JMIR Publications

ABSTRACT

Background:

Diabetes during pregnancy poses serious health risks to both mother and child. Regular physical activity can reduce these risks, yet few clinic-based interventions of physical activity for pregnant women with diabetes have been attempted.

Objective:

The purpose of the current study was to assess the feasibility and acceptability and to explore the potential efficacy of a counseling- and mHealth-based physical activity intervention for pregnant women with diabetes delivered in a single-arm pilot trial.

Methods:

Participants (N=17) who had type 2 or gestational diabetes, could read and write in English or Spanish, and were between 10 and 27 weeks gestation were recruited from the UCSD Diabetes and Pregnancy Program. Immediately following a clinic visit with their physician, participants engaged in a one-on-one counseling and goal setting session. They were given a Fitbit and shown how to use the Fitbit app, including entering personalized step goals, and were encouraged to build up to 10,000 daily steps. Daily steps were recorded for 12 weeks, until they were 36 weeks gestation, or until one week before they gave birth, whichever came first. Feasibility was measured by recruitment, retention, and adherence, and acceptability was measured using consumer satisfaction questionnaires and follow-up interviews. Potential efficacy was explored by looking at change in daily steps over time.

Results:

Participants were primarily Hispanic (76%), had public insurance (88%), and had type 2 diabetes (71%). Of the 17 who began the intervention, 13 (76%) completed a follow-up visit and 12 (71%) continued wearing the Fitbit regularly after eight weeks in the intervention. Adherence in wearing the Fitbit was relatively high, with a median wear adherence of 90% of days. The intervention was generally well accepted, with 85% indicating they were motivated to exercise more following the counseling session, 85% indicating the Fitbit was helpful in increasing their activity, and 92% recommending the program overall. Mean daily steps increased from baseline (Mean(sd) = 6122 (2439)) to week 3 (Mean(sd) = 6269 (2166)), then decreased through week 12 (Mean(sd) = 4191 (2228)).

Conclusions:

High acceptability, retention, and adherence suggests this may be a promising approach to delivering a simple, low burden intervention in a clinical setting to a high risk, underserved population. A randomized trial is needed to determine if this approach is effective in slowing the reduction in activity typically seen throughout pregnancy. Clinical Trial: https://clinicaltrials.gov/ct2/show/NCT03302377