Electronic Monitoring of Mom’s Schedule (eMOMS™): A Feasibility Randomized Controlled Trial Targeting Postpartum Weight Retention and Breastfeeding Duration Among Populations With Overweight/Obesity

Abstract

Background:

Globally, rising trends in gestational diabetes and body mass index contribute to maternal and neonatal morbidity and mortality. Lifestyle modifications and breastfeeding may reverse this effect, although few studies combine these into one intervention.

Research Aims:

To measure postpartum weight retention, breastfeeding duration, hemoglobin A1C, and mean arterial blood pressure at 6 months postpartum among women with elevated pre-pregnancy body mass index.

Methods:

The electronic Monitoring of Mom’s Schedule study (eMOMS™) was a feasibility, three-arm, randomized controlled trial modeled after a Diabetes Prevention Program and breastfeeding support. A health coach delivered a 12-month virtual intervention. Study arm results were compared using Wilcoxon signed-ranks exact test reporting from a two-sided test and bootstrapped samples with 95% confidence intervals.

Results:

Between September 2019 and May 2021, 100 individuals were screened, and 35 were randomized: nine to Group 1, 14 to Group 2, and 12 to Group 3. At baseline, participants averaged 13.0 (SD = 2.5) weeks gestation, with a mean pre-pregnancy body mass index of 29.7 (SD = 3.0). With 5,000 bootstrapped samples, mean weight retention from baseline to 6 months postpartum was: 4.0 kg, 95% CI [1.6, 6.2] for Group 1; 3.7 kg, CI [-1.8, 9.8] for Group 2; and 7.5 kg, CI [4.1, 11.6] for Group 3. Mean (exclusive) breastfeeding duration was 9.3 weeks, 95% CI [0.43, 26.1]; 9.6 weeks, CI [4.4, 15.7]; and 15.1 weeks, CI [6.5, 23.3] for each group, respectively.

Conclusion:

Our intervention was positively associated with postpartum weight retention and breastfeeding duration. Future research is needed to assess intervention components.

Keywords

breastfeeding breastfeeding duration breastfeeding support lactation education maternal behavior maternal health nutrition postpartum care public health randomized controlled trials social support

Get full access to this article

View all access options for this article.

References

Ackermann

R. T.

Finch

E. A.

Brizendine

Zhou

Marrero

D. G.

(2008). Translating the Diabetes Prevention Program into the community. The DEPLOY pilot study. American Journal of Preventive Medicine, 35(4), 357–363. https://doi.org/10.1016/j.amepre.2008.06.035

Acosta-Manzano

Acosta

F. M.

Coll-Risco

Romero-Gallardo

Flor-Alemany

Martínez-González

L. J.

Alvarez-Cubero

M. J.

Segura-Jiménez

Aparicio

V. A.

(2022). The influence of exercise, lifestyle behavior components, and physical fitness on maternal weight gain, postpartum weight retention, and excessive gestational weight gain. International Journal of Sport Nutrition and Exercise Metabolism, 32(6), 425–438. https://doi.org/10.1123/ijsnem.2021-0201

Ainsworth

B. E.

Sternfeld

Richardson

M. T.

Jackson

(2000). Evaluation of the kaiser physical activity survey in women. Medicine and Science in Sports and Exercise, 32(7), 1327–1338. https://doi.org/10.1097/00005768-200007000-00022

Aroda

V. R.

Christophi

C. A.

Edelstein

S. L.

Zhang

Herman

W. H.

Barrett-Connor

Delahanty

L. M.

Montez

M. G.

Ackermann

R. T.

Zhuo

Knowler

W. C.

Ratner

R. E.

(2015). The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: the Diabetes Prevention Program outcomes study 10-year follow-up. Journal of Clinical Endocrinology and Metabolism, 100(4), 1646–1653. https://doi.org/10.1210/jc.2014-3761

Avenell

Grant

A. M.

McGee

McPherson

Campbell

M. K.

McGee

M. A

. RECORD Trial Management Group. (2004). The effects of an open design on trial participant recruitment, compliance and retention – a randomized controlled trial comparison with a blinded, placebo-controlled design. Clinical trials (London, England), 1(6), 490–498. https://doi.org/10.1191/1740774504cn053oa

Babendure

J. B.

Reifsnider

Mendias

Moramarco

M. W.

Davila

Y. R.

(2015). Reduced breastfeeding rates among obese mothers: A review of contributing factors, clinical considerations and future directions. International Breastfeeding Journal, 1(10), 21. https://doi.org/10.1186/s13006-015-0046-5

