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

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Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: In 2011, we launched the ‘’Smarter Pregnancy’’ mHealth coaching program, which has shown to effectively improve inadequate nutrition and lifestyle behaviors in women before and during pregnancy. It is known that in deprived neighborhoods risk factors for adverse pregnancy outcomes, such as inadequate nutrition and lifestyle behaviors, accumulate. It has however not yet been investigated whether the Smarter Pregnancy 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 performed an additional analysis on data from women who were either contemplating pregnancy or already 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, taking into account the behaviors at baseline. We adjusted the analyses 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. non-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 (i.e. deprived). 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, 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 as neighborhood deprivation.

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