Lessons Learned: Feasibility of Implementing an Individually-Tailored, Adaptive “Just in Time” Intervention to Manage Gestational Weight Gain

Excessive gestational weight gain (GWG) represents a major public health concern contributing to the obesity epidemic. Half of all pregnant women in the U.S. begin their pregnancies overweight or obese and 60% of these women exceed GWG guidelines. Despite focused prevention efforts, to date, behavioral intervention studies show little to no evidence for preventing excessive GWG among overweight and obese pregnant women (OW/OBPW); suggesting the need for effective weight management interventions. A time-varying, individually-tailored intervention that adapts to each OW/OBPW’s unique needs across pregnancy may be necessary to manage GWG. We have developed the conceptual framework for such an intervention in a NIH-funded study that uses control systems engineering to optimize a prenatal weight gain intervention. Our dynamical model relies on integrating mechanistic energy balance, theory of planned behavior, and self-regulation models to describe how internal processes can be impacted by intervention dosages, and in turn, reinforce positive outcomes (engaging in healthy eating and physical activity) to manage GWG. This research aims to establish feasibility of delivering this intervention and collecting intensive longitudinal data that will be used to optimize the intervention in the future using control systems engineering. Before the fully adaptive intervention is tested from 20 weeks gestation through delivery, we will first examine the feasibility of our decision-rules for adapting the intervention and program dosages in a pilot study. Beginning in January, four OW/OBPW will be randomized to each of 7 intervention dosages (total N=28) over a 4-week period during the second or third trimester. The intervention design and components (e.g., education, goal-setting, self-monitoring, and engaging in healthy eating/physical activity behaviors) to manage GWG will be discussed as well as the feasibility of implementing varied intervention dosages and using mobile-health tools to monitor weight, dietary intake, and physical activity. Results from focus groups targeting user acceptability of dosages, data collection procedures, and self-monitoring behaviors obtained after completing the 4-week intervention will also be discussed. Lastly, we will discuss the lessons learned from implementing this pilot study and how this knowledge will be used to inform program modifications, dynamical modeling, and optimizing the intervention to effectively and efficiently manage GWG.