Binns

Lee

Low

W. Y.

(2016). The long-term public health benefits of breastfeeding. Asia Pacific Journal of Public Health, 28(1), 7–14. https://doi.org/10.1177/1010539515624964

Bruno

Petrella

Bertarini

Pedrielli

Neri

Facchinetti

(2017). Adherence to a lifestyle programme in overweight/obese pregnant women and effect on gestational diabetes mellitus: A randomized controlled trial. Maternal & Child Nutrition, 13(3), Article e12333. https://doi.org/10.1111/mcn.12333

Buckland

Hector

Kolt

G. S.

Fahey

Arora

(2020). Interventions to promote exclusive breastfeeding among young mothers: A systematic review and meta-analysis. International Breastfeeding Journal, 15(1), 102. https://doi.org/10.1186/s13006-020-00340-6

10.

Buckman

Diaz

A. L.

Tumin

Bear

(2020). Parity and the association between maternal sociodemographic characteristics and breastfeeding. Breastfeeding Medicine, 15(7), 443–452. https://doi.org/10.1089/bfm.2019.0284

11.

Campbell

Shackleton

(2018). Pre-pregnancy body mass index and breastfeeding initiation, early cessation and longevity: Evidence from the first wave of the UK Millennium Cohort Study. Journal of Epidemiology and Community Health, 72(12), 1124–1131. https://doi.org/10.1136/jech-2017-209074

12.

Casagrande

S. S.

Linder

Cowie

C. C.

(2018). Prevalence of gestational diabetes and subsequent Type 2 diabetes among U.S. women. Diabetes Research and Clinical Practice, 141, 200–208. https://doi.org/10.1016/j.diabres.2018.05.010

13.

Catalano

P. M.

Shankar

(2017). Obesity and pregnancy: Mechanisms of short term and long term adverse consequences for mother and child. British Medical Journal, 356, 1–21. https://doi.org/10.1136/bmj.j1

14.

Chen

Yan

(2018). Estimated global overweight and obesity burden in pregnant women based on panel data model. PLOS ONE, 13(8), Article e0202183. https://doi.org/10.1371/journal.pone.0202183

15.

Chu

Yang

Wang

Zhou

(2021). Metabolic effects of breastfeeding in women with previous gestational diabetes mellitus: A meta-analysis. Breastfeeding Medicine, 16(12), 938–946. https://doi.org/10.1089/bfm.2020.0151

16.

Cox

(2019). Thirty years with the Edinburgh Postnatal Depression Scale: Voices from the past and recommendations for the future. British Journal of Psychiatry, 214(3), 127–129. https://doi.org/10.1192/bjp.2018.245

17.

Cox

J. L.

Holden

J. M.

Sagovsky

(1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782–786.

18.

Creedy

D. K.

Dennis

C. L.

Blyth

Moyle

Pratt

De Vries

S. M.

(2003). Psychometric characteristics of the breastfeeding self-efficacy scale: Data from an Australian sample. Research in Nursing and Health, 26(2), 143–152. https://doi.org/10.1002/nur.10073

19.

Deng

Hou

Liu

Yao

(2022). Effects of diet and exercise interventions to prevent gestational diabetes mellitus in pregnant women with high-risk factors in China: A randomized controlled study. Clinical Nursing Research, 31(5), 836–847. https://doi.org/10.1177/10547738211055576

20.

Dennis

C. L.

(2003). The breastfeeding self-efficacy scale: Psychometric assessment of the short form. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32(6), 734–744. https://doi.org/10.1177/0884217503258459

21.

Deputy

N. P.

Kim

S. Y.

Conrey

E. J.

Bullard

K. M.

(2018). Prevalence and changes in preexisting diabetes and gestational diabetes among women who had a live birth—United States, 2012-2016. Morbidity and Mortality Weekly Report, 67(43), 1201–1207. https://doi.org/10.15585/mmwr.mm6743a2

22.

Domanski

Lange

A. E.

Ittermann

Allenberg

Spoo

R. A.

Zygmunt

Heckmann

(2018). Evaluation of neonatal and maternal morbidity in mothers with gestational diabetes: A population-based study. BMC Pregnancy and Childbirth, 18(1), 367. https://doi.org/10.1186/s12884-018-2005-9

23.

Driscoll

A. K.

Gregory

E. C. W.

(2020). Increases in prepregnancy obesity: United States, 2016-2019. NCHS Data Brief, 392, 1–8. https://www.cdc.gov/nchs/products/databriefs/db392.htm

24.

Emory University. (2024). Lifestyle Coach Training. Diabetes Training and Technical Assistance Center (DTTAC). https://emorycenters4phtraining.emory.edu/dttac/

25.

