• Batoul Hojeij, Sam Schoenmakers, Isa Van Mullem, Sten P Willemsen, Andras Dinnyes, Kevin D Sinclair, Melek Rousian, and Steegers-TheunissenRégine P MRPMDepartment of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. Electronic address: r.steegers@erasmusmc.nl..
• Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
• Am J Prev Med. 2024 Nov 29.

IntroductionMaternal lifestyle behaviors can affect blood pressure with consequences for maternal and offspring health. The aim of this study was to investigate the effectiveness of the Smarter Pregnancy digital lifestyle coaching program on maternal blood pressure during the first trimester.MethodsThe study was conducted on data of the Rotterdam Periconception Cohort from 2010 to 2019, and analysis was completed in 2024. The intervention group included 132 pregnant women using Smarter Pregnancy for 6-24 weeks within 30 months before the study entry. The control group included 1,091 pregnant women who did not use Smarter Pregnancy. Outcomes included changes in systolic, diastolic, and mean arterial blood pressures between baseline and first trimester. Lifestyle behaviors were tracked in the intervention group at 12 and 24 weeks of the program, using lifestyle risk score for vegetables, fruits, smoking, and alcohol.ResultsUsing multivariable analysis, the intervention group showed reductions in systolic (βadj= -2.34 mmHg, 95% CI= -4.67, -0.01), diastolic (βadj= -2.00 mmHg, 95% CI= -3.57, -0.45), and mean arterial (βadj= -2.22 mmHg, 95% CI= -3.81, -0.52) blood pressures compared with the control group. When stratifying for conception mode, reductions were observed in diastolic (βadj= -2.38, 95% CI= -4.20, -0.56) and mean arterial (βadj= -2.63, 95% CI= -4.61, -0.56) blood pressures only in women who underwent assisted reproduction (n=91). Smarter Pregnancy use was associated with a reduction in lifestyle risk score, indicating improved lifestyle behaviors, after 12 (β= -0.84, 95% CI= -1.19, -0.49) and 24 (β= -1.07, 95% CI= -1.44, -0.69) weeks. The lifestyle risk score was also significantly reduced in assisted reproduction and natural pregnancy subgroups.ConclusionsThe use of Smarter Pregnancy is associated with consistent but small reductions in maternal blood pressure during the first trimester, supporting further implementation in health care.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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