InterventionWeight-related SMS texts promoting appropriate pregnancy weight gain: A pilot study
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)
- et al.
Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the fit for delivery study
Am J Clin Nutr
(2011) - et al.
Efficacy of an intervention to prevent excessive gestational weight gain
Am J Obstet Gynecol
(2004) - et al.
Newborn size among obese women with weight gain outside the 2009 Institute of Medicine recommendation
Obstet Gynecol
(2011) - 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) - et al.
The disease burden associated with overweight and obesity
J Am Med Assoc
(1999) - et al.
Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk
Am J Epidemiol
(2000) - et al.
Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults
N Engl J Med
(2003) Excessive pregnancy weight gain raises the risk of having a fat baby
- et al.
Interventions for preventing excessive weight gain during pregnancy
Cochrane Database Syst Rev
(2012) - et al.
Randomized controlled trial to prevent excessive weight gain in pregnant women
Int J Obes Relat Metab Disord
(2002)