The Effectiveness of eHealth Technologies on Weight Management in Pregnant and Postpartum Women: Systematic Review and Meta-Analysis

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Abstract

Background

The emergence and utilization of electronic health (eHealth) technologies has increased in a variety of health interventions. Exploiting the real-time advantages offered by mobile technologies during and after pregnancy has the potential to empower women and encourage behaviors that may improve maternal and child health.

Objective

The objective of this study was to assess the effectiveness of eHealth technologies for weight management during pregnancy and the postpartum period and to review the efficacy of eHealth technologies on health behaviors, specifically nutrition and physical activity.

Methods

A systematic search was conducted of the following databases: MEDLINE, EMBASE, Cochrane database of systematic reviews (CDSR), Cochrane central register of controlled trials (CENTRAL), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO. The search included studies published from 1990 to July 5, 2016. All relevant primary studies that involved randomized controlled trials (RCTs), non-RCTs, before-and-after studies, historically controlled studies, and pilot studies were included. The study population was adult women of childbearing age either during pregnancy or the postpartum period. eHealth weight management intervention studies targeting physical activity, nutrition, or both, over a minimum 3-month period were included. Titles and abstracts, as well as full-text screening were conducted. Study quality was assessed using Cochrane’s risk of bias tool. Data extraction was completed by a single reviewer, which was then verified by a second independent reviewer. Results were meta-analyzed to calculate pooled estimates of the effect, wherever possible.

Results

Overall, 1787 and 176 citations were reviewed at the abstract and full-text screening stages, respectively. A total of 10 studies met the inclusion criteria ranging from high to low risk of bias. Pooled estimates from studies of the effect for postpartum women resulted in a significant reduction in weight (−2.55 kg, 95% CI −3.81 to −1.28) after 3 to 12 months and six studies found a nonsignificant reduction in weight gain for pregnant women (−1.62 kg, 95% CI −3.57 to 0.33) at approximately 40 weeks.

Conclusions

This review found evidence for benefits of eHealth technologies on weight management in postpartum women only. Further research is still needed regarding the use of these technologies during and after pregnancy.

Related collections

Most cited references 36

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Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies

Siobhan O’Connor, Peter Hanlon, Catherine A O'Donnell … (2016)

Background Numerous types of digital health interventions (DHIs) are available to patients and the public but many factors affect their ability to engage and enrol in them. This systematic review aims to identify and synthesise the qualitative literature on barriers and facilitators to engagement and recruitment to DHIs to inform future implementation efforts. Methods PubMed, MEDLINE, CINAHL, Embase, Scopus and the ACM Digital Library were searched for English language qualitative studies from 2000 – 2015 that discussed factors affecting engagement and enrolment in a range of DHIs (e.g. ‘telemedicine’, ‘mobile applications’, ‘personal health record’, ‘social networking’). Text mining and additional search strategies were used to identify 1,448 records. Two reviewers independently carried out paper screening, quality assessment, data extraction and analysis. Data was analysed using framework synthesis, informed by Normalization Process Theory, and Burden of Treatment Theory helped conceptualise the interpretation of results. Results Nineteen publications were included in the review. Four overarching themes that affect patient and public engagement and enrolment in DHIs emerged; 1) personal agency and motivation; 2) personal life and values; 3) the engagement and recruitment approach; and 4) the quality of the DHI. The review also summarises engagement and recruitment strategies used. A preliminary DIgital Health EnGagement MOdel (DIEGO) was developed to highlight the key processes involved. Existing knowledge gaps are identified and a number of recommendations made for future research. Study limitations include English language publications and exclusion of grey literature. Conclusion This review summarises and highlights the complexity of digital health engagement and recruitment processes and outlines issues that need to be addressed before patients and the public commit to digital health and it can be implemented effectively. More work is needed to create successful engagement strategies and better quality digital solutions that are personalised where possible and to gain clinical accreditation and endorsement when appropriate. More investment is also needed to improve computer literacy and ensure technologies are accessible and affordable for those who wish to sign up to them. Systematic review registration International Prospective Register of Systematic Reviews CRD42015029846 Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0359-3) contains supplementary material, which is available to authorized users.

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Gestational weight gain and long-term postpartum weight retention: a meta-analysis.

