title: A cohort study of a tailored web intervention for preconception care.
abstract: BACKGROUND
  Preconception care may be an efficacious tool to reduce risk factors for adverse pregnancy outcomes that are associated with lifestyles and health status before pregnancy. We conducted a web-based cohort study in Italian women planning a pregnancy to assess whether a tailored web intervention may change knowledge and behaviours associated with risks for adverse pregnancy outcomes.
  
  
  METHODS
  The study was entirely conducted on the web on a cohort of Italian women of childbearing age. Data collected at baseline on health status, lifestyles and knowledge of risk factors for adverse pregnancy outcomes were used for generating a tailored document including recommendations for folic acid supplementation, obesity and underweight, smoking, alcohol consumption, vaccinations, chronic and genetic diseases, exposure to medications. Prevalence of risk factors and knowledge was assessed 6 months after the intervention. Logistic regression models were used to explore the factors associated with risk factors after the intervention.
  
  
  RESULTS
  Of the 508 enrolled women, 282 (55.5%) completed the study after 6 months since the delivery of tailored recommendations. At baseline, 48% of the participants took folic acid supplementation (95% CI 43.2; 51.9) and 69% consumed alcohol (95% CI 64.7; 72.9). At the follow up 71% of the participants had a preconception visit with a physician. Moreover we observed a decrease of alcohol consumption (-46.5% 95% CI -53.28; -38.75) and of the proportion of women not taking folic acid supplementation (-23.4% 95% CI -31.0; 15.36). We observed an improvement in knowledge of the information about the preconception behaviours to prevent adverse pregnancy outcomes (20.9% 95% CI 14.6%; 27.1%). Having a preconception visit during follow up was significally associated to an increase in folic acid supplementation (OR 2.53 95% CI 1.40; 4.60).
  
  
  CONCLUSIONS
  Our results suggest that a tailored web intervention may improve general preconception health in women planning a pregnancy. A web preconception intervention may be integrated with classic preconception care by health professionals. Clinical trials should be conducted to confirm these findings.
authors.affiliation: Bambino Gesù Children's Hospital IRCCS, Epidemiology Unit, Piazza S, Onofrio 4, Rome 00165, Italy. eleonora.agricola@gmail.com.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Agricola
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Pandolfi
authors.forename: Michaela V
authors.initials: MV
authors.lastname: Gonfiantini
authors.forename: Francesco
authors.initials: F
authors.lastname: Gesualdo
authors.forename: Mariateresa
authors.initials: M
authors.lastname: Romano
authors.forename: Emanuela
authors.initials: E
authors.lastname: Carloni
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Mastroiacovo
authors.forename: Alberto E
authors.initials: AE
authors.lastname: Tozzi
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000517:prevention & control; D002986:Clinical Trials as Topic / Q000379:methods / Q000592:standards; D015331:Cohort Studies; D019587:Dietary Supplements / Q000706:statistics & numerical data; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data; D007558:Italy; D009819:Office Visits / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods* / Q000592:standards; D016742:Preconception Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000517:prevention & control*; D012307:Risk Factors; D016896:Treatment Outcome; D014803:Vitamin B Complex / Q000627:therapeutic use
chemical_list: D014803:Vitamin B Complex; D005492:Folic Acid
references.citation: Hum Reprod. 2010 Jan;25(1):253-64
references.pmid: 19828554
references.citation: Eur J Epidemiol. 1993 May;9(3):322-6
references.pmid: 8405319
references.citation: Obstet Gynecol. 2005 Sep;106(3):665-6
references.pmid: 16135611
references.citation: Epidemiol Infect. 2007 May;135(4):555-62
references.pmid: 17076939
references.citation: Epidemiol Infect. 2000 Oct;125(2):347-57
references.pmid: 11117958
references.citation: Med 2 0. 2012 Aug 14;1(2):e3
references.pmid: 25075231
references.citation: MMWR Recomm Rep. 2006 Apr 21;55(RR-6):1-23
references.pmid: 16617292
references.citation: Midwifery. 2009 Feb;25(1):14-20
references.pmid: 17408822
references.citation: Stat Med. 1998 Apr 30;17(8):873-90
references.pmid: 9595617
references.citation: Fertil Steril. 2012 May;97(5):1136-42.e1-4
references.pmid: 22425198
references.citation: J Med Internet Res. 2012 Jun 29;14(3):e92
references.pmid: 22743601
references.citation: Patient Educ Couns. 2006 Oct;63(1-2):24-8
references.pmid: 16406474
references.citation: Matern Child Health J. 2012 Dec;16(9):1854-61
references.pmid: 22173331
references.citation: Acad Radiol. 2008 Sep;15(9):1165-72
references.pmid: 18692758
references.citation: Am J Obstet Gynecol. 2008 Dec;199(6 Suppl 2):S259-65
references.pmid: 19081420
references.citation: Int J Epidemiol. 2009 Aug;38(4):938-43
references.pmid: 18782897
references.citation: J Med Internet Res. 2014 Jan 27;16(1):e26
references.pmid: 24472854
references.citation: Minerva Ginecol. 2011 Oct;63(5):411-9
references.pmid: 21926950
references.citation: Matern Child Health J. 2006 Sep;10(5 Suppl):S73-7
references.pmid: 16775757
references.citation: Am J Health Promot. 2010 Jul-Aug;24(6):388-95
references.pmid: 20594096
references.citation: Clin Epidemiol. 2012;4:259-65
references.pmid: 23071405
references.citation: Am J Health Promot. 2013 Jan-Feb;27(3 Suppl):eS11-20
references.pmid: 23286652
references.citation: Epidemiol Rev. 2014;36:19-30
references.pmid: 23985430
references.citation: Am J Obstet Gynecol. 2008 Dec;199(6 Suppl 2):S266-79
references.pmid: 19081421
references.citation: Health Educ Behav. 2011 Dec;38(6):603-16
references.pmid: 21511954
references.citation: J Med Internet Res. 2011 Jan 06;13(1):e2
references.pmid: 21212045
references.citation: J Med Internet Res. 2012 Oct 26;14(5):e138
references.pmid: 23103790
references.citation: BMJ. 2012 May 31;344:e3467
references.pmid: 22654073
references.citation: J Med Internet Res. 2012 Feb 22;14(1):e36
references.pmid: 22356829
references.citation: J Am Med Inform Assoc. 2013 May 1;20(3):568-76
references.pmid: 23065196
references.citation: Womens Health Issues. 2008 Nov-Dec;18(6 Suppl):S87-96
references.pmid: 19059553
references.citation: J Med Internet Res. 2011 Dec 31;13(4):e126
references.pmid: 22209829
references.citation: BMC Public Health. 2008 Oct 27;8:372
references.pmid: 18954432
references.citation: Public Health Genomics. 2010;13(2):89-94
references.pmid: 19609073
references.citation: Eur J Epidemiol. 2010 May;25(5):297-304
references.pmid: 20148289