Accepted for/Published in: JMIR Mental Health
Date Submitted: Mar 18, 2025
Date Accepted: Oct 2, 2025
The effect of a pragmatic eHealth behavioral gestational weight gain intervention on household chaos in pregnant people of lower socioeconomic status: a randomized controlled trial
ABSTRACT
Background:
Household chaos is an established risk factor for childhood obesity development, especially in families with lower socioeconomic status (SES). It is unclear if high household chaos emerges in pregnancy, and if household chaos impacts the effectiveness of weight-related behavioral interventions.
Objective:
This study aimed to describe how household chaos changed across gestation and determine whether household chaos mediated the effect of an eHealth behavioral gestational weight gain (GWG) intervention in pregnant people with low SES.
Methods:
Pregnant people who were enrolled in the U.S. Special Supplemental Nutrition program for Women, Infant, and Children (WIC) were recruited for a randomized controlled trial testing the effectiveness of an eHealth-based pragmatic intervention for GWG management. Usual Care Group participants received the standard WIC program guidance and monthly health coach support with general pregnancy recommendations. Intervention Group participants received the standard WIC program plus health information via email and weekly health coach discussions to promote healthy eating and adequate physical activity. Weight and household chaos were measured at baseline (early pregnancy, 10,0 to 16,6 weeks gestation) and end of intervention (late pregnancy, 35,0 to 37,6 weeks gestation). Household chaos changes were examined using a paired t-test and McNemar tests. Serial linear regression models and mediation analyses assessed the relationship between the Intervention Group (predictor), household chaos change (mediator), and GWG (outcome) with adjustment for covariates.
Results:
Among 258 participants (57% Black, 43% nulliparous, and 39% having obesity), almost half (48.0%) were classified as low household chaos at baseline, and there were minimal changes across gestation. Household chaos changes were divided; some improved or had no change (n=140, 54.2%), and some declined (n=118, 45.8%) across gestation. Household chaos did not mediate the effect of the intervention on GWG.
Conclusions:
In this sample, household chaos did not meaningfully change across gestation and did not negatively or positively impact the effect of an eHealth behavioral GWG intervention in pregnant people with lower SES. Clinical Trial: Clinical Trials.gov NCT04028843
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