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

Abstract

BACKGROUND Periconception lifestyle behaviors affect maternal, paternal, offspring and transgenerational health outcomes. Previous research in other target populations has shown that personalized lifestyle interventions in which face-to-face counselling and eHealth (‘blended care’) are combined may effectively target these lifestyle behaviors. OBJECTIVE We aim to assess the effectiveness of a periconceptional lifestyle intervention on the improvement of specific lifestyle components METHODS A blended periconception lifestyle care approach was developed, combining the outpatient lifestyle counselling service ‘Healthy Pregnancy’ with the eHealth platform ‘Smarter Pregnancy’ (www.smarterpregnancy.co.uk) in which lifestyle was coached for 24 weeks. All couples contemplating pregnancy or already pregnant (≤12 weeks of gestation) visiting the outpatient clinics of the Department of Obstetrics and Gynecology at the Erasmus MC, University Medical Center in Rotterdam, the Netherlands, between June and December 2018 were invited to participate. We measured changes in lifestyle behaviors at week 12 and 24 compared to baseline. Generalized estimating equations (GEE) were used to analyze the changes in lifestyle behaviors over time. Subgroup analyses were performed for women with obesity (body mass index [BMI] ≥30 kg/m2), women pregnant at the start of the intervention, and those participating as a couple. RESULTS A total of 539 women were screened for eligibility; 450 women and 61 men received the blended periconception intervention. 58.4% of participating women were included in their preconception period. 78.9% of the included participants completed the online lifestyle coaching. At baseline, at least one poor lifestyle behavior was present in most women (84.3%) and men (95.1%). In the total group, median fruit intake increased from 1.8 to 2.2 pieces/day (P <.001) and median vegetable intake increased from 151 to 165 grams/day (P <.001) after 24 weeks of online coaching. The probability of taking folic acid supplementation among women increased from 0.97 to 1 (P <.001) and the probability of consuming alcohol and using tobacco in the total group decreased from 0.25 to 0.19 (P = .002) and from 0.20 to 0.15 (P = 0.63), respectively. Overall, the program showed the strongest effectiveness for participating couples. Especially on vegetable en fruit intake, their consumption increased from 158 grams per day and 1.8 pieces per day at baseline, to 190 grams per day and 2.7 pieces per day at the end of the intervention. CONCLUSIONS We succeeded in including the majority of participating women in their preconception period. A high compliance rate was achieved and users demonstrate significant improvements on several lifestyle components. The blended periconception lifestyle care approach seems to be an effective method to improve lifestyle behaviors. The next step is to further disseminate this approach and to perform a randomized trial to compare the use of a blended care with the provision of only eHealth. Additionally, the clinical relevance of these results will have to be substantiated further.