Impact of a Blended Periconception Lifestyle Care Approach on Lifestyle Behaviors: Before-and-After Study
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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 counseling and eHealth (“blended care”) are combined, may effectively target these lifestyle behaviors. Objective: We aimed 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 counseling 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) who visited the outpatient clinics of the Department of Obstetrics and Gynecology at the Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands, between June and December 2018, were invited to participate. We measured changes in lifestyle behaviors at weeks 12 and 24 compared with baseline. Generalized estimating equations were used to analyze the changes in lifestyle behaviors over time. Subgroup analyses were performed for women with obesity (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, and 450 women and 61 men received the blended periconception intervention. Among the participating women, 58.4% (263/450) were included in the preconception period. Moreover, 78.9% (403/511) of the included participants completed the online lifestyle coaching. At baseline, at least one poor lifestyle behavior was present in most women (379/450, 84.2%) and men (58/61, 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=.63), respectively. Overall, the program showed the strongest effectiveness for participating couples. Particularly for vegetable and fruit intake, their consumption increased from 158 grams/day and 1.8 pieces/day at baseline to 190 grams/day and 2.7 pieces/day at the end of the intervention, respectively. Conclusions: We succeeded in including most participating women in the preconception period. A high compliance rate was achieved and users demonstrated improvements in 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 blended care with the provision of only eHealth. Additionally, the clinical relevance of these results will need to be substantiated further.
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Several studies aimed to implement preconception care (PCC) programs and some successfully led to an improved level of knowledge regarding PCC and subsequent improved periconceptional lifestyle behaviours.
“Several studies aimed to implement PCC programs and some successfully led to an improved level of knowledge regarding PCC and subsequent improved periconceptional lifestyle behaviours [7, 18–20].”
From Associations between periconceptional lifestyle behaviours and adverse pregnancy outcomes (2021) · cites this paper as [20]
The Discussion (Main Findings; page not specified) reports that targeted lifestyle components improved after the 24-week periconception intervention. The paper does not report an improvement in knowledge about preconception care or establish that improved knowledge led to the behavior changes; the Discussion (The Black Box of eHealth) says the mechanism remains unclear. (LLM, conf=0.87)
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BackgroundIntervention strategies to improve nutrition and health behaviours before conception
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Steegers-Theunissen, R. P. M., Wiegel, R. E., Jansen, P. W., Laven, J. S. E., & Sinclair, K. D. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21218211 · Cited by 82 · see citing works
Self-citationAssociations between periconceptional lifestyle behaviours and adverse pregnancy outcomes
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- Authors
- van der Windt, M., van der Kleij, R. M., Snoek, K. M., Willemsen, S. P., Dykgraaf, R. H. M., Laven, J. S. E., Schoenmakers, S., & Steegers-Theunissen, R. P. M.
- Affiliations
- Erasmus MC (NL)
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2020-09-30
- Volume
- 22
- Issue
- 9
- Pages
- e19378
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC7557440
- OpenAlex
- W3045824067
- Cited by
- 42
- References
- 5
- Citations by year
- 2025: 5 · 2024: 5 · 2023: 4 · 2022: 14 · 2021: 12 · 2020: 2
- FWCI
- 8.35
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- Leiden Repository (Leiden University) (submittedVersion, cc-by)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- ZonMw
- Erasmus Universitair Medisch Centrum Rotterdam
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- preconception care, blended care, lifestyle intervention, e-health, online coaching, lifestyle counseling, fruit and vegetable intake, folic acid supplementation, alcohol consumption, tobacco use, maternal obesity, normal pregnancy, pregnancy planning, maternal outcomes, gestational weight gain, gestational diabetes risk, preterm birth
- MeSH terms
- Healthy Lifestyle, Mentoring, Adult, Female, Humans, Life Style, Male, Telemedicine
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