BACKGROUND: The aim of this study was to estimate the effects of maternal text messages on inappropriate weight for gestational age (IWGA) in newborns in rural China. METHODS: Participants were pregnant women presenting for antenatal care at a Maternal and Child Health Center in Xi'an, China during the 2013 to 2015 period. In total, 2115 women completed the program with follow-up information included in the final analyses. All mothers were divided into four groups, including (1) a control group that received only a few "basic" messages, (2) a care-seeking (CS) message group, (3) good household prenatal practices (GHPP) message group, and (4) a group receiving all 148 text messages. The primary outcome was IWGA, including small for gestational age (SGA) and macrosomia (weighing >= 4,000g at birth). Multivariable logistic regression using an intent-to-treat estimate was utilized. RESULTS: In total, 19.5% of newborns were IWGA. The risk of IWGA was 23.0% in the control group, 19.6% in the CS group, 18.9% in the GHPP group, and 16.5% in the group with all texts. Compared to the control group, the odds ratio of IWGA was 0.65 (0.48 to 0.89) for the group receiving All Texts, which remained statistically significant after performing the Holm-Bonferroni correction. The odds ratio of macrosomia was 0.54 (0.34 to 0.87) and 0.57 (0.36 to 0.49) for the care seeking message group and the all texts group, respectively, with statistical significance. CONCLUSION: A package of free informational text messages, including advice for good household prenatal practices and care seeking, may prevent the inappropriate weight for gestational age through a protective effect on macrosomia. Advice to encourage care seeking in pregnancy may prevent macrosomia among neonates in rural China as well.

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