Effectiveness of SmartMoms, a Novel eHealth Intervention for Management of Gestational Weight Gain: Randomized Controlled Pilot Trial

Abstract

Background: Two-thirds of pregnant women exceed gestational weight gain (GWG) recommendations. Because excess GWG is associated with adverse outcomes for mother and child, development of scalable and cost-effective approaches to deliver intensive lifestyle programs during pregnancy is urgent.

Objective: The aim of this study was to decrease the proportion of women who exceed the Institute of Medicine (IOM) 2009 GWG guidelines.

Methods: In a parallel-arm randomized controlled trial, 54 pregnant women (age 18-40 years) who were overweight (n=25) or obese (n=29) were enrolled to test whether an intensive lifestyle intervention (called SmartMoms) decreased the proportion of women with excess GWG, defined as exceeding the 2009 IOM guidelines, compared to no intervention (usual care group). The SmartMoms intervention was delivered through mobile phone (remote group) or in a traditional in-person, clinic-based setting (in-person group), and included a personalized dietary intake prescription, self-monitoring weight against a personalized weight graph, activity tracking with a pedometer, receipt of health information, and continuous personalized feedback from counselors.

Results: A significantly smaller proportion of women exceeded the IOM 2009 GWG guidelines in the SmartMoms intervention groups (in-person: 56%, 10/18; remote: 58%, 11/19) compared to usual care (85%, 11/13; P=.02). The remote intervention was a lower cost to participants (mean US $97, SD $6 vs mean US $347, SD $40 per participant; P<.001) and clinics (US $215 vs US $419 per participant) and with increased intervention adherence (76.5% vs 60.8%; P=.049).

Conclusions: An intensive lifestyle intervention for GWG can be effectively delivered via a mobile phone, which is both cost-effective and scalable.

Trial registration: Clinicaltrials.gov NCT01610752; https://ichgcp.net/clinical-trials-registry/NCT01610752 (Archived by WebCite at http://www.webcitation.org/6sarNB4iW).

Keywords: gestational weight gain; intervention; lifestyle modification; pregnancy.

Conflict of interest statement

Conflicts of Interest: Drs Redman, Martin, and Thomas developed the trademarked approach of SmartMoms (a registered trademark of the Louisiana State University System). There are no direct benefits to these authors for publication of this manuscript and they have no financial affiliations with the companies who conducted the work to develop the SmartMoms Virtual Weight Management Suite, although they could financially benefit from any licensing of SmartMoms along with LSU-Pennington Biomedical Research Center and Montclair State University. All other authors have no conflicts of interest to declare.

©Leanne M Redman, L. Anne Gilmore, Jeffrey Breaux, Diana M Thomas, Karen Elkind-Hirsch, Tiffany Stewart, Daniel S Hsia, Jeffrey Burton, John W Apolzan, Loren E Cain, Abby D Altazan, Shelly Ragusa, Heather Brady, Allison Davis, J. Mick Tilford, Elizabeth F Sutton, Corby K Martin. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 13.09.2017.

Figures

Figure 1

Mean gestational weight gain (kg) for women in the usual care, remote, and in-person groups. The whiskers represent standard error.

Figure 2

Proportion of women in the usual care, remote, and in-person groups who had appropriate and excess gestational weight gain (GWG) based on the IOM 2009 guidelines. *The SmartMoms intervention (in-person and remote groups combined) was effective at reducing GWG.

Figure 3

Intervention adherence for the remote and in-person groups. The whiskers represent standard error.

Figure 4

Mean intervention cost (US $) for participants and clinics for the remote and in-person groups. The whiskers represent standard error. The intervention cost incurred by the clinic was fixed.