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 (Preprint)

Abstract

Background: Living in a deprived neighborhood is associated with several adverse pregnancy outcomes. This can be explained by the accumulation of risk factors, such as inadequate nutrition and lifestyle behaviors, in residents who live in those deprived neighborhoods. In 2011, we launched the ''Smarter Pregnancy'' mHealth coaching program, which has proven to be effective to improve inadequate nutrition and lifestyle behaviors in women before and during pregnancy. We did not investigate before, whether this mHealth program is equally effective in women who live in deprived neighborhoods.Objective: To study the associations between neighborhood deprivation and improvement of inadequate nutrition and lifestyle behaviors of women before and during pregnancy who subscribed to the ''Smarter Pregnancy'' program. Methods:We analyzed data from women who were contemplating pregnancy or already had been pregnant and used the ''Smarter Pregnancy'' program between 2011-2016. The program consisted of 24 weeks of coaching on five nutrition and lifestyle behaviors of which adequate daily intakes or lifestyle behaviors were defined as an intake of ≥200 grams of vegetables, two 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, adjusted for maternal age, body mass index, geographic origin, pregnancy status and participation as a couple.Results: A total of 2,554 women were included of whom 521 participated with their male partner. Overall, daily vegetable intake was most frequently inadequate at the start of the program (n=1,985; 77.7%). Women with a higher NSS (i.e. no deprived neighborhood) less often smoked (adjusted OR 0.85, 95%CI 0.77;0.93), more often consumed alcohol (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 to women who live in a neighborhood with a low NSS.In the total study 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, 2 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 who live in deprived neighborhoods. It is important to unravel differences in needs and behaviors of specific target groups in order to further tailor the mHealth program based on demographic characteristics, such a...