Abstract
OBJECTIVE: To assess whether participation in a health system-administered, telephone-based health coaching program during pregnancy was associated with lower gestational weight gain or postpartum weight retention and whether associations differed by the number of sessions or timing of participation. METHODS: In this retrospective cohort study, we used electronic health record data to identify pregnant Kaiser Permanente Northern California members with referral to a telephone-based health coaching program focused on healthy eating during pregnancy (Wellness Coaching in Pregnancy) from 2020 to 2022. Outcomes of interest were total gestational weight gain and postpartum weight retention up to 14 months postpartum. We also assessed the number and trimester of completed sessions. Regression models, weighted by the inverse probability of treatment weights calculated using a propensity score model containing maternal demographic, behavioral, and health characteristics, were used to estimate associations of Wellness Coaching in Pregnancy participation with gestational weight gain categories based on Institute of Medicine (IOM, now known as the National Academy of Medicine) recommendations and continuous postpartum weight retention. We also examined results stratified by the number of sessions completed and by trimester of initiation of Wellness Coaching in Pregnancy. RESULTS: The final cohort consisted of 931 individuals with 935 pregnancies (four individuals had two pregnancies during the study period); 525 pregnant individuals (56.1%) participated in Wellness Coaching in Pregnancy after referral, with a median of two completed sessions. Overall, Wellness Coaching in Pregnancy was not associated with gestational weight gain or postpartum weight retention. In secondary analyses, completing the first session of Wellness Coaching in Pregnancy in the first trimester was associated with 40% lower odds of gestational weight gain above IOM recommendations (adjusted odds ratio 0.60; 95% CI, 0.39-0.94) and 2.2 kg lower adjusted mean difference in postpartum weight retention up to 14 months postpartum (95% CI, -3.7 to -0.7) compared with individuals who were referred but did not participate in Wellness Coaching in Pregnancy. The number of sessions completed was not associated with gestational weight gain or postpartum weight retention. CONCLUSION: Within a large, integrated health care delivery system, an individualized health coaching program focused on healthy eating during pregnancy was not associated with gestational weight gain and postpartum weight retention overall. However, when health coaching was initiated in early pregnancy, it was beneficially associated with reduced excessive gestational weight gain and postpartum weight retention.