Background The COVID-19 pandemic has impacted the lives of expectant parents and parents of young babies, with disruptions in health care provision and loss of social support. Objective This study investigated the impact of the COVID-19 pandemic and its associated lockdown on this population through the lens of users of the UK National Health Service–approved pregnancy and parenting smartphone app, Baby Buddy. The study aims were threefold: to gain insights into the attitudes and experiences of expectant and recent parents (with babies under 24 weeks of age) during the COVID-19 pandemic; to investigate whether Baby Buddy is meeting users’ needs during this time; and to identify ways to revise the content of Baby Buddy to better support its users now and in future. Methods A mixed methods study design combining a web-based survey with semistructured telephone interviews among Baby Buddy users in the United Kingdom was applied. Data were collected from April 15 to mid-June 2020, corresponding to weeks 4-13 of the lockdown in the United Kingdom. Results A total of 436 expectant (n=244, 56.0%) and recent (n=192, 44.0%) parents responded to the web-based survey, of which 79.1% (n=345) were aged 25-39 years and 17.2% (n=75) spoke English as their second language. Of the 436 respondents, 88.5% (386/436) reported increased levels of anxiety around pregnancy, birth, and being a new parent, and 58.0% (253/436) were concerned about their emotional and mental health. Of the 244 pregnant respondents, 43.4% (n=106) were concerned about their physical health. Telephone interviews with 13 pregnant women and 19 recent parents revealed similarly increased levels of anxiety due to reduced health care provision and loss of support from friends and family. Although a minority of respondents identified some positive outcomes of lockdown, such as family bonding, many telephone interviewees reported feeling isolated, disregarded, and overwhelmed. Recent parents were particularly anxious about the impact of the lockdown on their baby’s development and socialization. Many interviewees were also concerned about their physical health as a consequence of both limited access to face-to-face medical appointments and their own poorer dietary and physical activity behaviors. Across both samples, 97.0% (423/436) of respondents reported that Baby Buddy was currently helping them, with many commenting that its role was even more important given the lack of face-to-face support from health care and parenting organizations. Greater speed in updating digital content to reflect changes due to the pandemic was suggested. Conclusions The COVID-19 pandemic has created heightened anxiety and stress among expectant parents and those with a young baby, and for many, lockdown has had an adverse impact on their physical and mental well-being. With reductions in health care and social support, expectant and new parents are increasingly relying on web-based resources. As a free, evidence-based app, Baby Buddy is well positioned to meet this need. The app could support its users even more by actively directing them to the wealth of existing content relevant to their concerns and by adding content to give users the knowledge and confidence to meet new challenges.

Background Interventions to promote a healthy diet, physical activity, and weight management during pregnancy are increasingly embracing digital technologies. Although some interventions have combined digital with interpersonal (face-to-face or telephone) delivery, others have relied exclusively on digital delivery. Exclusively digital interventions have the advantages of greater cost-effectiveness and broader reach and as such can be a valuable resource for health care providers. Objective This systematic review aims to focus on exclusively digital interventions to determine their effectiveness, identify behavior change techniques (BCTs), and investigate user engagement. Methods A total of 6 databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulated Index to Nursing and Allied Health Literature [CINAHL] Plus, Web of Science, and ProQuest) were searched for randomized controlled trials or pilot control trials of exclusively digital interventions to encourage healthy eating, physical activity, or appropriate weight gain during pregnancy. The outcome measures were gestational weight gain (GWG) and changes in physical activity and dietary behaviors. Study quality was assessed using the Cochrane Risk of Bias tool 2.0. Where possible, pooled effect sizes were calculated using a random effects meta-analysis. Results In total, 11 studies met the inclusion criteria. The risk of bias was mostly high (n=5) or moderate (n=3). Of the 11 studies, 6 reported on GWG as the primary outcome, 4 of which also measured changes in physical activity and dietary behaviors, and 5 studies focused either on dietary behaviors only (n=2) or physical activity only (n=3). The meta-analyses showed no significant benefit of interventions on total GWG for either intention-to-treat data (−0.28 kg; 95% CI −1.43 to 0.87) or per-protocol data (−0.65 kg; 95% CI −1.98 to 0.67). Substantial heterogeneity in outcome measures of change in dietary behaviors and physical activity precluded further meta-analyses. BCT coding identified 7 BCTs that were common to all effective interventions. Effective interventions averaged over twice as many BCTs from the goals and planning, and feedback and monitoring domains as ineffective interventions. Data from the 6 studies reporting on user engagement indicated a positive association between high engagement with key BCTs and greater intervention effectiveness. Interventions using proactive messaging and feedback appeared to have higher levels of engagement. Conclusions In contrast to interpersonal interventions, there is little evidence of the effectiveness of exclusively digital interventions to encourage a healthy diet, physical activity, or weight management during pregnancy. In this review, effective interventions used proactive messaging, such as reminders to engage in BCTs, feedback on progress, or tips, suggesting that interactivity may drive engagement and lead to greater effectiveness. Given the benefits of cost and reach of digital interventions, further research is needed to understand how to use advancing technologies to enhance user engagement and improve effectiveness.