Ina Nehring, Hans Hauner, Rüdiger von Kries … (2011)

Gestational weight gain (GWG) is known to be a potential risk factor for short-term postpartum weight retention (PPWR) and thus for overweight in women. Does GWG also determine the long-term risk of overweight in women? We aimed to study the short- and long-term effects of GWG in accordance with the Institute of Medicine (IOM) recommendations on postpartum weight retention. We systematically reviewed 5 databases and bibliographies of various publications supplemented by hand search for relevant articles published in English or German and performed meta-analyses to quantify the effect estimate of PPWR by using a random-effects model. We split the data into 4 categories of follow-up: <0.5, 0.5-1, ∼3, and ≥15 y. Of 1770 search hits, 9 observational studies remained suitable for the analysis. PPWR increased after longer time spans after delivery irrespective of whether GWG had been below, within, or above the guidelines. Compared with women with GWG within the recommendations, those with a GWG above the recommendations retained an additional 3.06 kg (95% CI: 1.50, 4.63 kg) after 3 y and 4.72 kg (95% CI: 2.94, 6.50 kg) on average after ≥15 y postpartum. Inadequate GWG was associated with less PPWR (-2.99 kg; 95% CI: -3.72, -2.27 kg) <6 mo after pregnancy. This association faded over time and became nonsignificant (-1.41 kg; 95% CI: -3.03, 0.21 kg) after ≥15 y. The results remained stable in sensitivity analyses that accounted for changes in IOM criteria over time and potential effect modification by low social class. A funnel plot did not suggest publication bias. GWG in accordance with the IOM recommendations is associated with long-term effects on PPWR.

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Maternal obesity: pregnancy complications, gestational weight gain and nutrition.

I Guelinckx, R Devlieger, K Beckers … (2008)

The obesity epidemic affects all, including women of reproductive age. One in five women attending prenatal care in the UK is obese. Prepregnancy obesity is associated with serious short- and long-term complications for mother and child. Furthermore, gestational weight gain (GWG) of obese pregnant women generally exceeds the Institute of Medicine recommended ranges. This observation can partially be explained by an unbalanced diet and lack of daily physical activity. Despite this, few lifestyle intervention trials in obese pregnant women are available. Two out of seven intervention trials focusing on GWG, nutrition and physical activity, reached a significant decrease in GWG. Developing guidelines to promote appropriated weight gain and healthy lifestyle in overweight and obese pregnant women remains a challenge. This review aims to summarize the complications associated with maternal prepregnancy overweight and obesity and to discuss possible strategies to improve the lifestyle habits of pregnant women.

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Author and article information

Contributors

Kristi B Adamo:

School of Human KineticsFaculty of Health SciencesUniversity of OttawaLees Campus, RM E250200 Lees AveOttawa, ON, K1N 6N5Canada1 613 562 5800 ext 1009kadamo@uottawa.ca

ORCID: http://orcid.org/0000-0001-7925-1889

Journal

Journal ID (nlm-ta): J Med Internet Res

Journal ID (iso-abbrev): J. Med. Internet Res

Journal ID (publisher-id): JMIR

Title: Journal of Medical Internet Research

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Print): 1439-4456

ISSN (Electronic): 1438-8871

Publication date Collection: October 2017

Publication date (Electronic): 13 October 2017

Volume: 19

Issue: 10

Electronic Location Identifier: e337

Affiliations

[1] ¹ School of Nursing Faculty of Health Sciences McMaster University Hamilton, ON Canada

[2] ² Clinical Nurse Specialist Hamilton Health Sciences Hamilton, ON Canada

[3] ³ Department of Medicine University of Calgary Calgary, AB Canada

[4] ⁴ School of Human Kinetics Faculty of Health Sciences University of Ottawa Ottawa, ON Canada

[5] ⁵ Department of Clinical Epidemiology and Biostatistics Faculty of Health Sciences McMaster University Hamilton, ON Canada

[6] ⁶ Reproductive Endocrinology and Women's Health Lab Pennington Biomedical Research Center Louisiana State University Baton Rouge, LA United States

[7] ⁷ Department of Pediatrics Faculty of Medicine University of Ottawa Ottawa, ON Canada

Author notes

Corresponding Author: Kristi B Adamo kadamo@ 123456uottawa.ca

Author information

Diana Sherifali http://orcid.org/0000-0002-4423-3848

Kara A Nerenberg http://orcid.org/0000-0003-3243-5765

Shanna Wilson http://orcid.org/0000-0002-4083-7601

Kevin Semeniuk http://orcid.org/0000-0003-3413-8190

Muhammad Usman Ali http://orcid.org/0000-0002-8516-3057

Leanne M Redman http://orcid.org/0000-0002-7267-7374

Kristi B Adamo http://orcid.org/0000-0001-7925-1889

Article

Publisher ID: v19i10e337

DOI: 10.2196/jmir.8006

PMC ID: 5660296

PubMed ID: 29030327

SO-VID: f6865e46-8abc-401f-9bea-d2904d39cc9e

Copyright © ©Diana Sherifali, Kara A Nerenberg, Shanna Wilson, Kevin Semeniuk, Muhammad Usman Ali, Leanne M Redman, Kristi B Adamo. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.10.2017.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 9 May 2017

Date revision requested : 28 June 2017

Date revision received : 12 July 2017

Date accepted : 12 July 2017

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