{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T17:17:12Z","timestamp":1788542232195,"version":"build-2803163510"},"reference-count":26,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Excessive gestational weight gain (GWG) occurs in 50% of pregnant patients with overweight or obesity and is associated with several perinatal complications. Scalable, evidence-based lifestyle interventions are needed.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To test whether an adaptive mobile health lifestyle intervention plus standard care reduces excessive GWG compared with standard care alone.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cluster-randomized clinical trial, with randomization at the clinician level, enrolled pregnant patients with a singleton pregnancy, prepregnancy body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) 25.0 to less than 40.0, and receiving care within an integrated health system. Data were analyzed from May 1, 2024, to February 12, 2026.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Clinicians randomized to the intervention received motivational interviewing guidance for discussing GWG, and their patients received personalized, automated feedback on GWG and physical activity via a smartphone application; a wireless scale and activity tracker; 13 weekly education topics delivered via app; and step-wise chats and\/or phone support from a lifestyle coach, for those experiencing accelerated GWG.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The co\u2013primary outcomes were weekly rate of GWG and total GWG (both continuous and categorized per IOM guidelines).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n From a total of 58 clinicians who consented to participate, 1265 patients (mean [SD] age, 33.4 (4.6) years; mean [SD] prepregnancy BMI, 29.8 [3.8]) consented to participate and were enrolled in the trial, including 677 patients in the intervention group and 588 patients in the standard care condition. The weekly rate of GWG was significantly lower in the intervention group vs standard care group (mean [SD] rate, 0.25 [0.20] vs 0.28 [0.20] kg\/week; mean between-group difference, \u22120.03 [95% CI, \u22120.05 to \u22120.01] kg\/week). Fewer patients in the intervention group exceeded IOM guidelines for weekly rate of GWG than in the standard care group (351 patients [51.9%] vs 354 patients [60.2%]; RR, 0.86 [95% CI, 0.78-0.95]), while more patients gained below the guidelines (148 patients [21.8%] vs 101 patients [17.2%]; relative risk [RR], 1.27 [95% CI, 1.01-1.61]). Total GWG was significantly lower in the intervention group than the standard care group (mean [SD], 9.7 [6.2] vs 10.6 [6.2] kg; mean between-group difference, \u22120.87 [95% CI, \u22121.40 to \u22120.34] kg). Fewer patients in the intervention exceeded IOM guidelines for total GWG than in standard care (299 patients [44.1%] vs 301 patients [51.2%]; RR, 0.87 [95% CI, 0.77-0.98]) while more patients gained below the total GWG guidelines [182 patients [26.8%] vs 126 patients [21.5%]; RR, 1.23 [95% CI, 1.04-1.45]).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This cluster-randomized trial found that an adaptive intervention leveraging technology effectively reduced the rate of GWG and total GWG among pregnant patients with overweight or obesity.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03880461<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.8007","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T15:30:40Z","timestamp":1776699040000},"page":"e268007","source":"Crossref","is-referenced-by-count":2,"title":["Adaptive Mobile Health Intervention to Reduce Excess Gestational Weight Gain"],"prefix":"10.1001","volume":"9","author":[{"given":"Monique M.","family":"Hedderson","sequence":"first","affiliation":[{"name":"Kaiser Permanente Northern California, Division of Research, Pleasanton"},{"name":"Center for Upstream Prevention of Adiposity and Diabetes Mellitus, Kaiser Permanente Northern California, Division of Research, Pleasanton"},{"name":"Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan D.","family":"Brown","sequence":"additional","affiliation":[{"name":"Center for Upstream Prevention of Adiposity and Diabetes Mellitus, Kaiser Permanente Northern California, Division of Research, Pleasanton"},{"name":"Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"},{"name":"Department of Internal Medicine, University of California, Davis, Sacramento"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles P.","family":"Quesenberry","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, Division of Research, Pleasanton"},{"name":"Center for Upstream Prevention of Adiposity and Diabetes Mellitus, Kaiser Permanente Northern California, Division of Research, Pleasanton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Xu","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, Division of Research, Pleasanton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily