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Feasibility of conducting an early pregnancy diet and lifestyle e-health intervention: the Pregnancy Lifestyle Activity Nutrition (PLAN) project

  • Rae-Chi Huang (a1), Desiree Silva (a1) (a2), Lawrie Beilin (a3), Cliff Neppe (a4), Katherine E. Mackie (a1), Emma Roffey (a1), Lisa Y. Gibson (a1), Nina D’Vaz (a1), Hayley Christian (a1) (a5), Christopher M. Reid (a6) (a7) and Susan L. Prescott (a1) (a2)...



Childhood obesity is a global issue. Excessive weight gain in early pregnancy is independently associated with obesity in the next generation. Given the uptake of e-health, our primary aim was to pilot the feasibility of an e-health intervention, starting in the first trimester, to promote healthy lifestyle and prevent excess weight gain in early pregnancy. Methods: Women were recruited between 8 and 11 weeks gestation and randomised to the intervention or routine antenatal care. The intervention involved an e-health program providing diet, physical activity and well-being advice over 12 weeks.


Women (n = 57, 43.9% overweight/obese) were recruited at 9.38 ± 1.12 (control) and 9.06 ± 1.29 (intervention) weeks’ gestation, mainly from obstetric private practices (81.2%). Retention was 73.7% for the 12-week intervention, 64.9% at birth and 55.8% at 3 months after birth.

No difference in gestational weight gain or birth size was detected. Overall treatment effect showed a mean increase in score ranking the perceived confidence of dietary change (1.2 ± 0.46, p = 0.009) and score ranking readiness to exercise (1.21 ± 0.51, p = 0.016) over the intervention. At 3 months, infants weighed less in the intervention group (5405 versus 6193 g, p = 0.008) and had a lower ponderal index (25.5 ± 3.0 versus 28.8 ± 4.0 kg/m3) compared with the control group.

Conclusion and Discussion:

A lifestyle intervention starting in the first-trimester pregnancy utilising e-health mode of delivery is feasible. Future studies need strategies to target recruitment of participants of lower socio-economic status and ensure maximal blinding. Larger trials (using technology and focused on early pregnancy) are needed to confirm if decreased infant adiposity is maintained.


Corresponding author

Address for correspondence: Rae-Chi Huang, The ORIGINS Project, Telethon Kids Institute, Nedlands, Western Australia, Australia. Email:


