An eHealth-based intervention against metabolic risks during pregnancy: learnings and challenges

Background: Excessive gestational weight gain (eGWG) is one of the major metabolic risks for fetal macrosomia, maternal overweight, gestational diabetes mellitus (GDM), and gestational hypertension during pregnancy, which also increase the risk of postpartum weight retention. Gestational weight gain (GWG) management is rising to be attractive during prenatal care, however, there is still lack of effective tools to assist health care providers (HCPs) to efficiently and continuously implement intervention and monitor from the early phase of pregnancy. The current study tested a prototype eHealth solution aiming to assist clinicians to prevent eGWG and associated gestational metabolic complications. Methods A randomized controlled study was conducted in a private hospital in Beijing, China, with control group (N = 181) and intervention group (N = 181) recruited in rolling fashion. The control group received standard prenatal care, while the intervention group was additionally provided with the integrated prenatal care eHealth solution, Pregnancy Butler, which includes mobile application-enabled on-line service and off-line consultation session. The prevalence of eGWG, associated metabolic health parameters, and final pregnancy outcome were evaluated. Results Although mostly with normal pre-pregnancy BMI, the incidence for eGWG was high among the study subjects, at 35%. Engagement with the eHealth platform of the intervention group was stable after initial phase, but less than desired. Pregnancy Butler intervention showed significant benefit (p-value = 0.0496) in preventing eGWG among obese and overweight subjects. And highly engaged active users in the intervention group had more favorable GWG classification (p-value = 0.022). The time-course data collected indicated that the metabolic risks were largely set early in the first trimester already. Conclusions Our preliminary results indicated that the effectiveness of the eHealth intervention considerably depend on each participant’s engagement level and baseline risk factors. In order to achieve more consistent and impactful outcome improvement, focusing on those with pre-existing metabolic risks, increasing engagement and adherence level, and emphasizing intervention from the first trimester could be promising directions. Trial registration: This study was retrospectively registered as “Pregnancy Butler for gestational weight gain management” (ChiCTR1800014647) under the China Clinical Trial Registry in 2018-Jan-26. http://www.chictr.org.cn/showprojen.aspx?proj=24171