Background Maternal obesity and excessive gestational weight gain are associated with adverse maternal and foetal health outcomes. Interventions targeting dietary and physical activity behaviours during pregnancy have typically been directed at women only. A digital intervention targeting couples could encourage expectant parents to support each other in improving energy balance (dietary and physical activity) behaviours. Aims This study aimed to investigate the role partners play in pregnant women’s energy balance behaviours, and to identify barriers and facilitators to participating as a couple in a digital intervention to encourage healthy eating and physical activity in pregnancy. Methods A qualitative design combined online focus groups and telephone interviews. Three focus groups were held with men (n = 15) and one mini focus group (n = 3) and 12 telephone interviews were conducted with women. Participants were either in the last trimester of pregnancy or had a baby under 18 months old. Most were from more deprived population groups where prevalence of maternal obesity is higher. Data were analysed thematically. Barriers and facilitators to participating as a couple in a digital intervention were mapped to the COM-B model and the Theoretical Domains Framework. Results Four main themes were identified; partner involvement and support; partner understanding of good energy balance behaviours; couple concordance of energy balance behaviours; partner influence on her energy balance behaviours. Most facilitators to participating in a digital intervention as a couple fell within the Reflective Motivation domain of COM-B. Men were motivated by the desire to be supportive partners and good role models. Women were motivated by their belief that partner involvement would improve their success in achieving goals and enhance couple-bonding. Other facilitators included concordance in dietary behaviours (Physical Opportunity), healthcare practitioner recommendation, perceptions of pregnancy as ‘ours’ (Social Opportunity) and feeling supported and involved (Automatic Motivation). Barriers were rarely mentioned but included potential for partner conflict, perceptions of pregnancy as ‘hers’ and economic constraints. Conclusions An opportunity exists to harness partner support to improve maternal energy balance behaviours. Barriers and facilitators to participating in a digital intervention as a couple indicate its potential to benefit emotional and relationship wellbeing in addition to physical health.

BACKGROUND The COVID-19 pandemic has impacted the lives of expectant parents and parents of young babies, with disruption to healthcare provision and loss of social support. This study investigated the impact of COVID-19 and associated lockdown on this population through the lens of users of the UK, NHS-approved pregnancy and parenting smartphone app, Baby Buddy. OBJECTIVE The study aims were threefold; firstly to gain insights into the attitudes and experiences of expectant parents and parents of young babies during the COVID-19 pandemic; secondly to investigate whether Baby Buddy is meeting the needs of its users at this time and thirdly to identify ways in which Baby Buddy could revise content to better support its users both now and in the future. METHODS A mixed methods study design combining an online survey with semi-structured telephone interviews amongst Baby Buddy users in the UK was applied. Data collection ran from April 15th to mid-June, corresponding to weeks 4 to 13 of UK in lockdown. RESULTS Online survey responses (n=436) and telephone interviews (n=32) revealed heightened levels of anxiety and stress amongst pregnant and postnatal respondents with over 88% (n= 386) of online survey respondents reporting increased levels of anxiety around pregnancy, birth and being a new parent. Loss of support from friends, family and healthcare services had detrimentally affected the wellbeing of respondents, leaving many feeling isolated, disregarded and overwhelmed. Whilst a minority identified some positive outcomes of lockdown, most respondents reported negative effects on their mental and physical health. Over 45% (n=106) of pregnant respondents were concerned about their physical health, with reduced levels of activity and poorer dietary behaviours being common. Postpartum respondents were especially worried about the effects of the lockdown on the development and socialisation of their baby. A total of 90% (n=392) of respondents reported that Baby Buddy was helping them at the moment, with many commenting that its role was even more important given the lack of face-to-face support from healthcare and parenting organisations. Greater speed in updating digital content to reflect changes brought about by the pandemic would have been appreciated. CONCLUSIONS The COVID-19 pandemic has created heightened anxiety and stress amongst expectant parents and those with a young baby, and for many, lockdown has had an adverse effect on physical and mental wellbeing. With a reduction in healthcare and social support, expectant and new parents are increasingly relying on online resources. As an evidence-based and free app, Baby Buddy is well positioned to meet this need. It could support its users even more by actively directing them to the wealth of existing content relevant to their concerns, and by adding content to give users the knowledge and confidence to meet the new challenges facing them.

