The effectiveness of an online intervention in preventing excessive gestational weight gain: the e-moms roc randomized controlled trial

This article was published May 2018 in BMC Pregnancy and Childbirth by Christine M. OlsonSusan W. GrothMeredith L. GrahamJennifer E. ReschkeMyla S. Strawderman, and Isabel Diana Fernandez. 

The full article is available here.

Here is the abstract for this article:


Excessive gestational weight gain (GWG) is common and contributes to the development of obesity in women and their offspring. Electronic or e-health interventions have the potential to reach large groups of women and prevent excessive GWG, but their effectiveness has not been demonstrated. The purpose of this study was to evaluate, in a real-world setting, the effectiveness of a self-directed, integrated online and mobile phone behavioral intervention in preventing excessive GWG.


This effectiveness trial was a double-blind, three-arm trial with a parallel group design. Two arms received the same e-health intervention during pregnancy with the third arm serving as the placebo control. The intervention was based on a previously efficacious non-digital intervention that was adapted to electronic format. It included three behavior change tools: a weight gain tracker, and separate diet and physical activity goal-setting and self-monitoring tools. Both treatment conditions received access to informational tools, event reminders, and a blogging feature. Healthy pregnant women age 18-35 years with body mass indexes (BMI) ≥18.5 and < 35, at ≤20 weeks gestation, and an e-mail address were eligible. The proportion of women with excessive total GWG, as defined by the Institute of Medicine (IOM), was the primary outcome. 1689 randomized women were analyzed in the intent-to-treat (ITT) analysis. The study was designed to have 87% power to detect a 10 percentage point reduction from a control rate of 55% with a sample of 1641 (p = 0.0167, two-sided).


In the ITT sample, 48.1% (SD = 2.0%) gained excessively in the intervention group as did 46.2% (SD = 2.4%) in the placebo control group. These proportions were not significantly different (RR 1.09; 95% CI 0.98, 1.20, p = 0.12). The results were not altered in several sensitivity analyses.


The addition of three behavior change tools to an informational placebo control did not result in a difference in the proportion of women with excessive total GWG compared to the placebo control in this effectiveness trial of an online, self-directed intervention. The similarity of intervention and control treatments and low usage of the behavior change tools in the intervention group are possible explanations.

Association between consistent weight gain tracking and gestational weight gain: Secondary analysis of a randomized trial

This article was published July 2017 in the Obesity Journal.

This article was written by: Christine M. Olson, Myla Strawderman, and Meredith L. Graham.

Here is the abstract for this article:

The effective components of interventions for reducing excessive gestational weight gain (GWG) remain to be identified. This study investigated the sociodemographic, physical, psychosocial, and environmental correlates of online GWG tracking and its independent association with GWG outcomes.

Eight hundred ninety-eight women in the intervention arms of a randomized trial assessing the effectiveness of an integrated online and mobile phone behavioral intervention to decrease the prevalence of excessive GWG were included in this secondary analysis. Data were analyzed using χ2 analysis and modified Poisson and linear regression approaches.

Only 16.5% of low-income (Medicaid-eligible) women consistently tracked GWG, as did 34.2% of not-low-income women. More highly educated, older, and white women were more likely to be consistent GWG trackers. Among not-low-income women, consistent GWG tracking was associated with 2.35 kg less GWG (95% CI: -3.23 to -1.46 kg; P < 0.0001) and a reduced risk of excessive GWG (RR 0.73; 95% CI: 0.59 to 0.89; P = 0.002). CONCLUSIONS:
Electronic tracking of GWG is an effective component of electronic and mobile health interventions aiming to decrease the prevalence of excessive GWG in not-low-income women. Income group-specific motivators are needed to increase the prevalence of GWG tracking.

Does usage of an e-health intervention reduce the risk of excessive gestational weight gain? A secondary analysis from a randomized controlled trial

This article was published January 2017 in the Journal of Medical Internet Research.

This article was written by: Meredith L. Graham, Myla Strawderman, Margaret M. Demment, and Christine M. Olson.

Here is the abstract for this article:

Excessive gestational weight gain (GWG) contributes to the development of obesity in mother and child. Internet-based interventions have the potential for delivering innovative and interactive options for prevention of excessive GWG to large numbers of people.

