1181-OR: Virtual Behavioral Intervention in Prenatal Care to Limit Gestational Weight Gain and Prevent Gestational Diabetes: A Pragmatic Trial

by sugaradmin



Introduction and Objective: Excess gestational weight gain (GWG) is common and increases risk for gestational diabetes (GDM), obesity, diabetes. We assessed whether Healthy for Two, a virtual behavioral intervention in prenatal care clinics, vs. usual prenatal care, reduces GWG and GDM among women with pre-pregnancy overweight/obesity using a pragmatic randomized controlled trial design.Methods: Eligibility was <=15 weeks gestation and overweight/obesity. Patients were recruited from 9 academic and community-based obstetrics practices and randomized 1:1 to Healthy for Two or usual prenatal care. The intervention included 9 health coaching calls, mHealth education and self-monitoring of weight. The primary outcome was total GWG and the secondary outcomes were GDM incidence, infant low birth weight, health behaviors and wellness. Analysis used a modified intention to treat approach.Results: 187 were randomized to Healthy for Two and 190 to usual prenatal care. Both arms had similar total mean GWG (22.2 lbs in usual care and 22.4 lbs in Healthy for Two) without a statistically significant between arm difference (0.15 lbs, p=0.94). The rates of GDM were not statistically significantly different between arms (11.7% in usual care and 14.4% in Healthy for Two). We detected statistically significant improvements in dietary quality (higher fruits, vegetables), exercise, depression, perceived stress and sleep between Healthy for Two and usual care, at some time points.Conclusion: Both the virtual behavioral intervention and usual prenatal care achieved a mean GWG similar to efficacy trials (~22 lbs) without a between arm difference in GWG or GDM. The virtual behavioral intervention achieved improvements in diet, exercise and wellness (mood, sleep and stress). Further studies are needed to examine how to target effective weight management programs in pregnancy to lower resource settings and for women who need structured support beyond counseling and referrals by providers.

Disclosure

W.L. Bennett: None.

Funding

NIH-NIDDK (R18DK122416)



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