F.","family":"Liu","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, Division of Research, Pleasanton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen L.","family":"Li","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, Division of Research, Pleasanton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sneha B.","family":"Sridhar","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, Division of Research, Pleasanton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tali","family":"Sedgwick","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, Division of Research, Pleasanton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Page","family":"Kissel","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, Division of Research, Pleasanton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hillary D. Serrato","family":"Bandera","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, Division of Research, Pleasanton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mibhali M.","family":"Bhalala","sequence":"additional","affiliation":[{"name":"The Permanente Medical Group, Kaiser Permanente Northern California, Pleasanton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl L.","family":"Albright","sequence":"additional","affiliation":[{"name":"University of Hawaii at Manoa School of Nursing and Dental Hygiene, Honolulu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assiamira","family":"Ferrara","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California, Division of Research, Pleasanton"},{"name":"Center for Upstream Prevention of Adiposity and Diabetes Mellitus, Kaiser Permanente Northern California, Division of Research, Pleasanton"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"issue":"40","key":"zoi260260r1","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.15585\/mmwr.mm6540a10","article-title":"QuickStats: gestational weight gain among women with full-term, singleton births, compared with recommendations\u201448 states and the District of Columbia, 2015.","volume":"65","year":"2016","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"2","key":"zoi260260r2","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1093\/tbm\/ibx050","article-title":"A framework for examining the function of digital health technologies for weight management.","volume":"8","author":"Azar","year":"2018","journal-title":"Transl Behav Med"},{"issue":"21","key":"zoi260260r3","doi-asserted-by":"publisher","first-page":"2207","DOI":"10.1001\/jama.2017.3635","article-title":"Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis.","volume":"317","author":"Goldstein","year":"2017","journal-title":"JAMA"},{"issue":"4","key":"zoi260260r4","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1097\/AOG.0b013e3182113ae4","article-title":"Newborn size among obese women with weight gain outside the 2009 Institute of Medicine recommendation.","volume":"117","author":"Vesco","year":"2011","journal-title":"Obstet Gynecol"},{"issue":"20","key":"zoi260260r5","doi-asserted-by":"publisher","first-page":"2094","DOI":"10.1001\/jama.2021.4230","article-title":"Counseling and behavioral interventions for healthy weight and weight gain in pregnancy: evidence report and systematic review for the US Preventive Services Task Force.","volume":"325","author":"Cantor","year":"2021","journal-title":"JAMA"},{"issue":"20","key":"zoi260260r6","doi-asserted-by":"publisher","first-page":"2087","DOI":"10.1001\/jama.2021.6949","article-title":"Behavioral counseling interventions for healthy weight and weight gain in pregnancy: US Preventive Services Task Force recommendation statement.","volume":"325","author":"Davidson","year":"2021","journal-title":"JAMA"},{"issue":"9","key":"zoi260260r7","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1111\/obr.12557","article-title":"Electronic-based lifestyle interventions in overweight or obese perinatal women: a systematic review and meta-analysis.","volume":"18","author":"Lau","year":"2017","journal-title":"Obes Rev"},{"issue":"3","key":"zoi260260r8","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1023\/B:PREV.0000037641.26017.00","article-title":"A conceptual framework for adaptive preventive interventions.","volume":"5","author":"Collins","year":"2004","journal-title":"Prev Sci"},{"issue":"24","key":"zoi260260r9","doi-asserted-by":"publisher","first-page":"2617","DOI":"10.1001\/jama.2012.6866","article-title":"Effect of a stepped-care intervention approach on weight loss in adults: a randomized clinical trial.","volume":"307","author":"Jakicic","year":"2012","journal-title":"JAMA"},{"key":"zoi260260r10","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2024.107781","article-title":"Protocol of an adaptive mobile health intervention for the management of gestational weight gain: The LEAP cluster randomized controlled trial.","volume":"149","author":"Sridhar","year":"2025","journal-title":"Contemp Clin