Preventing Excessive Gestational Weight Gain During Consecutive Pregnancies: Findings from an mHealth Intervention

Excessive gestational weight gain (EGWG) poses significant health risks, including increased pregnancy complications, obesity, and metabolic disorders. Addressing EGWG is critical for women with a history of EGWG, as recurrence is common in consecutive pregnancies. This study presents findings from a subanalysis of the intervention arm of the INTER-ACT multi-center randomied controlled trial (RCT), which evaluated the impact of a combined mobile health (mHealth) and face-to-face lifestyle coaching intervention on EGWG recurrence during consecutive pregnancies. This subanalysis focuses on the intervention arm of the INTER-ACT RCT, conducted in six hospitals in Flanders, Belgium. The intervention consisted of two phases: the interpregnancy period (six weeks to six months postpartum) and the consecutive pregnancy (before 15 weeks post-conception to birth). Participants (n = 172) with a history of EGWG received health coaching and used an app to self-monitor weight, steps, and mental health. A multiple regression model assessed the effects of self-monitoring and coaching attendance on EGWG during the consecutive pregnancy in the intervention arm. App engagement decreased from 78% during the interpregnancy period to 37% during the consecutive pregnancy. Self-monitoring behaviors (logging weight, steps, and mental health) or coaching attendance did not independently predict EGWG. A prior history of EGWG was the strongest predictor of EGWG recurrence, followed by older maternal age. While mHealth interventions can promote self-monitoring, sustaining engagement across pregnancies remains challenging. Future strategies should focus on improving long-term adherence to mHealth tools to enhance GWG outcomes and maternal health, especially for women motivated to engage with these technologies. These findings, derived from the intervention arm of the INTER-ACT RCT, suggest that further research is needed to assess the broader applicability of these results. Excessive gestational weight gain (EGWG) is a known risk factor for adverse maternal and child health outcomes, with recurrence common in subsequent pregnancies. Digital health interventions show promise but face engagement challenges. This study adds to the literature by evaluating an mHealth intervention aimed at reducing EGWG recurrence, demonstrating that while some women engaged with the intervention, overall results showed no significant effect. These findings highlight the need for further research to identify which women may benefit, how to maintain engagement, and how app-base strategies can be integrated with broader environmental and behavioral support.