The use of the mHealth program Smarter Pregnancy in preconception care: rationale, study design and data collection of a randomized controlled trial

Dijk, Matthijs R. van; Oostingh, Elsje C.; Koster, Maria P. H.; Willemsen, Sten P.; Laven, Joop S.E.; Steegers‐Theunissen, Régine P.M.

doi:10.1186/s12884-017-1228-5

Cited by 51 publications

(41 citation statements)

References 37 publications

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“…Each woman will be provided with a free subscription to the mHealth coaching programme ‘Smarter Pregnancy’ (Erasmus MC, University Medical Centre, Rotterdam, the Netherlands) that has been shown to improve nutrition and other lifestyle behaviours in this target population before 45–48. The programme offers personal coaching for 26 weeks, which is based on current personal circumstances, pregnancy, nutrition and lifestyle status.…”

Section: Methods and Analysismentioning

confidence: 99%

Towards Prepared mums (TOP-mums) for a healthy start, a lifestyle intervention for women with overweight and a child wish: study protocol for a randomised controlled trial in the Netherlands

et al. 2019

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IntroductionPericonception obesity is associated with a higher risk for adverse perinatal outcomes such as gestational diabetes mellitus, preeclampsia, large for gestational age, operative delivery and preterm birth. Lifestyle interventions during pregnancy have resulted in insufficient effects on reducing these perinatal complications. A few reasons for this disappointing effect can be suggested: (1) the time period during pregnancy for improvement of developmental circumstances is too short; (2) the periconception period in which complications originate is not included; and (3) lifestyle interventions may not have been sufficiently multidisciplinary and customised. A preconception lifestyle intervention might be more effective to reduce perinatal complications. Therefore, the aim of the Towards Prepared mums study is to evaluate the effect of a lifestyle intervention starting prior to conception on lifestyle behaviour change.Methods and analysisThis protocol outlines a non-blinded, randomised controlled trial. One hundred and twelve women (18–40 years of age) with overweight or obesity (body mass index≥25.0 kg/m2) who plan to conceive within 1 year will be randomised to either the intervention or care as usual group. The intervention group will receive a multidisciplinary, customised lifestyle intervention stimulating physical activity, a healthy diet and smoking cessation, if applicable. The lifestyle intervention and monitoring will take place until 12 months postpartum. The primary outcome is difference in weight in kg from baseline to 6 weeks postpartum. Secondary outcomes are gestational weight gain, postpartum weight retention, smoking cessation, dietary and physical activity habits. Furthermore, exploratory outcomes include body composition, cardiometabolic alterations, time to pregnancy, need for assisted reproductive technologies, perinatal complications of mother and child, and lung function of the child. Vaginal and oral swabs, samples of faeces, breast milk, placenta and cord blood will be stored for evaluation of microbial flora, epigenetic markers and breast milk composition. Furthermore, a cost-effectiveness analysis will take place.Ethics and disseminationEthical approval was obtained from the Medical Ethical Committee of Maastricht University Medical Centre+ (NL52452.068.15/METC152026). Knowledge derived from this study will be made available by publications in international peer-reviewed scientific journals and will be presented at (inter)national scientific conferences. A dissemination plan for regional and national implementation of the intervention is developed.Trial registration numberClinicalTrials.gov NCT02703753.

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Section: Methods and Analysismentioning

confidence: 99%

Towards Prepared mums (TOP-mums) for a healthy start, a lifestyle intervention for women with overweight and a child wish: study protocol for a randomised controlled trial in the Netherlands

et al. 2019

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“…Despite the low uptake of PCC-consults, the majority of prospective parents use the internet as their primary source of information regarding preconception health [11]. Women appreciate anonymity and self-management of online information in the privacy of their own home [11,44]. The aim of the social marketing strategy in this intervention is to trigger women to actively prepare for their pregnancy by guiding them towards a website (www.…”

