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|Nutrition, behavior change and physical activity outcomes from the PEARS RCT-An mHealth-supported, lifestyle intervention among pregnant women with overweight and obesity|
|Ainscough KM, O'Brien EC, Lindsay KL, Kennelly MA, O'Sullivan EJ, O'Brien OA, McCarthy M, de Vito G, McAuliffe FM|
|Frontiers in Endocrinology 2020 Feb 4;10(938):Epub|
|6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*|
BACKGROUND: Diet quality and physical activity positively impact pregnancy outcomes among women with obesity, but successful lifestyle interventions require intense clinician time. We aimed to investigate the impact of a behavioral-lifestyle intervention (PEARS) supported by a smartphone app among pregnant women with overweight and obesity, on nutrient intake, behavioral stage-of-change and physical activity. METHOD(S): Pregnant women (BMI 25 to 39.9 kg/m2, measured, n = 565) were randomized at 15.6 weeks' gestation to the intervention (n = 278), or a control group (n = 287) (ISRCTN29316280). The intervention was grounded in behavior-change theory. Participants received nutrition (low glycaemic index and healthy eating) and exercise advice, a smartphone app and fortnightly emails. The control group received usual care which does not include dietary advice. At baseline and 28 weeks' gestation, dietary data were obtained through 3-day food diaries (n = 290 matched), and stage-of-change and physical activity data were self-reported. App usage data were collected. RESULT(S): There were no differences between the groups at baseline. Compared with the control group, the intervention group had improved dietary intakes post-intervention with; lower glycaemic index (MD -1.75); free sugars (%TE) (MD -0.98); fat (%TE) (MD -1.80); and sodium (mg) (MD -183.49). Physical activity (MET-minutes/week) was higher in the intervention group post-intervention (MD 141.4; 95% CI 62.9 to 219.9). The proportion of participants at "maintenance" stage-of-change for physical activity was higher in the intervention group (56.3 versus 31.2%). App use was associated with lower glycaemic index and less energy from free sugars, but not with physical activity. CONCLUSION(S): A behavioral-lifestyle intervention in pregnancy supported by a smartphone app improved dietary intakes, physical activity, and motivation to engage in exercise.