Trials"},{"issue":"10077","key":"zoi260260r12","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(17)30569-X","article-title":"Structural racism and health inequities in the USA: evidence and interventions.","volume":"389","author":"Bailey","year":"2017","journal-title":"Lancet"},{"issue":"6","key":"zoi260260r13","doi-asserted-by":"publisher","DOI":"10.2196\/33929","article-title":"A web-based mHealth intervention with telephone support to increase physical activity among pregnant patients with overweight or obesity: feasibility randomized controlled trial.","volume":"6","author":"Thomas","year":"2022","journal-title":"JMIR Form Res"},{"issue":"6","key":"zoi260260r14","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1016\/S2213-8587(20)30107-8","article-title":"A telehealth lifestyle intervention to reduce excess gestational weight gain in pregnant women with overweight or obesity (GLOW): a randomised, parallel-group, controlled trial.","volume":"8","author":"Ferrara","year":"2020","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"1","key":"zoi260260r16","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2019-0076","article-title":"A 2017 US reference for singleton birth weight percentiles using obstetric estimates of gestation.","volume":"144","author":"Aris","year":"2019","journal-title":"Pediatrics"},{"issue":"6","key":"zoi260260r17","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.1016\/j.jada.2009.03.001","article-title":"Dietary quality during pregnancy varies by maternal characteristics in Project Viva: a US cohort.","volume":"109","author":"Rifas-Shiman","year":"2009","journal-title":"J Am Diet Assoc"},{"issue":"3","key":"zoi260260r18","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1007\/s13142-014-0252-5","article-title":"The EARLY trials: a consortium of studies targeting weight control in young adults.","volume":"4","author":"Lytle","year":"2014","journal-title":"Transl Behav Med"},{"issue":"3","key":"zoi260260r19","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1177\/0962280206074463","article-title":"Multiple imputation of discrete and continuous data by fully conditional specification.","volume":"16","author":"van Buuren","year":"2007","journal-title":"Stat Methods Med Res"},{"issue":"4","key":"zoi260260r20","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1016\/0167-9473(95)00057-7","article-title":"Partially parametric techniques for multiple imputation.","volume":"22","author":"Schenker","year":"1996","journal-title":"Comput Stat Data Anal"},{"issue":"63","key":"zoi260260r21","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1093\/biomet\/63.3.581","article-title":"Inference and missing data.","author":"Rubin","year":"1976","journal-title":"Biometrika"},{"issue":"2","key":"zoi260260r22","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1111\/j.1541-0420.2008.01066.x","article-title":"A comparison of methods for estimating the causal effect of a treatment in randomized clinical trials subject to noncompliance.","volume":"65","author":"Little","year":"2009","journal-title":"Biometrics"},{"issue":"9","key":"zoi260260r24","doi-asserted-by":"publisher","first-page":"1396","DOI":"10.1002\/oby.22250","article-title":"Lifestyle interventions limit gestational weight gain in women with overweight or obesity: LIFE-Moms prospective meta-analysis.","volume":"26","author":"Peaceman","year":"2018","journal-title":"Obesity (Silver Spring)"},{"key":"zoi260260r25","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2025.104399","article-title":"The impact of m-health interventions on gestational weight gain and physical activity among pregnant women with overweight and obesity: a meta-analysis of randomized controlled trials.","volume":"146","author":"Sari","year":"2025","journal-title":"Midwifery"},{"issue":"3","key":"zoi260260r26","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1002\/oby.23088","article-title":"Self-monitoring via digital health in weight loss interventions: a systematic review among adults with overweight or obesity.","volume":"29","author":"Patel","year":"2021","journal-title":"Obesity (Silver Spring)"},{"key":"zoi260260r11","doi-asserted-by":"crossref","DOI":"10.1201\/9781584888178","volume-title":"Cluster Randomized Trials","author":"Hayes","year":"2009"},{"key":"zoi260260r15","volume-title":"Weight Gain During Pregnancy: Reexamining the Guidelines","author":"Rasmussen","year":"2009"},{"key":"zoi260260r23","first-page":"134","volume-title":"The Encyclopedia of Statistical Science","author":"Baker","year":"1997"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2847952\/hedderson_2026_oi_260260_1776101081.48211.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T15:30:41Z","timestamp":1776699041000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2847952"}},"subtitle":["A Cluster-Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,4,20]]},"references-count":26,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.8007","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,20]]}}}