Section: Congenital Anomaliesmentioning

confidence: 99%

Study design of a stepped wedge cluster randomized controlled trial to evaluate the effect of a locally tailored approach for preconception care – the APROPOS-II study

et al. 2020

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Background: In a previous feasibility study (APROPOS) in a single municipality of the Netherlands, we showed that a locally tailored preconception care (PCC) approach has the potential to positively affect preconceptional lifestyle behaviours. Therefore, we designed a second study (APROPOS-II) to obtain a more robust body of evidence: a larger group of respondents, more municipalities, randomization, and a more comprehensive set of (clinical) outcomes. The aim of this study is to assess the effectiveness and the implementation process of a local PCCapproach on preconceptional lifestyle behaviours, health outcomes and the reach of PCC among prospective parents and healthcare providers. Methods: This study is an effectiveness-implementation hybrid type 2 trial. This involves a stepped-wedge cluster randomized controlled trial design aiming to include over 2000 future parents from six municipalities in the Netherlands. The intervention has a dual-track approach, focusing on both the uptake of PCC among future parents and the provision of PCC by healthcare providers. The PCC-approach consists of 1) a social marketing strategy directed towards prospective parent(s) and 2) a local care pathway to improve interdisciplinary collaboration. Data will be collected before and after the introduction of the intervention through questionnaires and medical records in each of the participating municipalities. The primary outcome of this study is change in lifestyle behaviours (e.g. folic acid use, smoking and alcohol use). Secondary outcomes are pregnancy outcomes (e.g. miscarriage, preterm birth, gestational diabetes) and the uptake of PCC. Moreover, a process evaluation will be performed, providing information on the efficacy, feasibility, barriers and facilitators regarding the implementation of the intervention. Discussion: The APROPOS-II study introduces a locally tailored PCC-approach in six municipalities in the Netherlands that will contribute to the body of evidence regarding the effectiveness of PCC and its implementation. If this intervention has a positive effect on lifestyle behaviour changes, leading to improved pregnancy outcomes and the future health of prospective parents and their offspring, it could subsequently be upscaled to (inter)national implementation. Trial registration: Dutch Trial register: NL7784 (Registered June 6th, 2019).

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“…Pregnancy'' program. [22] However, especially with regard to vegetable intake, this improvement becomes less when a woman's NSS is higher, which indicates living in a non-deprived neighborhood. Although women with a higher NSS were less likely to smoke and more likely to consume alcohol at the start of the program compared to women with a lower NSS, we observed no significant differences in the amount of improvement of these lifestyle behaviors.…”

Section: Alcohol Consumption (Yes) N (%)mentioning

confidence: 99%

“…[22,24] The aim of the current study was to investigate the associations between neighborhood deprivation and the improvement of inadequate nutrition and lifestyle behaviors of women before and during pregnancy of the ''Smarter Pregnancy'' program.…”

Section: Introductionmentioning

confidence: 99%

“…[19] In 2011, after more than 30 years of research on the impact of nutrition and lifestyle behaviors on reproduction, we developed and launched the ''Smarter Pregnancy'' mHealth coaching program [21] for women who are contemplating pregnancy or already pregnant and their male partners. [22,23] A survey showed that this mHealth program effectively improves nutrition and lifestyle behaviors (i.e. vegetable and fruit intake, folic acid supplement use, smoking and alcohol consumption)…”

Section: Introductionmentioning

confidence: 99%

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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)

Gootjes¹,

Dijk²,

Köster³

et al. 2018

Preprint

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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...

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The use of the mHealth program Smarter Pregnancy in preconception care: rationale, study design and data collection of a randomized controlled trial

Cited by 51 publications

References 37 publications

Towards Prepared mums (TOP-mums) for a healthy start, a lifestyle intervention for women with overweight and a child wish: study protocol for a randomised controlled trial in the Netherlands

Towards Prepared mums (TOP-mums) for a healthy start, a lifestyle intervention for women with overweight and a child wish: study protocol for a randomised controlled trial in the Netherlands

Study design of a stepped wedge cluster randomized controlled trial to evaluate the effect of a locally tailored approach for preconception care – the APROPOS-II study

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)

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