title: Impact of an mHealth Platform for Pregnancy on Nutrition and Lifestyle of the Reproductive Population: A Survey.
abstract: BACKGROUND
  Poor nutrition and lifestyle behaviors exert detrimental effects on reproduction and health during the life course. Therefore, lifestyle interventions during the periconceptional period can improve fertility, pregnancy outcome, and health of subsequent generations.
  
  
  OBJECTIVE
  This survey investigates the compliance, usability, and initial effectiveness of the Web-based mHealth platform, Smarter Pregnancy.
  
  
  METHODS
  A free subscription to the mHealth platform, Smarter Pregnancy, was provided to couples contemplating pregnancy (n=1275) or already pregnant (n=603). After baseline identification of inadequate nutrition and lifestyle behaviors, a personal online coaching program of 6 months was generated. Using multiple imputation and the generalized estimating equation model with independent correlations, we estimated the changes from inadequate to adequate nutrition and lifestyle behaviors over time. Subgroup analyses were performed for (1) overweight and obese women (body mass index [BMI] ≥25 kg/m(2)), (2) pregnant women at the start of the program, and (3) couples.
  
  
  RESULTS
  A 64.86% (1218/1878) compliance rate was observed and 54.7% (range 39.2-73.4%) of participants rated the program usability as positive or very positive. Adequate nutrition and lifestyle behaviors at baseline were 21.57% (405/1878) for vegetable intake, 52.61% (988/1878) for fruit intake, 85.44% (1303/1525) for folic acid use, 86.79% (1630/1878) for no tobacco use, and 64.43% (1210/1878) for no alcohol consumption. After 6 months of coaching, these lifestyle behaviors improved by 26.3% (95% CI 23.0-29.9) for vegetable intake, 38.4% (95% CI 34.5-42.5) for fruit intake, 56.3% (95% CI 48.8-63.6) for folic acid use, 35.1% (95% CI 29.1-41.6) for no tobacco use, and 41.9% (95% CI 35.2-48.9) for no alcohol consumption. The program showed the strongest effectiveness for participating couples.
  
  
  CONCLUSIONS
  This novel Web-based mHealth platform shows high compliance and usability, and users demonstrate improvements in nutrition and lifestyle behaviors. The next step will be further validation in randomized controlled trials and implementation.
authors.affiliation: Erasmus Medical Center (MC), Department of Obstetrics and Gynecology, University Medical Center, Rotterdam, Netherlands.
authors.forename: Matthijs R
authors.identifier: http://orcid.org/0000-0003-2147-3803
authors.initials: MR
authors.lastname: Van Dijk
authors.forename: Nicole A
authors.identifier: http://orcid.org/0000-0001-9147-1497
authors.initials: NA
authors.lastname: Huijgen
authors.forename: Sten P
authors.identifier: http://orcid.org/0000-0002-1675-2931
authors.initials: SP
authors.lastname: Willemsen
authors.forename: Joop Se
authors.identifier: http://orcid.org/0000-0002-5444-9845
authors.initials: JS
authors.lastname: Laven
authors.forename: Eric Ap
authors.identifier: http://orcid.org/0000-0001-6658-9274
authors.initials: EA
authors.lastname: Steegers
authors.forename: Régine Pm
authors.identifier: http://orcid.org/0000-0002-4353-5756
authors.initials: RP
authors.lastname: Steegers-Theunissen
keywords: lifestyle; mHealth; nutrition; preconception care; pregnancy