Fan

W. Q.

Molinaro

(2021). Maternal obesity adversely affects early breastfeeding in a multicultural, multi-socioeconomic Melbourne community. Australian and New Zealand Journal of Obstetrics and Gynaecology, 61(1), 78–85. https://doi.org/10.1111/ajo.13232

26.

Gibson

McKenzie-McHarg

Shakespeare

Price

Gray

(2009). A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatrica Scandinavica, 119(5), 350–364. https://doi.org/10.1111/j.1600-0447.2009.01363.x

27.

González-Plaza

Bellart

Martínez-Verdú

M. Á.

Arranz

Á.

Luján-Barroso

Seguranyes

(2022). Pre-pregnancy overweight and obesity prevalence and relation to maternal and perinatal outcomes. Enfermeria clinica (English Edition), 32(Suppl. 1), S23–S30. https://doi.org/10.1016/j.enfcle.2021.04.006

28.

Gyasi-Antwi

Walker

Moody

Okyere

Salt

Anang

Eduful

Laryea

Ottie-Boakye

Asah-Opoku

Asibey

Sarfo-Kantanka

Baffour-Agyei

Shaw

Adams

(2020). Global prevalence of gestational diabetes mellitus: A systematic review and meta-analysis. New American Journal of Medicine, 1(3), 1–10. https://nottingham-repository.worktribe.com/output/4766016

29.

Harris

P. A.

Taylor

Thielke

Payne

Gonzalez

Conde

J. G.

(2009). Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010

30.

Healthy People 2030. (2023). Increase the proportion of infants who are breastfed exclusively through age 6 months—MICH-15. U.S. Department of Health and Human Services. https://health.gov/healthypeople/objectives-and-data/browse-objectives/infants/increase-proportion-infants-who-are-breastfed-exclusively-through-age-6-months-mich-15

31.

Huang

Rifas-Shiman

S. L.

Ertel

K. A.

Rich-Edwards

Kleinman

Gillman

M. W.

Gillman

James-Todd

(2015). Pregnancy hyperglycaemia and risk of prenatal and postpartum depressive symptoms. Paediatric and Perinatak Epidemiology, 29(4), 281–289. https://doi.org/10.1111/ppe.12199

32.

Hung

T. H.

Hsieh

T. T.

(2016). Pregestational body mass index, gestational weight gain, and risks for adverse pregnancy outcomes among Taiwanese women: A retrospective cohort study. Taiwanese Journal of Obstetrics and Gynecology, 55(4), 575–581. https://doi.org/10.1016/j.tjog.2016.06.016

33.

Jacobson

L. T.

Collins

T. C.

Lucas

Zackula

Okut

Nazir

Robbins

Stern

J. E.

Wolfe

Grainger

D. A.

(2020). Electronic Monitoring of Mom’s Schedule (eMOMS™): Protocol for a feasibility randomized controlled trial to improve postpartum weight, blood sugars, and breastfeeding among high BMI women. Contemporary Clinical Trials Communications, 18, Article 100565. https://doi.org/10.1016/j.conctc.2020.100565

34.

Jacobson

L. T.

Wolfe

Zackula

Okut

Hampton

F. E.

Grainger

D. A.

Griebel-Thompson

A. K.

Kong

K. L.

Befort

(2023). Electronic Monitoring Of Mom’s Schedule (eMOMS™): Recruitment of pregnant populations with elevated BMI in a feasibility randomized controlled trial. Preventive Medicine Reports, 34, Article 102254. https://doi.org/10.1016/j.pmedr.2023.102254

35.

Jarlenski

McManus

Diener-West

Schwarz

E. B.

Yeung

Bennett

W. L.

(2014). Association between support from a health professional and breastfeeding knowledge and practices among obese women: Evidence from the Infant Practices Study II. Women’s Health Issues, 24(6), 641–648. https://doi.org/10.1016/j.whi.2014.08.002

36.

Kansas Information for Communities. 2023. Birth map for pre-pregnancy overweight and obesity in 2022. Kansas Department of Health and Environment. http://kic.kdheks.gov/birthmap.php

37.

Knowler

W. C.

Barrett-Connor

Fowler

S. E.

Hamman

R. F.

Lachin

J. M.

Walker

E. A.

Nathan

D. M.

(2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346(6), 393–403. https://doi.org/10.1056/NEJMoa012512

38.

Knowler

W. C.

Fowler

S. E.

Hamman

R. F.

Christophi

C. A.

Hoffman

H. J.

Brenneman

A. T.

Brown-Friday

J. O.

Goldberg

Venditti

Nathan

D. M.

(2009). 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet, 374(9702), 1677–1686. https://doi.org/10.1016/s0140-6736(09)61457-4

39.

