Abstract
ImportanceHealthy nutrition and appropriate supplementation during preconception have important implications for the health of the mother and newborn. The best way to deliver preconception care to address health risks related to nutrition is unknown.MethodsWe conducted a secondary analysis of data from a randomized controlled trial designed to study the impact of conversational agent technology in 13 domains of preconception care among 528 non-pregnant African American and Black women. This analysis is restricted to those 480 women who reported at least one of the ten risks related to nutrition and dietary supplement use.InterventionsAn online conversational agent, called “Gabby”, assesses health risks and delivers 12 months of tailored dialogue for over 100 preconception health risks, including ten nutrition and supplement risks, using behavioral change techniques like shared decision making and motivational interviewing. The control group received a letter listing their preconception risks and encouraging them to talk to a health care provider.ResultsAfter 6 months, women using Gabby (a) reported progressing forward on the stage of change scale for, on average, 52.9% (SD, 35.1%) of nutrition and supplement risks compared to 42.9% (SD, 35.4) in the control group (IRR 1.22, 95% CI 1.03–1.45, P = 0.019); and (b) reported achieving the action and maintenance stage of change for, on average, 52.8% (SD 37.1) of the nutrition and supplement risks compared to 42.8% (SD, 37.9) in the control group (IRR 1.26, 96% CI 1.08–1.48, P = 0.004). For subjects beginning the study at the contemplation stage of change, intervention subjects reported progressing forward on the stage of change scale for 75.0% (SD, 36.3%) of their health risks compared to 52.1% (SD, 47.1%) in the control group (P = 0.006).ConclusionThe scalability of Gabby has the potential to improve women’s nutritional health as an adjunct to clinical care or at the population health level. Further studies are needed to determine if improving nutrition and supplement risks can impact clinical outcomes including optimization of weight.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT01827215.
Highlights
Healthy nutrition during preconception has significant implications for the health of the mother and newborn
We previously reported the results a randomized controlled trial (RCT) of 528 African American and Black women ages 18– 34 designed to evaluate the effect of using Gabby that demonstrated a significantly greater increase in preconception risks progressing forward through the stages of the Transtheoretical Model [19] at 6 and months compared to a control group when all domains of preconception care were analyzed [20]
We report a secondary analysis of data from this RCT to study the impact of Gabby on a subset of 480 women who reported at least one of the ten preconception health risks in the nutrition domain
Summary
Healthy nutrition during preconception has significant implications for the health of the mother and newborn. Maternal nutrition and health status at the time of conception is an important determinant of embryonic and fetal growth, and emerging evidence suggests that a mother’s diet and lifestyle influences the long-term health of her infant [1]. Nutritional status is affected by numerous variables including access to healthy food choices and dietary supplements (e.g., folic acid), income, community environment, lifestyle habits such as smoking and participating in physical activity, and the presence of physiological stressors [2]. Evidence-based clinical guidelines include nutrition recommendations such as daily folic acid, appropriate iron and calcium consumption, healthy food choices, a safe amount of fish, and caffeine reduction to improve birth outcomes [3,4,5]. Healthcare providers often lack enough time and resources to deliver individualized care to reproductive-aged women with nutritional risks during a clinical encounter [6, 7]
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