App-Supported Lifestyle Interventions in Pregnancy to Manage Gestational Weight Gain and Prevent Gestational Diabetes: Scoping Review

Abstract

Background Excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) are common pregnancy complications that have been shown to be preventable through the use of lifestyle interventions. However, a significant gap exists between research on pregnancy lifestyle interventions and translation into clinical practice. App-supported interventions might aid in overcoming previous implementation barriers. The current status in this emerging research area is unknown. Objective This scoping review aims to provide a comprehensive overview of planned, ongoing, and completed studies on eHealth and mobile health (mHealth) app–supported lifestyle interventions in pregnancy to manage GWG and prevent GDM. The review assesses the scope of the literature in the field; describes the population, intervention, control, outcomes, and study design (PICOS) characteristics of included studies as well as the findings on GWG and GDM outcomes; and examines app functionalities. Methods The scoping review was conducted according to a preregistered protocol and followed established frameworks. Four electronic databases and 2 clinical trial registers were systematically searched. All randomized and quasi-randomized controlled trials (RCTs) of app-supported lifestyle interventions in pregnancy and related qualitative and quantitative research across the different study phases were considered for inclusion. Eligible studies and reports of studies were included until June 2022. Extracted data were compiled in descriptive analyses and reported in narrative, tabular, and graphical formats. Results This review included 97 reports from 43 lifestyle intervention studies. The number of published reports has steadily increased in recent years; of the 97 included reports, 38 (39%) were trial register entries. Of the 39 identified RCTs, 10 efficacy or effectiveness trials and 8 pilot trials had published results on GWG (18/39, 46%); of these 18 trials, 7 (39%) trials observed significant intervention effects on GWG outcomes. Of all 39 RCTs, 5 (13%) efficacy or effectiveness trials reported GDM results, but none observed significant intervention effects on GDM. The RCTs included in the review were heterogeneous in terms of their PICOS characteristics. Most of the RCTs were conducted in high-income countries, included women with overweight or obesity and from all BMI categories, delivered multicomponent interventions, delivered interventions during pregnancy only, and focused on diet and physical activity. The apps used in the studies were mostly mHealth apps that included features for self-monitoring, feedback, goal setting, prompts, and educational content. Self-monitoring was often supported by wearable activity monitors and Bluetooth-connected weight scales. Conclusions Research in this field is nascent, and the effectiveness and implementability of app-supported interventions have yet to be determined. The complexity and heterogeneity of intervention approaches pose challenges in identifying the most beneficial app features and intervention components and call for consistent and comprehensive intervention and outcome reporting.

Internet-Based Interventions for Preventing Premature Birth Among Pregnant Women: Systematic Review

“…This contrasts with web-based interventions for nonpregnant adults, where longer durations are more common [ 59 ]. Given the evolving physical conditions during pregnancy, there is a growing need for long-term interventions that cover the entire pregnancy period, aligning with the emphasis on a holistic approach to pregnancy health care [ 60 ]. This approach encompasses not only the pregnancy period itself but also the early and prepregnancy stages as well as the postpartum period.…”

Remote lifestyle intervention to reduce postpartum weight retention: Protocol for a community-engaged hybrid type I effectiveness-implementation trial (Preprint)

“…We designed this hybrid type 1 effectiveness-implementation randomized controlled trial to test The iterative process of end-user interviews that informed the design, features and functionality of the H42 mHealth app was especially valuable for adapting and improving it, including methods for incorporating weight goals and progress (i.e., simple, colorful graph versus weight change statistics) and translating the interactive goal setting activity for Spanish-speaking participants. Comprehensive measures of adherence to coaching, the H42 mHealth app and the smart scale are a major strength of the study given the growing complexity of remote lifestyle intervention packages and the critical need to differentiate the effects of unique components [26]. Similarly, access to robust engagement metrics for distinct mHealth app features (i.e., interactive goal setting, coach messaging, access to weight data, comprehension quizzes, educational videos) may build upon patterns of website engagement characterized by Power et al [105] in a low-income Latina sample; of note in this study, website engagement was a strong predictor of weight retention at six months postpartum.…”

“…Based on strong evidence, counseling and lifestyle interventions during and after pregnancy are a recommended and well-established strategy for limiting GWG [24][25][26][27] and reducing PPWR [28][29][30][31] and their implementation is being tested in real-world settings. For example, our team is testing a remote health coaching intervention to limit GWG integrated into prenatal care clinics [32,33].…”

Women's perspectives on mHealth behavior change interventions for the management of overweight, obesity, or gestational diabetes: A qualitative meta‐synthesis

“…[22][23][24] However, the quality of pregnancy and postpartum mHealth applications and their usability appears to be variable. 25,26 The effectiveness and implementability of mHealth interventions in pregnancy and postpartum health behavior change has yet to be determined as this is a relatively new research area and the variability in intervention approaches creates issues for systematic review. 26 A recent scoping review identified 43 health behavior change app-based interventions to manage GWG and prevent type 2 diabetes after GDM.…”

“…25,26 The effectiveness and implementability of mHealth interventions in pregnancy and postpartum health behavior change has yet to be determined as this is a relatively new research area and the variability in intervention approaches creates issues for systematic review. 26 A recent scoping review identified 43 health behavior change app-based interventions to manage GWG and prevent type 2 diabetes after GDM. The authors noted the mHealth interventions were typically multicomponent and focused on diet and physical activity with self-monitoring commonly supported by wearables such as activity monitors or weighing scales with Bluetooth connectivity.…”