged from 32% to 77%. 24,25,27,32 However, a majority (n = 8, 67%) had only a single contact. Half of the studies (n = 6) had no follow-up period (i.e., outcomes were assessed immediately after the intervention).…”

“…A majority of studies also received a weak rating on blinding (n = 7, 58%); 24,[27][28][29][33][34][35] this was mostly due to study design (e.g., pre-post) and the nature of the interventions, resulting in awareness among both assessors and participants of intervention status. A similar number of studies received a weak rating on data collection methods (n = 7, 58%) 24,26,[28][29][30]34,35 because most authors did not use validated tools or did not report their psychometric properties. Finally, five (42%) of the studies received a weak rating for withdrawals and dropouts because of high attrition (52%-77%) or unreported follow-up rates.…”