Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Nov 27, 2020
Date Accepted: Feb 4, 2021
Effectiveness of a Smartphone App to Promote Healthy Weight Gain, Diet and Physical Activity During Pregnancy (HealthyMoms): Randomized controlled trial
ABSTRACT
Background:
Excessive gestational weight gain (GWG) during pregnancy is a major public health concern associated with negative health outcomes for mother and child. Scalable interventions are needed, and digital interventions have the potential to reach many women and promote healthy GWG. Most previous studies of digital interventions have been small pilot studies and/or have not included women from all BMI-categories. We therefore examined the effectiveness of a smartphone application (app) in a large sample (n=305) covering all BMI-categories.
Objective:
To investigate the effectiveness of a 6-month intervention (the HealthyMoms app) on GWG, body fatness, dietary habits, moderate-to-vigorous physical activity (MVPA), glycemia and insulin resistance in comparison to standard maternity care.
Methods:
A 2-arm parallel randomized controlled trial was conducted. Women in early pregnancy at maternity clinics in Östergötland, Sweden were recruited. Eligible women who provided written informed consent completed baseline measures, before being randomized in a 1:1 ratio to either intervention (n=152) or control group (n=153). The control group received standard maternity care while the intervention group also received the HealthyMoms smartphone app for 6 months (which includes multiple features e.g. information, push notifications, self-monitoring, and feedback features for GWG, diet and physical activity). Outcome measures were assessed at Linköping University Hospital at baseline (mean 13.9 [SD 0.7] gestational weeks) and follow-up (mean 36.4 [SD 0.4] gestational weeks). Primary outcome was GWG and secondary outcomes were body fatness (Bod Pod), dietary habits (Swedish Healthy Eating Index) using the web-based 3-day dietary record Riksmaten FLEX, MVPA using the ActiGraph wGT3x-BT accelerometer, glycemia and insulin resistance.
Results:
Overall, we found no statistically significant effect on GWG; however, the data indicate that the effect of the intervention differed by pre-pregnancy BMI, as women with overweight and obesity before pregnancy gained less weight in the intervention group as compared to the control group in the imputed analyses (-1.33 kg [95% CI -2.92; 0.26, P=.10]) and completers only analyses (-1.67 kg [95% CI -3.26; -0.09, P=.031]). Bayesian analyses showed that there was a 99% probability of any intervention effect on GWG among women with overweight and obesity, and an 81% probability that this effect was > 1 kg. The intervention group had higher scores for the Swedish Healthy Eating Index at follow-up than the control group (0.27 [95% CI, 0.05 to 0.50], P=.017). We observed no statistically significant differences in body fatness, MVPA, glycemia and insulin resistance between the intervention and control group at follow-up.
Conclusions:
The results of this trial demonstrate the potential of a smartphone app (HealthyMoms) to promote healthy dietary behaviors and weight gain in pregnancy, especially in women with overweight and obesity Clinical Trial: clinicaltrials.gov; NCT03298555
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