The objective of this study was to create a novel measure of Internet-based intervention usage patterns and examine whether usage of an Internet-based intervention is associated with reduced risk of excessive GWG.

The website featured blogs, local resources, articles, frequently asked questions (FAQs), and events that were available to women in both the intervention and control arm. Weekly reminders to use the website and to highlight new content were emailed to participants in both arms. Only intervention arm participants had access to the weight gain tracker and diet and physical activity goal-setting tools. A total of 1335 (898 intervention and 437 control) relatively diverse and healthy pregnant women were randomly assigned to the intervention arm or control arm. Usage patterns were examined for both intervention and control arm participants using latent class analysis. Regression analyses were used to estimate the association between usage patterns and three GWG outcomes: excessive total GWG, excessive GWG rate, and GWG.

Five usage patterns best characterized the usage of the intervention by intervention arm participants. Three usage patterns best characterized control arm participants’ usage. Control arm usage patterns were not associated with excessive GWG, whereas intervention arm usage patterns were associated with excessive GWG.

The control and intervention arm usage pattern characterization is a unique methodological contribution to process evaluations for self-directed Internet-based interventions. In the intervention arm some usage patterns were associated with GWG outcomes.

eMoms: Electronically-mediated weight interventions for pregnant and postpartum women. Study design and baseline characteristics

This article was published July 2015 in Contemporary Clinical Trials.

This article was written by: Isabel Diana Fernandez, Susan W. Groth, Jennifer E. Reschke, Meredith L. Graham, Myla Strawderman, and Christine M. Olson.

Here is the abstract for this article:
The influence of childbearing in the development of obesity is situated within two different but related contexts: pregnancy-related weight gain and weight gain prevention and control in young adult women. Pregnancy related weight gain contributes to long-term weight retention in childbearing women.

To present the study design, data collection procedures, recruitment challenges, and the baseline characteristics for the eMoms of Rochester study, a randomized clinical trial testing the effect of electronically-mediated behavioral interventions to prevent excessive gestational weight gain (GWG) and postpartum weight retention among women aged 18–35 years of diverse income and racial/ethnic backgrounds in an urban setting.

Randomized double blind clinical trial. A total of 1722 women at or below 20 weeks of gestation were recruited primarily from obstetric practices and randomized to 3 treatment groups: control arm; intervention arm with access to intervention during pregnancy and control at postpartum (e-intervention 1); and intervention arm with access to intervention during pregnancy and postpartum (e-intervention 2). Enrollment and consent were completed via study staff or online. Data were collected via online surveys, medical charts, and measurement of postpartum weights. The primary endpoints are gaining more weight than recommended by the Institution of Medicine guidelines and weight retained at 12 months postpartum.

This study will provide evidence on the efficacy of behavioral interventions in the prevention of excessive GWG and postpartum weight retention with potential dissemination to obstetric practices and/or health insurances.

The Theory, Development, and Implementation of an e-Intervention to Prevent Excessive Gestational Weight Gain: e-Moms Roc

This article was published December 2014 in Telemedicine and e-Health.

This article was written by: Meredith L. Graham, Keriann H. Uesugi,
Jeff Niederdeppe, Geri K. Gay, and Christine M. Olson.

Here is the abstract for this article:
Background: Gaining more weight during pregnancy than is recommended by the Institute of Medicine is prevalent and contributes to the development of obesity in women. This article describes the development and use of e-Moms of Rochester (e-Moms Roc), an electronic intervention (e-intervention), to address this health issue in a socioeconomically diverse sample of pregnant women.

Materials and Methods: Formative research in the form of intercept interviews, in-depth interviews, and focus groups was conducted to inform the design of the e-intervention. The Web site continuously tracked each participant’s use of e-intervention features.

Results: An e-intervention, including Web site and mobile phone components, was developed and implemented in a randomized control trial. Formative research informed the design. Participants in all arms accessed blogs, local resources, articles, frequently asked questions, and events. Participants in the intervention arms also accessed the weight gain tracker and diet and physical activity goal-setting tools. Overall, 80% of women logged into the Web site and used a tool or feature at least twice. Among those in the intervention arm, 70% used the weight gain tracker, but only 40% used the diet and physical activity goal-setting tools.