Liu

Wilcox

Hutto

Turner-McGrievy

Wingard

(2022). Effects of a lifestyle intervention on postpartum weight retention among women with elevated weight. Obesity, 30(7), 1370–1379. https://doi.org/10.1002/oby.23449

40.

Mate

Reyes-Goya

Santana-Garrido

Á.

Vázquez

C. M.

(2021). Lifestyle, maternal nutrition and healthy pregnancy. Current Vascular Pharmacology, 19(2), 132–140. https://doi.org/10.2174/1570161118666200401112955

41.

Meek

J. Y.

Noble

(2022). Policy statement: Breastfeeding and the use of human milk. Pediatrics, 150(1), Article e2022057988. https://doi.org/10.1542/peds.2022-057988

42.

Monaghan

T. F.

Agudelo

C. W.

Rahman

S. N.

Wein

A. J.

Lazar

J. M.

Everaert

Dmochowski

R. R.

(2021). Blinding in clinical trials: Seeing the big picture. Medicina (Kaunas, Lithuania), 57(7), Article 647. https://doi.org/10.3390/medicina57070647

43.

Nagashima

Sato

(2017). Information criteria for Firth’s penalized partial likelihood approach in Cox regression models. Statistics in Medicine, 36(21), 3422–3436. https://doi.org/10.1002/sim.7368

44.

Office on Women’s Health. (2018). Your Guide to Breastfeeding. U.S. Department of Health and Human Services. https://www.womenshealth.gov/patient-materials/resource/guides

45.

Ovesen

P. G.

Jensen

D. M.

Damm

Rasmussen

Kesmodel

U. S.

(2015). Maternal and neonatal outcomes in pregnancies complicated by gestational diabetes. A nation-wide study. Journal of Maternal-Fetal and Neonatal Medicine, 28(14), 1720–1724. https://doi.org/10.3109/14767058.2014.966677

46.

Pinheiro

T. V.

Goldani

M. Z.

(2018). Maternal pre-pregnancy overweight/obesity and gestational diabetes interaction on delayed breastfeeding initiation. PLOS ONE, 13(6), Article e0194879. https://doi.org/10.1371/journal.pone.0194879

47.

Ramji

Challa

Murphy

P. A.

Quinlan

Crane

J. M. G.

(2018). A comparison of breastfeeding rates by obesity class. The Journal of Maternal-Fetal & Neonatal Medicine, 31(22), 3021–3026. https://doi.org/10.1080/14767058.2017.1362552

48.

Ren

Zhang

Fan

Feng

Xia

(2023). Utility of the capability, opportunity, and motivation behaviour (COM-B) model in explaining the negative association between pre-pregnancy body mass index and exclusive breastfeeding at six weeks postpartum. Appetite, 188, Article 106631. https://doi.org/10.1016/j.appet.2023.106631

49.

Renault

K. M.

Carlsen

E. M.

Hædersdal

Nilas

Secher

N. J.

Eugen-Olsen

Cortes

Olsen

S. F.

Halldorsson

T. I.

Nørgaard

(2017). Impact of lifestyle intervention for obese women during pregnancy on maternal metabolic and inflammatory markers. Internationa Journal of Obesity, 41(4), 598–605. https://doi.org/10.1038/ijo.2017.9

50.

Reynolds

Kingsland

Daly

Licata

Tully

Doherty

Farragher

Desmet

Lecathelinais

McKie

Williams

Wiggers

Hollis

(2023). Breastfeeding practices and associations with pregnancy, maternal and infant characteristics in Australia: A cross-sectional study. International Breastfeeding Journal, 18(1), 8. https://doi.org/10.1186/s13006-023-00545-5

51.

Schmidt

M. D.

Freedson

P. S.

Pekow

Roberts

Sternfeld

Chasan-Taber

(2006). Validation of the Kaiser Physical Activity Survey in pregnant women. Medicine and Science in Sports and Exercise, 38(1), 42–50. https://doi.org/10.1249/01.mss.0000181301.07516.d6

52.

Temple Newhook

Newhook

L. A.

Midodzi

W. K.

Murphy Goodridge

Burrage

Gill

Halfyard

Twells

. (2017). Poverty and breastfeeding: Comparing determinants of early breastfeeding cessation incidence in socioeconomically marginalized and privileged populations in the FiNaL study. Health Equity, 1(1), 96–102. https://doi.org/10.1089/heq.2016.0028

53.

