Understanding Pregnancy and Postpartum Health Using Ecological Momentary Assessment and Mobile Technology: Protocol for the Postpartum Mothers Mobile Study

Abstract

Background There are significant racial disparities in pregnancy and postpartum health outcomes, including postpartum weight retention and cardiometabolic risk. These racial disparities are a result of a complex interplay between contextual, environmental, behavioral, and psychosocial factors. Objective This protocol provides a description of the development and infrastructure for the Postpartum Mothers Mobile Study (PMOMS), designed to better capture women’s daily experiences and exposures from late pregnancy through 1 year postpartum. The primary aims of PMOMS are to understand the contextual, psychosocial, and behavioral factors contributing to racial disparities in postpartum weight and cardiometabolic health, with a focus on the daily experiences of stress and racism, as well as contextual forms of stress (eg, neighborhood stress and structural racism). Methods PMOMS is a longitudinal observation study that is ancillary to an existing randomized control trial, GDM 2 (Comparison of Two Screening Strategies for Gestational Diabetes). PMOMS uses an efficient and cost-effective approach for recruitment by leveraging the infrastructure of GDM 2 , facilitating enrollment of participants while consolidating staff support from both studies. The primary data collection method is ecological momentary assessment (EMA) and through smart technology (ie, smartphones and scales). The development of the study includes: (1) the pilot phase and development of the smartphone app; (2) feedback and further development of the app including selection of key measures; and (3) implementation, recruitment, and retention. Results PMOMS aims to recruit 350 participants during pregnancy, to be followed through the first year after delivery. Recruitment and data collection started in December 2017 and are expected to continue through September 2020. Initial results are expected in December 2020. As of early May 2019, PMOMS recruited a total of 305 participants. Key strengths and features of PMOMS have included data collection via smartphone technology to reduce the burden of multiple on-site visits, low attrition rate because of participation in an ongoing trial in which women are already motivated and enrolled, high EMA survey completion and the use of EMA as a unique data collection method to understand daily experiences, and shorter than expected timeframe for enrollment because of the infrastructure of the GDM 2 trial. Conclusions This protocol outlines the development of the PMOMS, one of the first published studies to use an ongoing EMA and mobile technology protocol during pregnancy and throughout 1 year postpartum to understand the health of childbearing populations and enduring racial disparities in postpartum weight and cardiometabolic health. Our findings will contribute to the improvement of data collection methods,...

Ecological momentary assessment of stress, racism and other forms of discrimination during pregnancy using smartphone technology

“…32,37 These studies used other devices for EMA data collection, and the main PMOMS study extends this body of work via continuous data collection throughout pregnancy and the postpartum period using smartphone technology. 9 Not only are these mobile devices already being used by "the population of focus in our study," smartphones are also equipped Respondents who said "Yes" to ever experiencing microaggressions The number of people who said "yes" to ever experiencing a microaggression. Out of the people who ever experienced some form of microaggression, the percentage of the sample who experienced each specific microaggression.…”

“…The PMOMS study is an innovative, ongoing longitudinal cohort study designed to understand the factors related to racial disparities in postpartum weight and cardio-metabolic health. 9 The study includes pregnant populations recruited during mid-pregnancy and followed through the first year postpartum. Participants complete daily surveys via smartphones, weigh themselves via Bluetooth enabled scales, and…”

“…Postpartum Mothers Mobile Study participants use a smartphone to complete non-EMA and daily EMA surveys via a web-based application. 9 EMA data are collected at the beginning of day (BOD), Table S1 includes details about each measure. It is important to emphasise that the following measures are all self-reported, and thus, subject to the participants' ability and willingness to appraise the experience.…”

“…This limitation is addressed due to the sampling strategy for EMA prompts over the pregnancy and postpartum period. 9 Another limitation is the calculation of rate for race and gender discrimination based on the frequency of events in a given day. The upper limit is four, although a participant indicating four or more times in a day may have experienced it well beyond that, and so rates may be under-estimated.…”

“…Black birthing people with similar pre-pregnancy weights or weight gain during pregnancy are 2-3 times more likely to retain or gain more weight after pregnancy compared with their White counterparts 6,7 and are twice as likely to retain more than 10 pounds 1 year postpartum 8 ; these health outcomes are the focus for the Postpartum Mothers Mobile Study (PMOMS; described further below). 9 Many prior studies that have focused on factors at the individual level, such as behavioural or life style factors, have not explained the racial disparities in these outcomes. 1,[10][11][12] Current interest among researchers has produced an emerging body of work that specifically investigates the contextual, institutional, and structural factors 11,[13][14][15] contributing to the racial disparities in perinatal health.…”