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1. Vickers, MH. Developmental programming and transgenerational transmission of obesity. Ann Nutrit Metabol. 2014; 64, 2634.
2. Moodie, AR. Australia: the healthiest country by 2020. Med J Aus. 2008; 189, 588590.
3. Gaillard, R, Durmus, B, Hofman, A, Mackenbach, JP, Steegers, EAP, Jaddoe, VWV. Risk factors and outcomes of maternal obesity and excessive weight gain during pregnancy. Obesity. 2013; 21, 10461055.
4. Gaillard, R, Welten, M, Oddy, WH, et al. Associations of maternal prepregnancy body mass index and gestational weight gain with cardio-metabolic risk factors in adolescent offspring: a prospective cohort study. BJOG. 2016; 123, 207216.
5. Fraser, A, Tilling, K, Macdonald-Wallis, C, et al. Association of maternal weight gain in pregnancy with offspring obesity and metabolic and vascular traits in childhood. Circulation. 2010; 121, 2557U48.
6. Margerison-Zilko, CE, Shrimali, BP, Eskenazi, B, Lahiff, M, Lindquist, AR, Abrams, BF. Trimester of maternal gestational weight gain and offspring body weight at birth and age five. Matern Child Health J. 2012; 16, 12151223.
7. Rogozinska, E, Marlin, N, Jackson, L, et al. Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation. Health Technol Assess. 2017; 21, 1158.
8. Abdel-Aziz, SB, Hegazy, IS, Mohamed, DA, Abu El Kasem, MMA, Hagag, SS.Effect of dietary counseling on preventing excessive weight gain during pregnancy. Pub Health. 2018; 154, 172181.
9. Di Carlo, C, Iannotti, G, Sparice, S, et al. The role of a personalized dietary intervention in managing gestational weight gain: a prospective, controlled study in a low-risk antenatal population. Arch Gynecol Obstetr. 2014; 289, 765770.
10. Guelinckx, I, Devlieger, R, Mullie, P, Vansant, G. Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial. Am J Clin Nutrit. 2010; 91, 373380.
11. Jeffries, K, Shub, A, Walker, SP, Hiscock, R, Permezel, M. Reducing excessive weight gain in pregnancy: a randomised controlled trial. Med J Aust. 2009; 191, 429433.
12. Korpi-Hyovalti, E, Heinonen, S, Schwab, U, Laaksonen, DE, Niskanen, L. Effect of intensive counselling on physical activity in pregnant women at high risk for gestational diabetes mellitus. A clinical study in primary care. Prim Care Diabetes. 2012; 6, 261268.
13. Krukowski, RA, West, D, DiCarlo, M, et al. A behavioral intervention to reduce excessive gestational weight gain. Matern Child Health J. 2017; 21, 485491.
14. Luoto, R, Kinnunen, TI, Aittasalo, M, et al. Primary prevention of gestational diabetes mellitus and large-for-gestational-age newborns by lifestyle counseling: a cluster-randomized controlled trial. PLoS Med. 2011; 8.
15. Rauh, K, Gabriel, E, Kerschbaum, E, et al. Safety and efficacy of a lifestyle intervention for pregnant women to prevent excessive maternal weight gain: a cluster-randomized controlled trial. BMC Pregnancy Childbirth 2013; 13.
16. Ronnberg, AK, Ostlund, I, Fadl, H, Gottvall, T, Nilsson, K. Intervention during pregnancy to reduce excessive gestational weight gain-a randomised controlled trial. BJOG 2015; 122, 537544.
17. Ruiz, JR, Perales, M, Pelaez, M, Lopez, C, Lucia, A, Barakat, R. Supervised exercise-based intervention to prevent excessive gestational weight gain: a randomized controlled trial. Mayo Clin Proc. 2013; 88, 13881397.
18. Wang, C, Wei, YM, Zhang, XM, et al. A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women. Am J Obstet Gynecol. 2017; 216, 340351.
19. Haby, K, Berg, M, Gyllensten, H, Hanas, R, Premberg, Å. Mighty mums–a lifestyle intervention at primary care level reduces gestational weight gain in women with obesity. BMC Obes. 2018; 5, 16.
20. Thomas, JG, Bond, DS, Raynor, HA, Papandonatos, GD, Wing, RR. Comparison of smartphone-based behavioral obesity treatment with gold standard group treatment and control: a randomized trial. Obesity (Silver Spring, Md) 2019; 27, 572580.
21. Chan, KL, Chen, MT. Effects of social media and mobile health apps on pregnancy care: meta-analysis. Jmir Mhealth Uhealth. 2019; 7, 13.
22. Bovend’Eerdt, TJ, Botell, RE, Wade, DT. Writing SMART rehabilitation goals and achieving goal attainment scaling: a practical guide. Clin Rehabil. 2009; 23, 352361.
23. Michie, S, Wood, CE, Johnston, M, Abraham, C, Francis, JJ, Hardeman, W. Behaviour change techniques: the development and evaluation of a taxonomic method for reporting and describing behaviour change interventions (a suite of five studies involving consensus methods, randomised controlled trials and analysis of qualitative data). Health Technol Assess. 2015; 19, 1188.