Conclusions: To maximize and sustain potential usage of e-Moms Roc over time, the e-intervention included customized reminders, tailored content, and community features such as blogs and resources. Usage was comparable to those in other weight studies with young adults and higher than reported in a published study with pregnant women. This e-intervention specifically designed for pregnant women was used by the majority of women.

The full article is available online at:

Determinants of Pregnant Women’s Online Self-Regulatory Activities for Appropriate Gestational Weight Gain

This article was published in September 2014 in Health Communication.

This article was written by: Hye Kyung Kim, Jeff Niederdeppe, Jamie Guillory, Meredith Graham, Christine Olson and Geri Gay.

Here is the abstract for the research article:
This study examined psychosocial and sociodemographic factors associated with pregnant women’s use of Web-based tools to set and monitor personal goals for healthy diet and physical activity. These tools were made available to women participating in a randomized trial testing a Web-based intervention to promote appropriate gestational weight gain. We used data from a baseline survey of pregnant women assigned to the intervention group and log data on women’s use of various intervention features (N = 873). Women who believed that appropriate gestational weight gain would lead to healthy outcomes for their child were more likely to engage in online goal-setting and self-monitoring. Less positive outcome expectancy beliefs about the relationship between their own weight and baby’s health partially explains why some at risk subpopulations (e.g., African-American women) were less likely to utilize online self-regulatory tools. This study specifies key psychosocial and motivational factors that guide the construction and monitoring of goals among pregnant women. These findings offer guidance for the design of interventions to promote self-regulatory techniques by identifying groups for whom those features are most likely to be useful, as well as psychological determinants of their use.

The full article is available at:

How an Online Intervention to Prevent Excessive Gestational Weight Gain Is Used and by Whom: A Randomized Controlled Process Evaluation

This article was published in August 2014 in the Journal of Medical Internet Research.

This article was written by: Margaret Demment, Meredith Graham, and Christine Olson

Here is the abstract for the research article:

Background: Online interventions have emerged as a popular strategy to promote healthy behaviors. Currently, there is little agreement about how to capture online intervention engagement. It is also uncertain who engages with weight-related online interventions and how engagement differs by demographic and weight characteristics.

Objective: The objectives of this study were to (1) characterize how pregnant women engaged with features of an online intervention to prevent excessive gestational weight gain, (2) identify demographic and weight status subgroups of women within the sample, and (3) examine differences in use of intervention features across the demographic and weight status subgroups.

Methods: A sample of racially and socioeconomically diverse pregnant women from a northeastern US city was assigned to the intervention group in a randomized controlled trial to prevent excessive gestational weight gain (n=1014). The intervention website included these features: weight-gain tracker, health-related articles, blogs, physical activity and diet goal-setting tools, and local resources. Engagement variables were created to capture the amount, consistency, and patterns of feature use across pregnancy using latent class analysis. Demographic/weight status subgroups were also created using latent class analysis. Differences in engagement across the demographic/weight status subgroups were examined using chi-square analysis.

Results: Six engagement patterns emerged: “super-users” (13.02%, 132/1014), “medium-users” (14.00%, 142/1014), “consistent weight-tracker users” (14.99%, 152/1014); “almost consistent weight-tracker users” (21.99%, 223/1014), “inconsistent weight-tracker users” (15.98%, 162/1014), and “non-users” (20.02%, 203/1014). Four demographic/weight status subgroups emerged: three minority and one white. There were different engagement patterns by demographic/weight status subgroups. Super-users were more likely to be in the white subgroup, while non-users were more likely to be in the minority subgroups. However, around a third of women in minority subgroups were consistently or almost consistently engaging with the weight-tracker (black, young women, 32.2%, 67/208; black, heavier women, 37.9%, 50/132; Hispanic women, 27.4%, 32/117).

Conclusions: While white and higher income women had higher engagement in general, depending on the measure, there was still considerable engagement by the minority and low-income women.

The full article is available at:

Barriers to weight-related health behaviors: A qualitative comparison of the socio-ecological conditions between pregnant and postpartum low-income women

This article was published online in July 2014 in the Maternal and Child Nutrition Journal.

The authors are Meredith L. Graham, Keriann H. Uesegi and Christine M. Olson.

The abstract for the research publication is included here:

The association between socioecological factors and poor health outcomes for low-income women and their children has been the focus of disparities research for several decades. This research compares the socioecological conditions among low-income women from pregnancy to post-partum and highlights the factors that make weight management increasingly difficult after delivery.

