A pragmatic, scalable e-health intervention for management of gestational weight gain in low-income mothers

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Project Summary Pregnancy is critical nutritional time point that influences the immediate and long-term health of both the mother and child. While the health and nutritional status of women (eg. obesity, smoking etc.) prior to pregnancy is arguably the most important for long-term health outcomes, the nutritional status of women during pregnancy including gestational weight gain, influences birth outcomes, health, and long-term risk for chronic disease. More than one in eight women in the U.S. lived in poverty in 2015 and women with low incomes are the most vulnerable to poor nutrition, maternal obesity, excess weight gain in pregnancy and poor birth outcomes. Lifestyle interventions during pregnancy positioned to reduce excess gestational weight gain may reduce risk factors for chronic disease in women and obesity in children. To impact the health of the most vulnerable pregnant women, infants and children in the U.S., there is a critical need for scalable and effective healthcare services targeting under-served, minority women through community-based programs. The USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) – a National program – is highly suited to deliver scalable and effective lifestyle interventions in low income and nutritionally at risk pregnant women. However, there is a dearth of clinical trials testing efficacious, well-designed, culturally relevant and appropriately powered interventions aimed to promote healthy weight gain in pregnant women with low incomes. In response to the National Institutes of Health funding opportunity (PA-18-135); Maternal nutrition and pre-pregnancy obesity: effects on mothers, infants and children, the overarching goal of this research is to develop and test the effectiveness of SmartMoms® a patient-centered, pragmatic and scalable weight management program previously shown to foster healthy gestational weight gain and to increase the proportion of pregnant women who achieve appropriate gestational weight gain. This research will be conducted in two phases; Acculturation of SmartMoms (Aim 1), and a state-wide, randomized controlled trial in 432 pregnant women enrolled in the Louisiana Women’s, Infants and Children (WIC) program (Aim 2). The primary hypothesis is that compared to WIC participants receiving usual care, participants receiving SmartMoms a smartphone based, high-intensity, health literacy-appropriate and culturally adapted lifestyle intervention promoting healthy gestational weight gain will have greater adherence to the 2009 IOM gestational weight gain guidelines and significant improvements in physiological and behavioral factors.