24. Hill, B, Skouteris, H, Fuller-Tyszkiewicz, M, Kothe, EJ, McPhie, S. A path model of psychosocial and health behaviour change predictors of excessive gestational weight gain. J Reprod Infant Psychol. 2016; 34, 139161.
25. Mason, P, Butler, CC. Health Behavior Change: A Guide for Practitioners, 2nd edn, 2010. Churchill Livingstone Elsevier, London.
26. Webster, J, Nicholas, C, Velacott, C, Cridland, N, Fawcett, L. Validation of the WHOQOL-BREF among women following childbirth. Aus New Zealand J Obstetr Gynaecol. 2010; 50, 132137.
27. Nybo Andersen, AM, Wohlfahrt, J, Christens, P, Olsen, J, Melbye, M. Maternal age and fetal loss: population based register linkage study. BMJ 2000; 320, 17081712.
28. Risch, HA, Weiss, NS, Clarke, EA, Miller, AB. Risk factors for spontaneous abortion and its recurrence. Am J Epidemiol. 1988; 128, 420430.
29. Chaudhry, B, Wang, J, Wu, SY, et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Internal Med. 2006; 144, 742752.
30. Head, KJ, Noar, SM, Iannarino, NT, Harrington, NG. Efficacy of text messaging-based interventions for health promotion: a meta-analysis. Soc Sci Med. 2013; 97, 4148.
31. O’Brien, OA, McCarthy, M, Gibney, ER, McAuliffe, FM. Technology-supported dietary and lifestyle interventions in healthy pregnant women: a systematic review. Eur J Clin Nutrit. 2014; 68, 760766.
32. Soltani, H, Duxbury, AMS, Arden, MA, Dearden, A, Furness, PJ, Garland, C. Maternal obesity management using mobile technology: a feasibility study to evaluate a text messaging based complex intervention during pregnancy. J Obes. 2015, 10.
33. Knight-Agarwal, C, Davis, DL, Williams, L, Davey, R, Cox, R, Clarke, A. Development and pilot testing of the eating4two mobile phone app to monitor gestational weight gain. Jmir Mhealth Uhealth. 2015; 3.
34. Willcox, JC, Wilkinson, SA, Lappas, M, et al. A mobile health intervention promoting healthy gestational weight gain for women entering pregnancy at a high body mass index: the txt4two pilot randomised controlled trial. BJOG 2017; 124, 17181728.
35. Herring, SJ, Cruice, JF, Bennett, GG, Rose, MZ, Davey, A, Foster, GD. Preventing excessive gestational weight gain among African American women: a randomized clinical trial. Obesity 2016; 24, 3036.
36. Poston, L, Bell, R, Croker, H, et al. Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol. 2015; 3, 767777.
37. Garnaes, KK, Morkved, S, Salvesen, KA, Salvesen, O, Moholdt, T. Exercise training during pregnancy reduces circulating insulin levels in overweight/obese women postpartum: secondary analysis of a randomised controlled trial (the ETIP trial). BMC Pregnancy Childbirth. 2018; 18.
38. Callaway, LK, Prins, JB, Chang, AM, McIntyre, HD. The prevalence and impact of overweight and obesity in an Australian obstetric population. Med J Aust. 2006; 184, 5659.
39. Gaillard, R, Felix, JF, Duijts, L, Jaddoe, VWV. Childhood consequences of maternal obesity and excessive weight gain during pregnancy. Acta Obstet Gynecol Scand. 2014; 93, 10851089.
40. Willcox, JC, Ball, K, Campbell, KJ, Crawford, DA, Wilkinson, SA. Correlates of pregnant women’s gestational weight gain knowledge. Midwifery. 2017; 49, 3239.
41. Shub, A, Huning, EY, Campbell, KJ, McCarthy, EA. Pregnant women’s knowledge of weight, weight gain, complications of obesity and weight management strategies in pregnancy. BMC Res Notes. 2013; 6, 278.
42. Bookari, K, Yeatman, H, Williamson, M. Australian pregnant women’s awareness of gestational weight gain and dietary guidelines: opportunity for action. J Pregnancy. 2016; 2016, 8162645.
43. Hyland, ME. Motivation and placebos: do different mechanisms occur in different contexts? Philos Trans Royal Soc B: Biol Sci. 2011; 366, 18281837.
44. Toledano, MB, Smith, RB, Brook, JP, Douglass, M, Elliott, P. How to establish and follow up a large prospective cohort study in the 21st Century–lessons from UK COSMOS. PLoS One. 2015; 10.
45. Dodd, JM, Turnbull, D, McPhee, AJ, et al. Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial. BMJ. 2014; 348, g1285.


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Feasibility of conducting an early pregnancy diet and lifestyle e-health intervention: the Pregnancy Lifestyle Activity Nutrition (PLAN) project

  • Rae-Chi Huang (a1), Desiree Silva (a1) (a2), Lawrie Beilin (a3), Cliff Neppe (a4), Katherine E. Mackie (a1), Emma Roffey (a1), Lisa Y. Gibson (a1), Nina D’Vaz (a1), Hayley Christian (a1) (a5), Christopher M. Reid (a6) (a7) and Susan L. Prescott (a1) (a2)...


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