A continuous behavioral lifestyle intervention supported by a smartphone app can assist in improving dietary intake and physical activity among pregnant women with overweight and obesity, according to study results published in Frontiers in Endocrinology.
Previous studies have reported that approximately 20% of all women meet the recommendations for physical activity during pregnancy, and despite positive results, many potential behavioral lifestyle interventions aimed at this population would be too expensive or burdensome to incorporate into routine practice. Mobile-health technologies, including smartphone apps, may assist in these efforts, but limited data are available.
The goal of the current study was to assess the impact of the Pregnancy Exercise and Nutrition Research Study (PEARS) behavioral lifestyle intervention, supported by a smartphone app, on diet, physical activity, and motivation to engage in exercise among pregnant women with overweight or obesity.
The study included 565 women (aged 18-45 years) recruited at their first antenatal visit between 2013 and 2016, with pregnancies at 10 to 18 weeks’ gestation (mean, 15.6 weeks’ gestation) and body mass index ≥25 kg/m2 and ≤39.9 kg/m2. The women were randomly assigned to an intervention group (278 women), which included nutritional and exercise advice, support through a smartphone app, and fortnightly emails, or to a control group (287 women), which included usual care with no dietary advice. At the baseline and 28 weeks’ gestation study visits, women were instructed to complete lifestyle questionnaires and record food and beverage intake in 3-day food diaries.
At baseline, there were no differences between intervention and control groups for mean daily glycemic index and glycemic load intakes. However, at 28 weeks’ gestation, dietary glycemic index (mean difference, -1.75; 95% CI, -2.81 to -0.71; P =.001) and glycemic load (mean difference, -14.84; 95% CI, -22.27 to -7.41; P <.001) were significantly lower in the intervention group compared with the control group.
Furthermore, mean daily energy, carbohydrates, sugars, free sugars, fat, saturated fat, sodium, and calcium intake were significantly lower in the intervention group compared with the control group, whereas protein intake was significantly higher.
Compared with usual care, self-reported physical activity measurements also increased after the intervention, including moderate activity (78.1±69.5 vs 50.1±60.1 minutes per week; P =.001) and metabolic equivalent task (MET)-minutes per week (609.8±448.6 vs 463.9±324.2; P <.001).
Of the 278 women in the intervention group, 197 used the app on ≥2 days, whereas 76 never used the app and 5 used it only on the day it was downloaded. At the 28 weeks’ gestation follow-up, mean glycemic index and percentage of energy from free sugars were significantly lower among app users vs nonusers, but there were no differences in physical activity levels. There was also a positive association between higher app use and fiber intake at 28 weeks’ gestation but not with other outcomes.
The researchers acknowledged several study limitations, including the use of self-reported data and the risk for social desirability bias, such that reported behaviors may have been altered to reflect what was expected from the participants during the intervention.
“[T]he findings of this study are of clinical significance as similar approaches could be implemented within antenatal care as a routine service,” concluded the researchers.
Ainscough KM, O’Brien EC, Lindsay KL, et al. Nutrition, behavior change and physical activity outcomes from the PEARS RCT – an mHealth-supported, lifestyle intervention among pregnant women with overweight and obesity. Front Endocrinol (Lausanne). 2020;10:938.