A Web-Based mHealth Intervention With Telephone Support to Increase Physical Activity Among Pregnant Patients With Overweight or Obesity: Feasibility Randomized Controlled Trial

Abstract

Background Pregnant patients with overweight or obesity are at high risk for perinatal complications. Excess gestational weight gain (GWG) further exacerbates this risk. Mobile health (mHealth) lifestyle interventions that leverage technology to facilitate self-monitoring and provide just-in-time feedback may motivate behavior change to reduce excess GWG, reduce intervention costs, and increase scalability by improving access. Objective This study aimed to test the acceptability and feasibility of a pilot mHealth lifestyle intervention for pregnant patients with overweight or obesity to promote moderate intensity physical activity (PA), encourage guideline-concordant GWG, and inform the design of a larger pragmatic cluster randomized controlled trial. Methods We conducted a mixed methods acceptability and feasibility randomized controlled trial among pregnant patients with a prepregnancy BMI of 25 to 40 kg/m2. Patients with singletons at 8 to 15 weeks of gestation who were aged ≥21 years and had Wi-Fi access were recruited via email from 2 clinics within Kaiser Permanente Northern California and randomized to receive usual prenatal care or an mHealth lifestyle intervention. Participants in the intervention arm received wireless scales, access to an intervention website, activity trackers to receive automated feedback on weight gain and activity goals, and monthly calls from a lifestyle coach. Surveys and focus groups with intervention participants assessed intervention satisfaction and ways to improve the intervention. PA outcomes were self-assessed using the Pregnancy Physical Activity Questionnaire, and GWG was assessed using electronic health record data for both arms. Results Overall, 33 patients were randomly assigned to the intervention arm, and 35 patients were randomly assigned to the usual care arm. All participants in the intervention arm weighed themselves at least once a week, compared with 20% (7/35) of the participants in the usual care arm. Participants in the intervention arm wore the activity tracker 6.4 days per week and weighed themselves 5.3 times per week, and 88% (29/33) of them rated the program “good to excellent.” Focus groups found that participants desired more nutrition-related support to help them manage GWG and would have preferred an app instead of a website. Participants in the intervention arm had a 23.46 metabolic equivalent of task hours greater change in total PA per week and a 247.2-minute greater change in moderate intensity PA per week in unadjusted models, but these effects were attenuated in adjusted models (change in total PA: 15.55 metabolic equivalent of task hours per week; change in moderate intensity PA: 199.6 minutes per week). We found no difference in total GWG (mean difference 1.14 kg) compared with usual care. Conclusions The pilot mHealth lifestyle intervention was feasible, highly acceptable, and promoted self-monitoring. Refined interventions are needed to effectively affect PA and GWG among pregnant patients with overweight or obesity. Trial Registration ClinicalTrials.gov NCT03936283; https://clinicaltrials.gov/ct2/show/NCT03936283

The Role of Digital Health in the Early Detection and Management of Obstetric Complications in the Community: A Systematic Review

“…In addition, there were also some articles discussed about short-massage service applications, mHealth technology [12], [19], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], Telemedicine [3], [20], [32], [33], [34], the use of applications [35], [36], [37], MyFitnessPal phone app [23], Mi Fit app [38], e-Moms Roc [16], WhatsApp social application [39], [40], SEESPA [41], RapidSMS [42], E screening [43], [44], PEARS [28], [45], and Cellular-enabled glucometers [46]. Others were about watch-based applications and video conferencing like using a smartwatch [47], Telehealth: video conference [45], [48], [49], flexible maternity virtual ward services [50], internet-based [24], [51], website Williamson [52], and Text or voice message [53].…”

App-Supported Lifestyle Interventions in Pregnancy to Manage Gestational Weight Gain and Prevent Gestational Diabetes: Scoping Review

“…Of the 39 RCTs, 18 (46%) had published results on GWG outcomes. Of these 18 RCTs, 8 (44%) were pilot RCTs [41,42,105,109,125,127,139,140], and 10 (56%) were efficacy or effectiveness RCTs [39,99,103,111,115,118,120,134,138,141]. Significant intervention effects on any GWG outcome were found in 7 (39%) of these 18 studies [39,103,115,118,120,127,134], whereas 11 (61%) observed no effect.…”

“…Finally, 67 (69%) reports from the database and trial register searches together with 15 (15%) eligible reports identified via internet search and 15 (15%) eligible reports identified by citation searching, amounting to a total of 97 reports from 43 studies, were included in this scoping review. Of the 97 included reports, 38 (39%) were TREs , 49 (50%) were full peer-reviewed articles [25,26,[38][39][40][41][42], 5 (5%) were conference abstracts [133][134][135][136][137], 2 (2%) were preprints [138,139], 1 (1%) was a master's thesis [140], 1 (1%) was a dissertation [141], and 1 (1%) was a grant report [142].…”

Using the Person-Based Approach to Develop a Digital Intervention Targeting Diet and Physical Activity in Pregnancy: Development Study

“…The decision to omit a weight monitoring feature and focus on healthy eating and PA rather than GWG-related messaging was based on the comments by participants, in particular those who had experienced difficulty with their weight, that weight messages were demotivating and a potential barrier to engagement. This approach contrasts with that of other existing digital interventions that aim to promote healthy eating and PA and prevent excessive GWG in pregnancy [ 25 , 44 , 45 ]. The extent to which weight monitoring contributes to the effectiveness of multifaceted digital interventions is unclear.…”