Thompson

F. E.

Subar

A. F.

Smith

A. F.

Midthune

Radimer

K. L.

Kahle

L. L.

Kipnis

(2002). Fruit and vegetable assessment: Performance of 2 new short instruments and a food frequency questionnaire. Journal of the American Dietetic Association, 102(12), 1764–1772.

54.

Treweek

Pitkethly

Cook

Fraser

Mitchell

Sullivan

Jackson

Taskila

T. K.

Gardner

(2018). Strategies to improve recruitment to randomised trials. The Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.MR000013.pub6

55.

Tuthill

E. L.

McGrath

J. M.

Graber

Cusson

R. M.

Young

S. L.

(2016). Breastfeeding Self-efficacy: A critical review of available instruments. Journal of Human Lactation, 32(1), 35–45. https://doi.org/10.1177/0890334415599533

56.

U.S. Census Bureau. (2023a). Quick facts: Garden City, KS, Wichita, KS, and United States. U.S. Department of Commerce. https://www.census.gov/quickfacts/fact/table/gardencitycitykansas,wichitacitykansas,US/PST045223

57.

U.S. Census Bureau. (2023b). Quick facts: Oklahoma, Iowa, Nebraska, Kansas, and United States. U.S. Department of Commerce. https://www.census.gov/quickfacts/fact/table/OK,IA,NE,US,KS/PST045221

58.

U.S. Centers for Disease Control and Prevention. (2024a). Breastfeeding among U.S. children born in 2014-2021, CDC NIS-Child. U.S. Department of Health and Human Services. https://www.cdc.gov/breastfeeding-data/survey/results.html?CDC_AAref_Val=https://www.cdc.gov/breastfeeding/data/nis_data/results.html

59.

U.S. Centers for Disease Control and Prevention. (2024b). Selected 2016-2021 Maternal and Child Health (MCH) indicators. U.S. Department of Health and Human Services. https://www.cdc.gov/prams/php/data-research/mch-indicators-by-site.html

60.

U.S. Centers for Disease Control and Prevention. (2024c). About the National Diabetes Prevention Program. U.S. Department of Health and Human Services. https://www.cdc.gov/diabetes-prevention/programs/index.html

61.

U.S. Centers for Disease Control and Prevention. (2024d). Behavioral Risk Factor Surveillance System. U.S. Department of Health and Human Services. https://www.marchofdimes.org/peristats/reports/united-states

62.

Van Uytsel

Bijlholt

Devlieger

Ameye

Jochems

van Holsbeke

Schreurs

Catry

Bogaerts

. (2022). Effect of the e-health supported INTER-ACT lifestyle intervention on postpartum weight retention and body composition, and associations with lifestyle behavior: A randomized controlled trial. Preventive Medicine, 164, Article 107321. https://doi.org/10.1016/j.ypmed.2022.107321

63.

Wang

M. C.

Freaney

P. M.

Perak

A. M.

Greenland

Lloyd-Jones

D. M.

Grobman

W. A.

Khan

S. S.

(2021). Trends in prepregnancy obesity and association with adverse pregnancy outcomes in the United States, 2013 to 2018. Journal of the American Heart Association, 10(17), Article e020717. https://doi.org/10.1161/jaha.120.020717

64.

World Health Organization. (2022). Breastfeeding recommendations. https://www.who.int/health-topics/breastfeeding#tab=tab_2

65.

Huang

Guo

Zheng

Yan

(2023). Interactive effect of prepregnancy overweight/obesity and GDM history on prevalence of GDM in biparous women. Frontiers in Endocrinology, 14, Article 1084288. https://doi.org/10.3389/fendo.2023.1084288

66.

Yaroch

A. L.

Tooze

Thompson

F. E.

Blanck

H. M.

Thompson

O. M.

Colón-Ramos

Shaikh

A. R.

McNutt

Nebeling

L. C.

(2012). Evaluation of three short dietary instruments to assess fruit and vegetable intake: The National Cancer Institute’s food attitudes and behaviors survey. Journal of the Academy of Nutrition and Dietetics, 112(10), 1570–1577. https://doi.org/10.1016/j.jand.2012.06.002

67.

Yogev

Hod

Oats

Metzger

Dyer

Trimble

Hadden

Rogers . (2010). Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: Preeclampsia. American Journal of Obstetrics and Gynecology, 202(3), 255.e251–257. https://doi.org/10.1016/j.ajog.2010.01.024

68.

Zhou

Sun

Heianza

Sun

Pei

Shang

(2022). Prevalence and trends in gestational diabetes mellitus among women in the United States, 2006-2017: A population-based study. Frontiers in Endocrinology, 13, Article 868094. https://doi.org/10.3389/fendo.2022.868094

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.53 MB