Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands.
Department of Biostatistics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands.
JMIR Mhealth Uhealth. 2019 Apr 11;7(4):e11664. doi: 10.2196/11664.
In 2011, we launched the Smarter Pregnancy mobile health (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 like inadequate nutrition and lifestyle behaviors accumulate. However, it has not yet been investigated whether the Smarter Pregnancy program is equally effective in women living in deprived neighborhoods.
This paper aimed to study the associations between neighborhood deprivation and improvement of inadequate nutrition and lifestyle behaviors of women who were either contemplating pregnancy or already pregnant and subscribed to the Smarter Pregnancy program.
We performed an additional analysis on data from women who used the Smarter Pregnancy program from 2011 to 2016. The program comprised 24 weeks of coaching on 5 nutrition and lifestyle behaviors, of which adequate intakes or lifestyle behaviors were defined as an intake of 200 grams or above of vegetables, 2 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.
Of the 2554 women included, 521 participated with their male partner. Overall, daily vegetable intake was most frequently inadequate at the start of the program (77.72, 1985/2554). Women with a higher NSS (ie, nondeprived neighborhood) smoked less often (adjusted odds ratio [OR] 0.85; 95% CI 0.77-0.93), consumed alcohol more often (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 with women who lived in a neighborhood with a low NSS (ie, deprived). In the total 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).
The Smarter Pregnancy mHealth coaching program empowers women to improve inadequate nutrition and lifestyle behaviors. Unexpectedly, the program seemed more effective in women living in deprived neighborhoods. It is important to unravel differences in needs and behaviors of specific target groups to further tailor the mHealth program on the basis of demographic characteristics like neighborhood deprivation.
2011 年，我们启动了更智能妊娠移动健康（mHealth）辅导计划，该计划已被证明能有效改善孕妇在妊娠前后的营养不足和生活方式行为。众所周知，在贫困社区，营养不足和生活方式行为等不良妊娠结局的风险因素会累积。然而，尚未研究该更智能妊娠计划是否对生活在贫困社区的孕妇同样有效。
本研究旨在研究社区贫困程度与使用更智能妊娠计划的孕妇营养不足和生活方式行为改善之间的关系。这些孕妇要么正在考虑怀孕，要么已经怀孕并订阅了更智能妊娠计划。
我们对 2011 年至 2016 年期间使用更智能妊娠计划的女性数据进行了额外分析。该计划包括 24 周的 5 项营养和生活方式行为辅导，其中充足的摄入量或生活方式行为定义为每天摄入 200 克或以上蔬菜、2 份水果、每天服用 400μg叶酸补充剂和不吸烟或不饮酒。社区贫困程度根据荷兰社会研究所在线调查的状态得分来确定。采用逻辑回归分析和广义估计方程模型，在考虑基线行为的基础上，评估社区状态评分（NSS）与营养不足和生活方式行为改善之间的关系。我们调整了分析结果，考虑了产妇年龄、体重指数、原籍国、妊娠状况和作为夫妻的参与情况。
在 2554 名女性中，521 名女性与伴侣一起参加了该项目。总体而言，在计划开始时，女性每天蔬菜摄入量不足的情况最为普遍（77.72%，1985/2554）。NSS 较高的女性（即非贫困社区）吸烟频率较低（调整后的优势比[OR]0.85；95%CI0.77-0.93），饮酒频率较高（调整后的 OR1.14，95%CI1.04-1.24），且不太可能完成 24 周的辅导（OR0.91，95%CI0.88-0.95），而 NSS 较低的女性（即贫困社区）完成 24 周辅导的可能性较高。在总人群中，经过 24 周辅导后，营养不足和生活方式行为的相对改善率在 26%至 64%之间。NSS 与这种改善呈负相关，这表明 NSS 较高的女性不太可能改善营养不足和生活方式行为，尤其是蔬菜摄入量（调整后的 OR0.89，95%CI0.82-0.97）。
更智能妊娠 mHealth 辅导计划使女性能够改善营养不足和生活方式行为。出乎意料的是，该计划在生活在贫困社区的女性中似乎更有效。重要的是，要了解特定目标群体的需求和行为差异，以便根据社区贫困等人口统计学特征进一步调整 mHealth 计划。