As part of the formative research for an online health intervention, group and individual interviews were conducted with low-income pregnant and post-partum women. Five pregnancy group interviews (n = 15 women), five post-partum group interviews (n = 23 women) and seven individual interviews with a total of 45 participants were conducted in Rochester, New York. All interviews were audio-recorded. The constant comparative method was used to code interview notes and identify emergent themes.

Subjects faced many challenges that affected their attitudes, beliefs and their ability to maintain or improve healthy weight behaviours. These included unemployment, relationship issues, minimal social support, lack of education, limited health care access, pre-existing medical conditions and neighbourhood disadvantage. Compared with pregnant women, post-partum women faced additional difficulties, such as child illnesses and custody issues. The most striking differences between pregnancy and post-partum related to the family’s medical problems and greater environmental constraints.

Many factors detracted from women’s capacity to engage in healthy weight behaviours post-partum, including challenges present prior to delivery, challenges present prior to delivery that worsen after delivery, and new challenges that begin after delivery. These additional post-partum challenges need to be considered in designing programmes, policies and interventions that promote healthy weight.

Does Social Support Predict Pregnant Mothers’ Information Seeking Behaviors on an Educational Website?

This article was published in March 2014 in the Maternal and Child Health Journal.

Authors are: Jamie Guillory, Jeff Niederdeppe, Hyekung Kim, J. P. Pollak, Meredith Graham, Christine Olson, Geri Gay

Abstract is included here:

We examine how social support (perceived support and support from a spouse, or committed partner) may influence pregnant women’s information seeking behaviors on a pregnancy website. We assess information seeking behavior among participants in a trial testing the effectiveness of a web-based intervention for appropriate gestational weight gain.

Participants were pregnant women (N = 1,329) recruited from clinics and private practices in one county in the Northeast United States. We used logistic regression models to estimate the likelihood of viewing articles, blogs, frequently asked questions (FAQs), and resources on the website as a function of perceived social support, and support from a spouse or relationship partner. All models included socio-demographic controls (income, education, number of adults and children living at home, home Internet use, and race/ethnicity).

Compared to single women, women who were married or in a committed relationship were more likely to information seek online by viewing articles (OR 1.95, 95 % CI [1.26–3.03]), FAQs (OR 1.64 [1.00–2.67]), and blogs (OR 1.88 [1.24–2.85]). Women who felt loved and valued (affective support) were more likely to seek information by viewing articles on the website (OR 1.19 [1.00–1.42]). While the Internet provides a space for people who have less social support to access health information, findings from this study suggest that for pregnant women, women who already had social support were most likely to seek information online. This finding has important implications for designing online systems and content to encourage pregnant women with fewer support resources to engage with content.

Article is available at:

The web of risk factors for excessive gestational weight gain in low income women

This article was published in February 2013 in the Maternal and Child Health Journal.

Authors are: Keriann H. Paul, Meredith L. Graham, Christine M. Olson

The abstract for the research publication is included here:

The objective of this study is to gain an in-depth understanding of issues related to gestational weight gain (GWG) including general health, diet, and physical activity among high and low income women and to elucidate socio-ecological and psychosocial risk factors that increase risk for excessive GWG.

We conducted 9 focus groups with high (n = 4 groups) and low (n = 5 groups) income pregnant women aged 18-35 years to discuss health, GWG, diet and physical activity following a discussion guide. The constant comparative method was used to code focus group notes and to identify emergent themes. Themes were categorized within the integrative model of behavioral prediction.

Low income women, in contrast to high income women, had higher BMIs, had more children, and were African American. Diet and physical activity behaviors reported by low income women were more likely to promote positive energy balance than were those of high income women. The underlying behavioral, efficacy, and normative beliefs described by both groups of women explained most of these behaviors. Experiencing multiple risk factors may lead to (1) engaging in several behavior changes during pregnancy unrelated to weight and (2) holding more weight gain-promoting beliefs than weight maintaining beliefs.

These factors could inhibit diet and physical activity behaviors and/or behavior changes that promote energy balance and in combination, result in excessive GWG. Low income women experience multiple risk factors for excessive GWG and successful interventions to prevent excessive GWG and pregnancy related weight gain will need to recognize the complex web of influences.

The article is available at: