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Effect of Telehealth on Promoting a Healthy Lifestyle and Weight Control Among Pregnant Women
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Nikki Maleki1    , Erfan Teymuri2 , Maryam Mahmoudi3 , Fatemeh Hajialiasgari4 , Ardalan Shariat5 , Negar Hassanzadeh *6 |
1- Master's Student of Telehealth, Department of Digital Health, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
2- Master's Student of Telehealth, Department of E-Health, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
3- Associate Professor of Nutrition, Department of Clinical Nutrition, School of Nutrition, Tehran University of Medical Sciences, Tehran, Iran.
4- Assistant Professor of Information Technology, Department of Digital Health, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
5- Assistant Professor of Telehealth, Department of Digital Health, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
6- Assistant Professor of Cardiology, Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. , hz91_negar@yahoo.com |
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Keywords: Telemedicine [MeSH], Pregnancy [MeSH], Diet [MeSH], Healthy Lifestyle [MeSH], Weight Gain [MeSH]
Article ID: Vol27-21 |
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Full-Text [PDF 765 kb]
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Type of Study: Review Article |
Subject:
Health System
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Abstract: (10 Views) |
Extended Abstract
Introduction
Obesity is one of the perennial challenges affecting individual health and healthy lifestyle, the scale of which has become unprecedented today, and its consequences for women's health and the financial burden on public healthcare are substantial. Obesity during pregnancy carries significant risks for both the mother and the fetus, including increased mortality, stillbirth, and the need for mechanical delivery. Furthermore, it leads to complications, such as gestational diabetes and gestational hypertension.
Over the past decade, there has been a surge in the utilization of affordable and accessible digital technologies to conduct lifestyle interventions and promote well-being across diverse demographic groups, such as children, elderly people, and pregnant women. Collectively, these methods are known as telehealth and encompass both online and offline applications of mass communication devices, particularly mobile phones, which is specifically known as mobile health (mHealth). The provision of such services must adhere to ethical considerations and established regulations in this domain.
The prevalence of utilizing telehealth applications in the fields of public health and medical care has culminated in a significant transformation in human lives. These applications employ behavior change techniques (BCTs), such as sending reminders, providing counseling, reinforcement, and education, to enhance program adherence and manage chronic illnesses, including cardiovascular diseases.
Telehealth in prenatal healthcare, facilitated by digital technologies (including applications and text messages), has contributed to improving pregnant women’s health behaviors and reducing gestational weight gain (GWG). Furthermore, by decreasing the number of required medical visits, it leads to a reduction in the financial burden. Therefore, this systematic review was conducted to evaluate the effect of telehealth on promoting a healthy lifestyle and weight control in pregnant women.
Methods
The current review was conducted based on search results from databases and libraries, including PubMed, Google Scholar, and Scopus, within the Patient, Intervention, Comparison, and Outcome (PICO) framework.
The search utilized relevant keywords, including “telehealth, telemedicine, eHealth, mHealth, pregnancy, healthy lifestyle, pregnant women, weight gain, diet plan, and nutrition.” Articles related to these topics were selected based on the researcher's objective to examine the effect of telehealth on promoting a healthy lifestyle and weight control in pregnant women.
In the initial stage, 631 articles published during 2020-2024 were identified. After reviewing the titles and excluding irrelevant articles, those without full texts, and other items, such as protocols and books, 15 articles were ultimately selected and thoroughly evaluated. These final articles were chosen because they aligned with the research objectives following review and summarization, and possessed clear methodologies.
Discussion and Conclusion
A study by Ferrara et al. on 398 pregnant women with a body mass index (BMI) ranging from 25 to 40 kg/m2 demonstrated that the telehealth intervention group, which utilized remote healthy lifestyle recommendations, had a lower mean weekly weight gain compared to the standard care group (0.26 kg versus 0.32 kg). Additionally, a study by van Dijk et al. in the Netherlands investigated on women aged 18 to 45 and their spouses who were either planning a pregnancy or were less than 13 weeks pregnant. Following 24 weeks, the remote healthy lifestyle recommendations intervention (smarter pregnancy) was shown to be effective in improving dietary behaviors, particularly vegetable consumption in women compared to the control group. Similarly, Holmes et al.’s study investigated 83 pregnant women over 18 years of age with overweight or obesity (BMI=20−45 kg/m2) between 15 and 20 weeks of gestation in Hawaii. To achieve significant improvement in the control of gestational weight gain, interventions initiated pre-conceptionally that incorporate personalized and interactive messaging may prove more effective, a point that underscores the importance of personalizing telehealth programs.
In Sandborg et al.’s qualitative study, the participation and satisfaction of 19 women in a randomized controlled trial (RCT) involving the HealthyMoms application were investigated. Based on the findings, HealthyMoms was recognized as a reliable tool for controlling GWG and was able to enhance users' awareness and motivation in adhering to a healthy lifestyle during pregnancy.
