Objectives

To expand the understanding of how to slow the accumulation of weight in childbearing women by developing, implementing, and evaluating electronically mediated patient intervention programs for pregnant and postpartum women.

Background

Although weight gain is expected as part of the normal course of pregnancy, a significant portion of women gain more weight than recommended by the Institute of Medicine. Excessive gestational weight gain is associated with maternal and offspring morbidity, including postpartum weight retention and childhood obesity. In addition, women of lower socioeconomic status and/or ethnic minorities may have increased incidence of excessive weight gain and retention. Furthermore, the postpartum period poses unique challenges to weight loss, such as limited time or financial resources, or postpartum depression.

Previous trials have suggested that the incidence of excessive gestational weight gain or postpartum weight retention may be reduced through interventions such as education regarding physical activity and diet and/or weight tracking. The majority of women, including those of low income, have access to the internet, which may serve as an effective method to implement such behavioral interventions. The e-Moms trial sought to expand on existing research through innovative intervention approaches that incorporated digital technologies among a socio-economically and racially/ethnically diverse cohort of young adults, in order to slow the accumulation of weight during pregnancy and the postpartum period.

Participants

Pregnant women ages 18-35, at 20 weeks gestation or earlier, were eligible to participate. The study took place in Rochester, NY with participants planning to deliver at four of the city’s hospitals. Exclusion criteria included BMI < 18.5 kg/m2 or ≥ 35.0 kg/m2 at the time of enrollment, prior medical conditions that could influence weight loss or gain, multiple gestation, weight loss surgery, participation in a commercial weight loss program, or presence of an eating disorder. Participants were recruited from obstetric and family private practices and clinics, as well as through community outreach. 563 women were enrolled in each of the three treatment arms.

Design

Eligible participants were divided into four strata defined by early pregnancy BMI and income, and then randomized to one of the three behavioral treatment arms: electronic intervention during pregnancy and postpartum, electronic intervention during pregnancy only, and a control group. Participants were given access to web content corresponding to their treatment arm. The electronic intervention utilized evidence-based behavior change strategies, developed from Fishbein and Yzer’s Integrative Model of Behavioral Prediction and Fogg’s Behavior Model for Persuasive Design.

During pregnancy, the electronic intervention featured resources for tracking weight, physical activity and diet goal setting, increasing caloric intake by the recommended amount, improving or maintaining a nutritious diet, and regularly engaging in moderate to vigorous physical activity. The postpartum resources were adapted to encourage safe weight loss according to participant’s weight and breast feeding goals. Safety alerts were sent if there were indications of inadequate weight gain during pregnancy, rapid postpartum weight loss, or depression. Website content for the control arm included information on having a healthy pregnancy unrelated to weight management, without providing behavior change strategies, self-monitoring tools, or logistical tips. This information was also available to the intervention participants. Data were obtained from online surveys, medical chart reviews, and in-person postpartum weight measurements at 6, 12 and 18 months postpartum.

The primary outcome was the proportion of women whose gestational gain was above recommendations from the Institute of Medicine guidelines. Early pregnancy weight from the first prenatal visit served as the baseline comparison.

Conclusions

The behavior change tools in the electronic intervention did not result in a significant difference in the proportion of women with excessive total GWG, as compared to the informational only control group.

Fernandez ID, Groth SW, Reschke JE, Graham ML, Strawderman M, Olson CM. eMoms: Electronically-Mediated Weight Interventions for Pregnant and Postpartum Women. Study Design and Baseline Characteristics. Contemporary clinical trials. 2015;43:63-74. doi:10.1016/j.cct.2015.04.013.

Olson CM, Groth SW, Graham ML, Reschke JE, Strawderman MS, Fernandez ID. The effectiveness of an online intervention in preventing excessive gestational weight gain: the e-moms roc randomized controlled trial. BMC Pregnancy and Childbirth. 2018;18(1):148. doi:10.1186/s12884-018-1767-4.

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