SmartMom: Teaching by Texting to Promote Health Behaviours in Pregnancy

Official title

Teaching by Texting to Promote Health Behaviours in Pregnancy

Overview

The goal of this randomized clinical trial is to evaluate the effectiveness of SmartMom, a text messaging-based mobile health program for prenatal education. The main questions are to determine if healthy pregnant people receiving SmartMom messages that promote health behaviours in pregnancy versus messages that don't provoke behaviour change have improvement in: 1. knowledge about healthy pregnancy and birth 2. standardized measures of depression, anxiety, and fear of childbirth 3. adoption of positive health behaviours in pregnancy 4. maternal, fetal, and newborn outcomes Participants in the intervention group will receive three evidence-based text messages per week, plus optional supplemental messages on topics relevant to them, throughout pregnancy. The control group will receive general interest messages on pregnancy-related topics that are not promoting behaviour change.

Interventions

• Behavioral SmartMom text messaging
  SmartMom is a mobile health program delivered via text messaging that guides participants through each week of pregnancy. Participants receive three messages per week with links to content focused on improving knowledge, providing information about prenatal assessments and screening, and encouraging the adoption of behaviours to support healthy pregnancy and physiologic birth. Messages are consistent with current professional guidelines and peer reviewed prenatal education curricula. SmartMom pr
• Behavioral Control text messaging
  Control arm participants will receive weekly text messages with accurate, general-interest information about pregnancy and about progress of the trial. Content is not geared to decision-making during pregnancy that may affect health outcomes.

Primary outcome measures

• Change in weight during pregnancy [Time frame: Enrollment, 38 weeks gestation]
• Attendance at prenatal care visits through pregnancy [Time frame: 38 weeks gestation]

Secondary outcome measures (10)

• Changes in health knowledge through pregnancy [Time frame: Enrollment, 38 weeks gestation]
• Health literacy at end of pregnancy [Time frame: 38 weeks gestation]
• Changes in fear of childbirth through pregnancy [Time frame: Enrollment, 38 weeks gestational age]
• Changes in depression through pregnancy [Time frame: Enrollment, 38 weeks gestational age]
• Changes in anxiety through pregnancy [Time frame: Enrollment, 38 weeks gestational age]
• Changes in use of tobacco, vaping, alcohol, or cannabis through pregnancy among users. [Time frame: Enrollment, 38 weeks gestational age]
• Rates of planned vaginal birth after cesarean [Time frame: 38 weeks gestation]
• Rates of exclusive breastfeeding at hospital discharge [Time frame: 1 month post birth]
• Rates of adverse pregnancy outcomes as measured by gestational diabetes, stillbirth, preterm birth (<37 weeks gestation) and small for gestational age (SGA) status at birth. [Time frame: 1 month post birth]
• Incremental costs per incidence of suboptimal weight gain and inadequate prenatal care avoided. [Time frame: Throughout pregnancy (up to 42 weeks) and birth, including hospital admission in which birth took place (up to 7 days).]

Eligibility criteria

Inclusion criteria

• pregnant person
• at 15 weeks gestation or earlier
• singleton pregnancy
• can read and understand English at grade 8 level and comfortable completing online surveys
• live in Canada (excluding British Columbia where SmartMom has been piloted)

Exclusion criteria

• health conditions existing prior to pregnancy that require individualized care (e.g. hypertension, cardiac disease, diabetes)
• previously had a baby with the SmartMom program

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Health services research

Study locations

Canada · 1 center

• BC Children's Hospital Research Institute — Vancouver

Publications

• Debessai Y, Costanian C, Roy M, El-Sayed M, Tamim H. Inadequate prenatal care use among Canadian mothers: findings from the Maternity Experiences Survey. J Perinatol. 2016 Jun;36(6):420-6. doi: 10.1038/jp.2015.218. Epub 2016 Jan 21. PMID 26796126
• Dzakpasu S, Fahey J, Kirby RS, Tough SC, Chalmers B, Heaman MI, Bartholomew S, Biringer A, Darling EK, Lee LS, McDonald SD. Contribution of prepregnancy body mass index and gestational weight gain to adverse neonatal outcomes: population attributable fractions for Canada. BMC Pregnancy Childbirth. 2015 Feb 5;15:21. doi: 10.1186/s12884-015-0452-0. PMID 25652811
• Ganer Herman H, Dekalo A, Jubran L, Schreiber L, Bar J, Kovo M. Obstetric outcomes and placental findings in gestational diabetes patients according to maternal prepregnancy weight and weight gain. J Matern Fetal Neonatal Med. 2019 May;32(10):1682-1687. doi: 10.1080/14767058.2017.1416078. Epub 2018 Feb 5. PMID 29402158
• Munro S, Hui A, Salmons V, Solomon C, Gemmell E, Torabi N, Janssen PA. SmartMom Text Messaging for Prenatal Education: A Qualitative Focus Group Study to Explore Canadian Women's Perceptions. JMIR Public Health Surveill. 2017 Feb 7;3(1):e7. doi: 10.2196/publichealth.6949. PMID 28174149
• van den Heuvel JF, Groenhof TK, Veerbeek JH, van Solinge WW, Lely AT, Franx A, Bekker MN. eHealth as the Next-Generation Perinatal Care: An Overview of the Literature. J Med Internet Res. 2018 Jun 5;20(6):e202. doi: 10.2196/jmir.9262. PMID 29871855
• Ennis M, Renner RM, Morando-Stokoe C, James S, Janssen PA, Leckie S, Dunn S, Mazza D, Norman WV. Exploring Methods to Mitigate Fraud in Web-Based Surveys: Multicase Study Analysis. J Med Internet Res. 2025 Dec 1;27:e78671. doi: 10.2196/78671. PMID 41324984
• Janssen P, Lecke S, Renner R, Zhang W, Vedam S, Norman WV, Bayrampour H, Tough S, Murray J, Muhajarine N, Dennis CL. Teaching by texting to promote positive health behaviours in pregnancy: a protocol for a randomised controlled trial of SmartMom. BMJ Open. 2024 Jan 18;14(1):e081730. doi: 10.1136/bmjopen-2023-081730. PMID 38238058

Identifiers

NCT: NCT05793944 · H22-00603

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