JMIR Publications

ABSTRACT

Background:

Excessive gestational weight gain is common and can result in maternal and child health complications. Pragmatic behavioral interventions that can be incorporated in standard obstetric care are needed, and financial incentives are a promising approach.

Objective:

This study evaluates the feasibility of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction in a behavioral program that provides small incentives for meeting goals of self-weighing and physical activity (i.e., behaviors) as well as larger incentives for meeting monthly or overall GWG goals.

Methods:

We recruited 40 adult women in their first trimester of pregnancy from February 2019 until September 2019 at an obstetric clinic. Participants were randomized to three intervention components using a 2 x 2 x 2 factorial design: 1) daily incentives for self-weighing (lottery/certain loss); 2) incentives for adhering to the Institute of Medicine’s gestational weight gain guidelines based on BMI category (monthly/overall); and 3) incentives for reaching physical activity goals (yes/no). Participants were asked to complete daily weigh-ins using the Withings Body™ wireless scale provided by the study, as well as wear a physical activity tracker (i.e., Fitbit Flex 2TM). Feasibility outcomes of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction were assessed. Weight assessments were conducted at baseline, 32-week gestation and 36-week gestation.

Results:

Participants were enrolled at, on average, 9.6 (1.8) weeks gestation; they were 61.5% Black or African American, 76.9% not married, and 74.4% with an annual household income of less than $50,000. Among the 39 participants who were oriented to their condition and received the intervention, 35 participants completed the follow-up data collection visit. Participants were generally quite positive about the intervention components, with a particular emphasis on the helpfulness and enjoyment of the e-scale in both the quantitative and qualitative feedback. Participants who received the loss incentive, on average, had 2.86 times as many days of self-weighing as those who received the lottery incentive. Participants had a relatively low level of activity, with no difference between those who received a physical activity incentive and those who did not.

Conclusions:

A financial incentive-based pragmatic intervention was feasible and acceptable for pregnant women for promoting self-weighing, physical activity, and healthy gestational weight gain. Participants were successfully recruited early in their first trimester of pregnancy and retained for follow-up data collection in the third trimester. Participants demonstrated promising engagement in self-weighing, particularly with loss-based incentives, and reported finding the self-weighing especially helpful. This study supports further investigation of pragmatic, clinic-based financial incentive-based interventions for healthy gestational weight gain. Clinical Trial: The study is registered with ClinicalTrials.gov (NCT03834194).