Abstract
BackgroundExcessive gestational weight gain (GWG) is common and contributes to the development of obesity in women and their offspring. Electronic or e-health interventions have the potential to reach large groups of women and prevent excessive GWG, but their effectiveness has not been demonstrated. The purpose of this study was to evaluate, in a real-world setting, the effectiveness of a self-directed, integrated online and mobile phone behavioral intervention in preventing excessive GWG.MethodsThis effectiveness trial was a double-blind, three-arm trial with a parallel group design. Two arms received the same e-health intervention during pregnancy with the third arm serving as the placebo control. The intervention was based on a previously efficacious non-digital intervention that was adapted to electronic format. It included three behavior change tools: a weight gain tracker, and separate diet and physical activity goal-setting and self-monitoring tools. Both treatment conditions received access to informational tools, event reminders, and a blogging feature. Healthy pregnant women age 18-35 years with body mass indexes (BMI) ≥18.5 and < 35, at ≤20 weeks gestation, and an e-mail address were eligible. The proportion of women with excessive total GWG, as defined by the Institute of Medicine (IOM), was the primary outcome. 1689 randomized women were analyzed in the intent-to-treat (ITT) analysis. The study was designed to have 87% power to detect a 10 percentage point reduction from a control rate of 55% with a sample of 1641 (p = 0.0167, two-sided).ResultsIn the ITT sample, 48.1% (SD = 2.0%) gained excessively in the intervention group as did 46.2% (SD = 2.4%) in the placebo control group. These proportions were not significantly different (RR 1.09; 95% CI 0.98, 1.20, p = 0.12). The results were not altered in several sensitivity analyses.ConclusionThe addition of three behavior change tools to an informational placebo control did not result in a difference in the proportion of women with excessive total GWG compared to the placebo control in this effectiveness trial of an online, self-directed intervention. The similarity of intervention and control treatments and low usage of the behavior change tools in the intervention group are possible explanations.Trial registrationNCT01331564, ClinicalTrials.gov.
Highlights
Excessive gestational weight gain (GWG) is common and contributes to the development of obesity in women and their offspring
This paper reports on the pregnancy portion of a longer study that followed women until 12 months postpartum in order to evaluate the effectiveness of pregnancy intervention and combined pregnancy and postpartum intervention on weight retention at 12 months postpartum
Five relatively small pilot or feasibility efficacy trials in the literature used mobile and web-based communication technologies to address excessive GWG [22,23,24,25,26]. Among those with positive results, engagement with behavior change interventions was higher than for this study, ranging from 61 to 86%. These findings suggest that the low prevalence of adherence in the intervention arm may have contributed to the null findings of this effectiveness trial with its self-directed, online intervention
Summary
Excessive gestational weight gain (GWG) is common and contributes to the development of obesity in women and their offspring. Electronic or e-health interventions have the potential to reach large groups of women and prevent excessive GWG, but their effectiveness has not been demonstrated. In the US in 2015, about 39% of normal weight, 61% of overweight, and 55% of obese women, gained more than the recommended amount of weight during pregnancy [5]. Electronic communication technologies have the potential to reach large numbers of women during pregnancy with behavioral interventions to prevent excessive weight gain. There is a growing body of evidence that electronic communication interventions, often called e- and m-health interventions, are efficacious in several different domains of health behavior change including weight loss and weight gain prevention among non-pregnant individuals [10, 11]
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