JAMA Netw Open
Technology‑enabled support curbs excess gestational weight gain
Clinical takeaway: For pregnant patients who are overweight or obese, pairing standard prenatal care with an adaptive, app‑based lifestyle program may meaningfully reduce the likelihood of excessive gestational weight gain—without adding visit burden.
Excess gestational weight gain (GWG) affects more than half of pregnant patients with overweight or obesity, raising the risk of gestational diabetes and cesarean delivery, while effective behavioral counseling remains difficult to deliver in routine care.
In a pragmatic, clinician‑cluster randomized trial within an integrated health system, 58 clinicians cared for 1,265 pregnant patients (mean age 33.4 years; mean pre-pregnancy BMI 29.8) assigned to standard care alone or standard care plus an adaptive mobile health intervention. Patients in the intervention received a smartphone app with personalized feedback, a wireless scale and activity tracker, 13 weekly education modules, and stepped lifestyle‑coach support when weight gain accelerated. Clinicians received guidance in motivational interviewing.
Compared with standard care, the intervention significantly lowered the weekly rate of GWG (0.25 vs. 0.28 kg/week; between‑group difference −0.03 kg/week, 95% CI, −0.05 to −0.01) and total GWG (9.7 vs. 10.6 kg; difference −0.87 kg, 95% CI, −1.40 to −0.34). Fewer patients exceeded Institute of Medicine guidelines for weekly GWG (51.9% vs. 60.2%; relative risk [RR], 0.86) and total GWG (44.1% vs. 51.2%; RR, 0.87). A greater share gained below guideline thresholds, suggesting improved distribution around recommended targets.
In an accompanying invited commentary, Elizabeth R. Stevens, PhD, MPH, and Devin M. Mann, MD, MS, noted that the trial highlights both the promise and current limitations of mobile health for behavioral care. Adaptive mobile health programs can deliver continuous, personalized feedback using real‑time data while reserving human coaching for patients at highest risk—an approach that may extend the reach of traditional counseling. However, the authors emphasize that reliance on human coaches remains a bottleneck, and that further automation of personalization will be needed to reach more patients without straining clinical systems. The trial’s modest but consistent effects align with decades of behavioral intervention research, suggesting incremental population‑level gains rather than dramatic individual change.
Source: Hedderson MM, et al. (2026, April 20). JAMA Network Open. Adaptive Mobile Health Intervention to Reduce Excess Gestational Weight Gain: A Cluster‑Randomized Clinical Trial