Supporting healthful lifestyles during pregnancy: a health coach intervention pilot study

Excessive gestational weight gain (GWG) is associated with adverse health outcomes in both the mother and child. Many previous lifestyle interventions in women with excess weight during pregnancy encouraging appropriate GWG have been unsuccessful, and there remains no consensus about the content, format, or theoretical framework of GWG interventions. We assessed the feasibility and acceptability of a remote health coach intervention to promote healthful lifestyle behaviors and appropriate GWG among overweight pregnant women.

At one northeastern US clinic, we enrolled 30 overweight (pre-pregnancy BMI ≥ 25 kg/m²) pregnant women at a median gestation of 12.5 weeks (IQR: 11–15) into a one-arm trial. We connected participants with a health coach to provide behavioral support to help participants adopt healthful lifestyles during pregnancy. Health coaches contacted participants by phone every 2–3 weeks to monitor goals, and sent emails and text messages between calls. Participants completed baseline (N = 30) and follow-up (N = 26) surveys at the end of the intervention (36 weeks gestation), as well as follow-up phone interviews (N = 18).

Among 30 participants, median age was 32 years (IQR: 28–33), median self-reported pre-pregnancy BMI was 27.3 kg/m² (IQR: 25.7–31.1), and 17/30 were white, 9/30 African-American, and 3/30 Asian. Three-quarters (22/29) of participants completed at least a college degree. Although 25/30 participants reported in baseline surveys that they worried about being able to lose the weight postpartum that they expected to gain during pregnancy, just 12/26 participants reported the same at follow-up (P < 0.001). In follow-up surveys, 21/26 participants reported that health coaches were helpful in keeping them motivated, and 22/26 thought the phone conversations helped them face problems and find solutions. Based on qualitative assessment, several themes emerged in follow-up interviews about the quality of the intervention including accountability and support from health coaches. Participants also expressed desire for more visual resources and integration with standard clinical care to improve the intervention.

We demonstrated feasibility and high participant satisfaction with our remote health coach intervention during pregnancy. We identified areas in which we could refine the intervention for inclusion in a full-scale RCT, such as integration with clinical care and additional visual resources.

Retrospectively registered at ClinicalTrials.gov (NCT03080064, 3/14/2017).