Intervention
Weight-related SMS texts promoting appropriate pregnancy weight gain: A pilot study

https://doi.org/10.1016/j.pec.2014.07.030Get rights and content

Highlights

  • Gestational weight gain has an impact on maternal and fetal health.

  • Few effective and disseminable interventions have been successful at promoting healthful gestational weight gain.

  • SMS texting might be an innovative way to promote healthful gestational weight gain.

Abstract

Objectives

Excessive gestational weight gain (GWG) puts women and children at risk of obesity. We piloted an SMS-texting intervention to promote healthy GWG among overweight and obese women.

Methods

We recruited 35 women and randomized them in a 2:1 fashion to: a tailored SMS-texting intervention (Preg CHAT) vs. a generic texting intervention (Txt4baby). Preg CHAT texts provided personalized feedback based on women's intake of sweetened beverages, fruits and vegetables, fast food, daily steps taken, and weight. We abstracted women's weights from charts and surveyed women at baseline and 32 weeks gestation.

Results

Few women refused the study; many (30%) did not complete the study, however. Of those in the Preg CHAT arm, 86% responded to texts, and 80% said they would recommend this program to a friend. For women who completed the surveys (n = 23), those in the Preg CHAT arm had a mean gain of 6 less pounds than women in the Txt4Baby arm (95% CI −15.9, 4.0; p = 0.24).

Conclusions

This pilot study shows feasibility, acceptability, and potential efficacy of a low-intensity and disseminable intervention to help overweight and obese women reduce GWG.

Practice implications

An SMS texting program might help overweight women reduce excessive GWG.

Introduction

Excessive weight gain during pregnancy is a significant public health problem with as many as 57% of pregnant women gaining more weight than recommended by the Institute of Medicine [1], [2]. Excessive gestational weight gain (GWG) puts both mother and baby at risk for obesity and subsequent obesity related chronic disease [1], [3], [4], [5], [6]. Interventions targeting GWG have only been somewhat successful, and more so for select groups [7]. For example, normal weight, higher income women, and those receiving exercise and/or nutritional counseling respond better to the interventions and are less likely to exceed GWG recommendations during pregnancy than overweight, lower income women, and those receiving no advice [8], [9], [10], [11]. Interventions are needed to help these women, particularly those who are overweight or obese as they are at highest risk of complications.

Further, past interventions even those that are effective are not easily disseminable. Most interventions rely on face-to-face or telephone counseling or group sessions [7]. An innovative method for promoting healthy GWG that has not been tested among pregnant women is using Short Message Service (SMS) as a platform. Mobile phone use appears to be similar across all socioeconomic groups [12], [13]. In fact, some socially disadvantaged populations are more likely to text daily than their more advantaged counterparts [14]. Thus, using an SMS intervention could have strong and low-cost impact and help hard-to-reach women if found effective. Although SMS interventions have been tested and found effective for weight management interventions among non-pregnant populations [15], [16], [17], [18], [19], none has attempted to promote healthy GWG via SMS texting.

The purpose of this pilot study was to assess the feasibility, acceptability, and preliminary efficacy of a SMS based intervention to help pregnant overweight and obese women gain an appropriate amount of weight.

Section snippets

Design

In 2012, we recruited participants from two prenatal clinics. We randomized eligible women in a 2:1 fashion to either a tailored SMS intervention arm (Preg CHAT text) or a generic texting intervention arm (Text4baby). The study was approved by our University's Institutional Review Board.

Participant recruitment

Study staff reviewed electronic obstetric medical records weekly to identify potentially eligible women scheduled for a prenatal visit. Clinic staff approached such women and asked whether they would be willing

Results

See Table 1 for demographic characteristics of the participants. In terms of feasibility, we were able to recruit 35 women in 3 months from only two prenatal clinics. The initial refusal rate among women was low (11%). Of the 35 women, 23 were randomized to the Preg CHAT text arm and 12 to the Txt4Baby arm. Two women miscarried at 17 and 18 weeks of gestation and were excluded from all analyses (one in each arm). Furthermore, 10 women withdrew from the study; however, their abstracted weight

Discussion

This was the first SMS-based study to attempt to change gestational weight gain among overweight and obese women. Similar to trials in non-pregnant populations [15], [16], [17], [19], we found significant and positive effects for women who were prompted to report their weight-related goals several times a week. What differentiates our work from all others is that pregnant women in this trial were expected to gain weight, just not gain excessive weight, whereas all other trials were attempting

Conflicts of interest

The authors have no conflicts of interest to disclose.

Acknowledgements

This project was funded by internal funds. Data was collected from February through October 2012 and analyzed in June 2013.

References (24)

  • S. Phelan et al.

    Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the fit for delivery study

    Am J Clin Nutr

    (2011)
  • C.M. Olson et al.

    Efficacy of an intervention to prevent excessive gestational weight gain

    Am J Obstet Gynecol

    (2004)
  • K.K. Vesco et al.

    Newborn size among obese women with weight gain outside the 2009 Institute of Medicine recommendation

    Obstet Gynecol

    (2011)
  • T.A. Simas et al.

    Impact of updated Institute of Medicine guidelines on prepregnancy body mass index categorization, gestational weight gain recommendations, and needed counseling

    J Womens Health (Larchmt)

    (2011)
  • A. Must et al.

    The disease burden associated with overweight and obesity

    J Am Med Assoc

    (1999)
  • P.A. van den Brandt et al.

    Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk

    Am J Epidemiol

    (2000)
  • E.E. Calle et al.

    Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults

    N Engl J Med

    (2003)
  • J. Josefson

    Excessive pregnancy weight gain raises the risk of having a fat baby

  • B. Muktabhant et al.

    Interventions for preventing excessive weight gain during pregnancy

    Cochrane Database Syst Rev

    (2012)
  • B.A. Polley et al.

    Randomized controlled trial to prevent excessive weight gain in pregnant women

    Int J Obes Relat Metab Disord

    (2002)
  • S.M. Asbee et al.

    Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling: a randomized controlled trial

    Obstet Gynecol

    (2009)
  • L.K. Koivusilta et al.

    Orientations in adolescent use of information and communication technology: a digital divide by sociodemographic background, educational career, and health

    Scand J Public Health

    (2007)
  • Cited by (0)

    View full text