JMIR Publications

ABSTRACT

Background:

Lifestyle behaviours, including diet, contribute to achievement of a successful pregnancy. Assessment of attitudes and practices towards these modifiable behaviours can aid in identifying gaps in knowledge and needs with an impact on interventions effectiveness. The recognized web-based coaching program Smarter Pregnancy 4.0 provides information, raises awareness and empowers the user to adopt and maintain healthy lifestyle behaviours.

Objective:

We investigated the effectiveness of periconception coaching by Smarter Pregnancy on attitudes and practices towards fruit and vegetable intake, and smoking in women conceiving through assisted reproductive technology (ART), and compared them with women conceiving naturally. We also examined the impact of attitudes on the change in practice.

Methods:

Women contemplating pregnancy through ART (N=1,060) or natural conception (N=631) were selected during the periconception period. The intervention groups, conceived through ART or naturally, received Smarter Pregnancy coaching, whereas the control group conceived through ART, and did not receive coaching. Practices were studied in terms of reported fruit and vegetable intake, and smoking. To study attitudes, women with unhealthy behaviours were analyzed for their intention to increase fruit and vegetable intake, as well as smoking cessation. Negative attitudes were considered as having no intention to improve certain unhealthy behaviour. Outcomes were compared after 12 and 24 weeks of the program activation between the ART intervention and control groups, and between the intervention groups of ART and natural conception. Changes in fruit and vegetable intake, and smoking after 12 and 24 weeks of coaching were compared between women with negative attitude versus positive attitude. Analysis was performed using linear and logistic regression models adjusted for maternal confounders and baseline attitudes and practices.

Results:

The ART intervention group showed higher vegetable intake and lower odds for negative attitudes towards vegetable intake after 12 weeks (βadj 25.72 grams, P<.001; ORadj 0.24, P<.001) and 24 weeks of coaching (βadj 23.84 grams, P<.001; ORadj 0.28, P<.001) compared to ART controls. No statistically significant effect was observed on attitudes and practices towards fruit intake and smoking behaviour. In both ART and natural conception groups, women with persistent negative attitude towards fruit and vegetable intake at week 12, showed lower fruit and vegetable intake at week 24 compared to women with positive attitude (βadj -0.49, P<.001; βadj -30.07, P<.001), whereas no difference was observed for smoking. No difference was observed for the studied attitudes and practices between both intervention groups.

Conclusions:

Web-based Smarter Pregnancy coaching improves vegetable intake-related attitudes and practices in women undergoing ART treatment. Women with no intention to increase fruit and vegetable intake had less improvement in their intakes. We confirm the beneficial effects of Smarter Pregnancy towards vegetable intake and recommend its implementation as blended care to also improve fruit intake and smoking cessation.