PhD defence M. (Melissa) van der Windt

Summary:

This thesis showed that women with obesity have an increased risk of neural tube defects in their offspring, with substantial evidence that this risk can be attributed to both a relative and an absolute folate deficiency. 
We showed that maternal alcohol consumption in the preconception period has a negative association with mid-pregnancy growth parameters. Furthermore, we developed a blended periconception lifestyle care intervention, combining face-to-face counselling with an eHealth intervention. We showed its effectiveness in improving lifestyle behaviours in (pre)pregnant women and their partner. We also developed a prototype of a digital life course care platform (‘Smarter Health’ app) providing personalised lifestyle care trajectories integrated in medical care journeys. We showed that this is a feasible healthcare innovation. In addition, we studied the implementation process of our blended periconception lifestyle care intervention. We found that facilitators in the implementation process are in the domains ‘characteristics of the intervention’ and ‘characteristics of the individuals’, while barriers are in the domains ‘inner setting’ and ‘implementation process’. We concluded that patients preferred telemedicine modalities, like video consultation and telephone consultation, over a physical consultation for the consumption of blended periconception lifestyle counselling. At last, we concluded that financial incentive-based contingency management is an effective lifestyle intervention in the reduction of smoking behaviour among (pre)pregnant women. We would like to further investigate the effects of adding psychological therapy to the already proven effective blended periconception lifestyle care intervention. The thesis ends with a study proposal on this subject.