BackgroundMaternal obesity and excessive gestational weight gain are associated with adverse maternal and foetal health outcomes. Interventions targeting dietary and physical activity behaviours during pregnancy have typically been directed at women only. A digital intervention targeting couples could encourage expectant parents to support each other in improving energy balance behaviours. AimsThis study aimed to investigate the role partners play in pregnant women’s energy balance behaviours, and to identify barriers and facilitators to participating as a couple in a digital intervention to encourage healthy eating and physical activity in pregnancy. MethodsA qualitative design combined online focus groups and telephone interviews. Three focus groups were held with men (n=15) and one mini focus group (n=3) and 12 telephone interviews were conducted with women. Participants were either in the last trimester of pregnancy or had a baby under 18 months old. Most were from more deprived population groups where prevalence of maternal obesity is higher. Data were analysed thematically. Barriers and facilitators to participating as a couple in a digital intervention were mapped to the COM-B model and the Theoretical Domains Framework.ResultsFour main themes were identified; partner involvement and support; partner understanding of good energy balance behaviours; couple concordance of energy balance behaviours; partner influence on her energy balance behaviours. Most facilitators to participating in a digital intervention as a couple fell within the Reflective Motivation domain of COM-B. Men were motivated by the desire to be supportive partners and good role models. Women were motivated by their belief that partner involvement would improve their success in achieving goals and enhance couple bonding. Other facilitators included concordance in dietary behaviours (Physical Opportunity), healthcare practitioner recommendation, perceptions of pregnancy as ‘ours’ (Social Opportunity) and feeling supported and involved (Automatic Motivation). Barriers were rarely mentioned but included potential for partner conflict, perceptions of pregnancy as ‘hers’ and economic constraints.ConclusionsAn opportunity exists to harness partner support to improve maternal energy balance behaviours. Barriers and facilitators to participating in a digital intervention as a couple indicate its potential to benefit emotional and relationship wellbeing in addition to physical health.

BACKGROUND In pregnancy, eating well, keeping active and avoiding excessive weight gain are associated with better maternal and foetal health outcomes. Dietary and physical activity (PA) interventions can be effective in changing behaviours and managing weight gain. The comparatively lower cost and greater accessibility of digital interventions make them an attractive alternative to in-person interventions. Baby Buddy is a free pregnancy and parenting app from UK charity Best Beginnings. It is designed to support parents, improve health outcomes and reduce inequalities and is actively used within the UK’s National Health Service. As such, it offers an ideal platform for delivering and evaluating a new antenatal dietary and PA intervention. OBJECTIVE The aim of this four-phased study was to create a theory-based intervention within Baby Buddy to empower, encourage and support expectant parents to develop healthier dietary and PA habits for pregnancy and parenthood. METHODS The intervention was developed using the person-based approach. A systematic review and meta-analysis of digital interventions targeting diet and/or PA in pregnancy (n=11) informed the rudimentary intervention concept by identifying effective behaviour change techniques. Three stages of qualitative research with pregnant and recently pregnant parents guided the intervention design. Study 1 (n=30), comprising 4 online focus groups and 12 telephone interviews, gauged response to the rudimentary concept and generated ideas for its development. Results were analysed thematically. At this stage the ‘Guiding Principles’ for the intervention development were established and regular team meetings ensured that the intervention design remained aligned with Best Beginnings’ objectives, evidence-based approach and feasibility criteria. Study 2 (n=29), comprising online individual and couple interviews, explored design ideas using wireframes and scripts and generated iterative feedback on the intervention content, branding and tone. A ‘Table of Changes Analysis’ tracked design amendments. Study 3 (n=21) tested an app prototype using ‘think aloud’ interviews with current Baby Buddy users. Public Patient Involvement and Engagement (PPIE) (n= 18) and other expert contributors (n=14) provided ad hoc input into the research process and design development. RESULTS Study 1 confirmed the appeal and relevance of the intervention concept and its novel approach of including partners. The identified themes underpinned the development of the intervention design. Iterative feedback from Study 2, in conjunction with PPIE and expert contributor input, helped refine the intervention design and ensure its relevance and appeal to a diverse target user group. Study 3 highlighted functionality, content and design issues with the app prototype and identified ways of improving the user-experience. CONCLUSIONS The development of this co-created, theory-based behaviour change intervention adhered to the person-based approach. Listening to target users at each stage of the design process yielded actionable insights to optimise the relevance and appeal of the intervention content, tone and branding to its target audience.

