The effects of a community-based multicomponent behavioral eHealth intervention for low-income pregnant individuals on dietary intake: The "SmartMoms in WIC" randomized clinical trial.

BACKGROUND

Pregnant individuals with low-income face socioeconomic barriers affecting nutrition and increasing risk for gestational weight gain (GWG) outside of recommendations. A multicomponent eHealth intervention lowered GWG, but the contribution of dietary changes remains unknown.

OBJECTIVE

The objective of the study was to evaluate intervention effects on dietary intake and its association with GWG.

DESIGN

The ∼24-week, investigator- and assessor-blinded, parallel-arm randomized clinical trial "SmartMoms in WIC", conducted between July 2019 and May 2024, assessed dietary intake by 24-hour recalls and Healthy Eating Index (HEI)-2020 in early (10,0-16,6 weeks) and late (35,0-37,6 weeks) pregnancy. GWG (kg) was calculated as late minus early pregnancy weight, and weekly GWG (g/week) as total GWG divided by weeks between visits.

PARTICIPANTS

/setting: Pregnant individuals (n=351) in Louisiana Women, Infants, and Children (WIC) program were randomized to Intervention (n=179) or Usual Care (n=172) at 15.2±1.6 (mean ± SD) weeks gestation.

INTERVENTION: The intervention supported dietary intake modification through health education, cooking equipment and recipes, in addition to WIC services. Usual Care received WIC services only.

MAIN OUTCOME MEASURES: Dietary intake included total energy, macro- and micronutrients, and food components, with HEI-2020 assessing alignment with the 2020-2025 Dietary Guidelines for Americans.

STATISTICAL ANALYSES PERFORMED: Linear mixed models assessed intervention effects on dietary intake and linear models examined associations with GWG, reporting estimated means, 95% confidence intervals, and P values.

RESULTS

From early to late pregnancy, energy intake did not change in the Intervention Group (-44 kcal/d; 95% CI: -179, 92; P=0.53, Padj=0.79) compared to an increase of 263 kcal/d (95% CI: 123, 402; P<0.001; Padj=0.001) in Usual Care, yielding a significant between-group difference of -306 kcal/d (95% CI: -500, -112; P=0.002; Padj=0.008). The Intervention Group had a greater increase in protein proportion (+2% total energy; 95% CI: 0.4, 3.5; P=0.02; Padj=0.03), and decreased intake of total fat (-12 g/day; 95% CI: -22, -3; P=0.01; Padj=0.02) and carbohydrate (-48 g/day; -75, -21; P<0.001; Padj=0.008) versus Usual Care. Dietary intake changes did not predict GWG.

CONCLUSIONS

By integrating a remote eHealth intervention within WIC's established framework, the intervention resulted in maintained energy intake in the Intervention Group, while the Usual Care Group showed increases in total energy, fat, and carbohydrate intake, and unhealthier food choices.