Conversely, in a mHealth trial conducted by Woo Baidal et al. (2021), although information regarding a healthy lifestyle was provided, the pictorial health warning labels and information about the sugar content of beverages did not succeed in reducing maternal consumption of sugar-sweetened beverages (SSBs).
Furthermore, a five-week, single-group intervention study, published by Giacobbi et al. (2021), instructed participants to listen daily to an audio file within a mHealth application. This intervention led to significant improvements in the participants’ psychological and physical status (remotely enhancing their health levels).
In the study by Leziak et al. on pregnant and postpartum women, it was determined that pregnant and postpartum women, particularly those with diabetes, demonstrated a favorable inclination toward mHealth technology for supporting adherence to lifestyle guidelines and therapeutic needs, thereby promoting a healthy pregnancy.
In Downs et al.’s two-group RCT, which investigated the effect of interventions on gestational excessive weight gain in overweight or obese pregnant women, the intervention group demonstrated lower caloric intake compared to the control group.
Sandborg et al.’s study assessed the effects of a six-month intervention (using the HealthyMoms application) compared to routine childbirth care on GWG, obesity, dietary habits, moderate-to-vigorous physical activity (MVPA), blood glucose levels, and insulin resistance. Although no significant effect was generally observed on GWG, the results revealed the potential of the HealthyMoms application as a platform for telehealth service provision to promote healthy dietary behaviors and weight loss during pregnancy in overweight and obese women.
Greene et al.’s research study on the pregnancy, exercise, and nutrition research study with smartphone application support (PEARS) and utilizing mHealth in a blended lifestyle intervention for pregnant women with overweight and obesity indicated that, overall, the PEARS intervention and the use of a supportive smartphone application were accepted by pregnant women, particularly those from vulnerable groups within this population.
Souza et al.’s study demonstrated that women who used the SmartMoms Canada application more frequently exhibited higher mean levels of MVPA (averaging 17.84 minutes more per day).
Furthermore, in the study by Henriksson et al., a higher number of log-ins to the HealthyMoms application was associated with both a reduced GWG and improved dietary quality.
Mattson et al.’s research indicated that the use of telehealth for nutritional counseling and the precise collection of remote weight data may constitute part of a comprehensive strategy for controlling GWG in high-risk populations.
In total, various studies have demonstrated that mHealth interventions, including applications, text messages, and online education, are able to promote healthy behaviors during pregnancy. These interventions often led to increased vegetable consumption, higher physical activity, and improved dietary quality. In some studies, the intervention group experienced less GWG; however, these differences were not always statistically significant.
The reviewed studies exhibited several significant limitations. For instance, the participants' awareness of their group and the difference in the level of interaction with research staff between the two groups complicated the assessment of the net effect of the intervention. A subsequent limitation was the small sample size observed in some studies. There were also limitations, such as non-random allocation of groups and the use of self-reported measurements, such as pre-pregnancy weight, which may have resulted in reporting bias and a reduction in generalizability. Language limitations were also noted in certain studies.
Finally, mHealth is a promising tool for weight management in pregnant women. However, improving intervention design, increasing sample sizes, and considering the aforementioned limitations could contribute to enhancing the impact and generalizability of this approach.
Ethical Statement
The study was approved by the Research Ethics Committee of the School of Medicine, Tehran University of Medical Sciences (IR.TUMS.MEDICINE.REC.1404.303).
Funding
This study has been extracted from a research project (No. 91870) approved by the School of Medicine, Tehran University of Medical Sciences.
Conflicts of Interest
No conflict of interest.
Acknowledgments
We would like to thank Dr. Gholamreza Hassanzadeh, the esteemed Director of the Digital Health Department at the School of Medicine, Tehran University of Medical Sciences, for his invaluable guidance in conducting this study.
Authors' Contributions
Nikki Maleki: Project administration and design, Project execution, Interpretation of the results, Drafting of the initial manuscript.
Erfan Teymuri: Project execution, Data analysis, Interpretation of the results, Drafting of the initial manuscript.
Maryam Mahmoudi (Ph.D): Project administration and design, Project execution, Drafting of the initial manuscript, Approval of the final manuscript.
Fatemeh Hajialiasgari (Ph.D): Project administration and design, Project execution, Interpretation of the results, Approval of the final manuscript.
Ardalan Shariat (Ph.D): Project administration and design, Project execution, Interpretation of the results, Drafting of the initial manuscript.
Negar Hassanzadeh (M.D): Project administration and design, Project execution, Data collection, Interpretation of the results, Approval of the final manuscript.
Key Message: Improving nutritional behaviors and lifestyle, managing GWG, factors influencing the efficacy of interventions, and emphasizing the importance of early initiation of interventions are effective in telehealth.
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Maleki N, Teymuri E, Mahmoudi M, Hajialiasgari F, Shariat A, Hassanzadeh N. Effect of Telehealth on Promoting a Healthy Lifestyle and Weight Control Among Pregnant Women. J Gorgan Univ Med Sci 2025; 27 (3) :1-9 URL: http://goums.ac.ir/journal/article-1-4556-en.html
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