BackgroundOptimal energy balance behaviours in pregnancy reduce maternal and foetal risk of obesity. A brief intervention (defined as one that is purposefully limited in frequency and time of contact) delivered by during routine antenatal care may promote health behaviour change. We aimed to assess the effectiveness of brief interventions targeting diet, physical activity (PA) and weight monitoring behaviours in improving gestational weight gain (GWG) and/or energy balance behaviours (diet, PA) during pregnancy.Methods We searched twelve databases for RCT or quasi-RCTs until September 2019. Eligible studies were brief interventions delivered during routine antenatal care, targeting GWG, diet and/or PA behaviours. Controls were either standard antenatal care or more intense lifestyle interventions. Pooled effect sizes were calculated using random-effects meta-analysis. Results were stratified by women’s baseline weight status. The ROB2 tool for risk of reporting bias was applied.ResultsWe identified twelve studies of which nine were eligible for meta-analysis. Meta-analysis showed that brief interventions significantly reduced total GWG by -1.26 kg (95% CI -1.80, -0.73) compared with controls. When reported as a proportion of women exceeding Institute of Medicine GWG guidelines, effects were non-significant (OR 0.99 (95% CI 0.82, 1.19)). Subgroup analysis found greater GWG reductions in women entering pregnancy with overweight or obesity. Study quality was variable; five were ‘high risk’, four ‘some concern’, and three ‘low risk’ for study bias.ConclusionOverall, brief interventions during routine antenatal care can lead to small but significant reductions in GWG. GWG reductions in women with overweight/obesity were more pronounced. Observed effect sizes were of equal magnitude to more resource-intensive antenatal lifestyle interventions. Although there is limited evidence for brief interventions changing diet-related or PA behaviours directly, if delivered during routine antenatal care they may offer a pragmatic strategy to prevent excess GWG.

Background In pregnancy, eating well, keeping active, and avoiding excessive weight gain are associated with better maternal and fetal health outcomes. Dietary and physical activity (PA) interventions can be effective in changing behaviors and managing weight gain. The comparatively lower cost and greater accessibility of digital interventions make them an attractive alternative to in-person interventions. Baby Buddy is a free pregnancy and parenting app from the charity Best Beginnings. Designed to support parents, improve health outcomes, and reduce inequalities, the app is actively used within the UK National Health Service. It offers an ideal platform for delivering and evaluating a new prenatal dietary and PA intervention. Objective The aim of this study was to create a theory-based intervention within Baby Buddy to empower, encourage, and support expectant parents to develop healthier dietary and PA habits for pregnancy and parenthood. Methods The intervention’s development process was guided by the Behavior Change Wheel, with the person-based approach used to create and test its design. Three stages of qualitative research with pregnant and recently pregnant parents guided the intervention design. Study 1 (n=30), comprising 4 web-based focus groups and 12 telephone interviews, gauged response to the rudimentary concept and generated ideas for its development. Results were analyzed thematically. At this stage, the guiding principles for the intervention development were established, and regular team meetings ensured that the intervention design remained aligned with Best Beginnings’ objectives, evidence-based approach, and feasibility criteria. Study 2 (n=29), comprising web-based individual and couple interviews, explored design ideas using wireframes and scripts and generated iterative feedback on the intervention content, branding, and tone. A table of changes analysis tracked design amendments. Study 3 (n=19) tested an app prototype using think-aloud interviews with current Baby Buddy users. A patient and public involvement and engagement activity (n=18) and other expert contributors (n=14) provided ad hoc input into the research process and design development. Results Study 1 confirmed the appeal and relevance of the intervention concept and its novel approach of including partners. The identified themes underpinned the development of the intervention design. Iterative feedback from study 2, in conjunction with patient and public involvement and engagement and expert contributor input, helped refine the intervention design and ensure its relevance and appeal to a diverse target user group. Study 3 highlighted functionality, content, and design issues with the app prototype and identified ways of improving the user experience. Conclusions This study illustrates the value of combining a theoretical method for intervention development with the person-based approach to create a theory-based intervention that is also user-friendly, appealing, and engaging for its target audience. Further research is needed to evaluate the effectiveness of the intervention in improving diet, PA, and weight management in pregnancy.