{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T19:59:26Z","timestamp":1792612766253,"version":"4.5.0"},"reference-count":75,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T00:00:00Z","timestamp":1704758400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["NIH BIRCWH K12 HD057022"],"award-info":[{"award-number":["NIH BIRCWH K12 HD057022"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["NIH\/NCATS Colorado CTSA UL1 TR002541"],"award-info":[{"award-number":["NIH\/NCATS Colorado CTSA UL1 TR002541"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["1K23HL133604"],"award-info":[{"award-number":["1K23HL133604"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Postpartum women with overweight\/obesity and a history of adverse pregnancy outcomes are at elevated risk for cardiometabolic disease. Postpartum weight loss and lifestyle changes can decrease these risks, yet traditional face-to-face interventions often fail. We adapted the Diabetes Prevention Program into a theory-based mobile health (mHealth) program called Fit After Baby (FAB) and tested FAB in a randomized controlled trial.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The FAB program provided 12 weeks of daily evidence-based content, facilitated tracking of weight, diet, and activity, and included weekly coaching and gamification with points and rewards. We randomized women at 6 weeks postpartum 2:1 to FAB or to the publicly available Text4baby (T4B) app (active control). We measured weight and administered behavioral questionnaires at 6 weeks, and 6 and 12 months postpartum, and collected app user data.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>81 eligible women participated (77% White, 2% Asian, 15% Black, with 23% Hispanic), mean baseline BMI 32\u00b15 kg\/m<jats:sup>2<\/jats:sup> and age 31\u00b15 years. FAB participants logged into the app a median of 51\/84 (IQR 25,71) days, wore activity trackers 66\/84 (IQR 43,84) days, logged weight 17 times (IQR 11,24), and did coach check-ins 5.5\/12 (IQR 4,9) weeks. The COVID-19 pandemic interrupted data collection for the primary 12-month endpoint, and impacted diet, physical activity, and body weight for many participants. At 12 months postpartum women in the FAB group lost 2.8 kg [95% CI -4.2,-1.4] from baseline compared to a loss of 1.8 kg [95% CI -3.8,+0.3] in the T4B group (p = 0.42 for the difference between groups). In 60 women who reached 12 months postpartum before the onset of the COVID-19 pandemic, women randomized to FAB lost 4.3 kg [95% CI -6.0,-2.6] compared to loss in the control group of 1.3 kg [95% CI -3.7,+1.1] (p = 0.0451 for the difference between groups).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>There were no significant differences between groups for postpartum weight loss for the entire study population. Among those unaffected by the COVID pandemic, women randomized to the FAB program lost significantly more weight than those randomized to the T4B program. The mHealth FAB program demonstrated a substantial level of engagement. Given the scalability and potential public health impact of the FAB program, the efficacy for decreasing cardiometabolic risk by increasing postpartum weight loss should be tested in a larger trial.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0296244","type":"journal-article","created":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T18:23:35Z","timestamp":1704824615000},"page":"e0296244","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":19,"title":["The Fit After Baby randomized controlled trial: An mHealth postpartum lifestyle intervention for women with elevated cardiometabolic risk"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4418-5919","authenticated-orcid":true,"given":"Jacinda M.","family":"Nicklas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Pyle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrey","family":"Soares","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Leiferman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheana S.","family":"Bull","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suhong","family":"Tong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann E.","family":"Caldwell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9096-7490","authenticated-orcid":true,"given":"Nanette","family":"Santoro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda A.","family":"Barbour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,1,9]]},"reference":[{"issue":"1","key":"pone.0296244.ref001","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1093\/epirev\/mxt006","article-title":"Pregnancy characteristics and women\u2019s future cardiovascular health: an underused opportunity to improve women\u2019s health?","volume":"36","author":"JW Rich-Edwards","year":"2014","journal-title":"Epidemiol Rev"},{"issue":"11","key":"pone.0296244.ref002","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1161\/CIR.0b013e31820faaf8","article-title":"Effectiveness-based guidelines for the prevention of cardiovascular disease in women\u20142011 update: a guideline from the american heart association","volume":"123","author":"L Mosca","year":"2011","journal-title":"Circulation"},{"issue":"3","key":"pone.0296244.ref003","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1001\/jamacardio.2021.4391","article-title":"Interventions to Mitigate Risk of Cardiovascular Disease After Adverse Pregnancy Outcomes: A Review","volume":"7","author":"AR Jowell","year":"2022","journal-title":"JAMA Cardiol"},{"issue":"18","key":"pone.0296244.ref004","doi-asserted-by":"crossref","first-page":"e902","DOI":"10.1161\/CIR.0000000000000961","article-title":"Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women: A Scientific Statement From the American Heart Association","volume":"143","author":"NI Parikh","year":"2021","journal-title":"Circulation"},{"issue":"2","key":"pone.0296244.ref005","doi-asserted-by":"crossref","first-page":"e000490","DOI":"10.1161\/JAHA.113.000490","article-title":"History of gestational diabetes mellitus and future risk of atherosclerosis in mid-life: the Coronary Artery Risk Development in Young Adults study","volume":"3","author":"EP Gunderson","year":"2014","journal-title":"J Am Heart Assoc"},{"issue":"7","key":"pone.0296244.ref006","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.2337\/dc11-0268","article-title":"Increased risk of hypertension after gestational diabetes mellitus: findings from a large prospective cohort study","volume":"34","author":"DK Tobias","year":"2011","journal-title":"Diabetes Care"},{"issue":"2","key":"pone.0296244.ref007","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s10654-010-9527-4","article-title":"Risk of diabetes after gestational diabetes and preeclampsia. 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