The use of mHealth to improve nutrition and lifestyle behaviors in subfertile couples undergoing assisted reproduction

This study was carried out to study the effectiveness of the mHealth nutrition and lifestyle coaching program Smarter Pregnancy in couples undergoing fertility treatment. The authors found that this program was effective in improving the nutrition and lifestyle behaviors in couples undergoing fertility treatment. 

Poor nutrition and lifestyle behaviors are common risk factors for many diseases including reproductive disorders. Nowadays, assisted reproductive techniques (ART) such as in vitro fertilization (IVF) treatment and intracytoplasmic sperm injection (ICSI) have increased pregnancy rates in couples who are subfertile. 

The adoption of good nutrition and lifestyle behaviors can increase the effectiveness of ARTs. Patients who are coping with fertility issues often are not aware of the effect that poor nutrition and lifestyle behaviors can have on fertility issues. Raising awareness of these issues remains difficult. The addition of mobile phone applications such as mHealth can provide a good way to monitor adherence to good nutrition and lifestyle behaviors. Smarter Pregnancy was developed to support patients in improving their nutrition and lifestyle behaviors. However, adherence to such programs in couples undergoing ARTs is still unknown.

There were 626 female patients undergoing IVF/ICSI. There were 222 male partners involved in this study. All participants completed questionnaires about their behaviors. One group received the Smarter Pregnancy support (intervention group; IG) while the control group (CG) received a "lighter" version of the Smarter Pregnancy. The IG received personalized coaching based on sex, pregnancy, nutritional, and behavioral (alcohol consumption, smoking). The CG did not receive personalized counseling on unhealthy behaviors. Participants were evaluated again at 24 and 36 weeks.

Both the IG and the CG showed more adequate behavior after 24 weeks of coaching. Folate (nutrient vital for good fetal health) was found to be higher in the IG (average folate of 48.6nmol/L) than the CG (average folate of 30.1nmol/L).

There was an improvement in poor dietary practice in both groups. This improvement was larger in the IG in women after 24 weeks. The same trend was found in men in the IG group. This was also found at 36 weeks follow up in both men and women in the IG group. Lifestyle risk factors (LRS) such as smoking, were found to be significantly improved in women in the IG.

Pregnancy rates at 52 weeks from the start of the program were slightly higher (not significant) in the CG compared to the IG (67.3% vs 62.5%). 

The authors found that the use of the mHealth coaching program Smarter Pregnancy is effective and improves nutrition and lifestyle behaviors in couples undergoing IVF/ICSI treatment.

This study was carried out in the Netherlands and so may not translate well to a worldwide population. Also, this study was based on questionnaires based on patient recollection. This method is not always trustworthy.