Understanding Pregnancy and Postpartum Health Using Ecological Momentary Assessment and Mobile Technology: Protocol for the Postpartum Mothers Mobile Study

Abstract

Background: There are significant racial disparities in pregnancy and postpartum health outcomes, including postpartum weight retention and cardiometabolic risk. These racial disparities are a result of a complex interplay between contextual, environmental, behavioral, and psychosocial factors.

Objective: This protocol provides a description of the development and infrastructure for the Postpartum Mothers Mobile Study (PMOMS), designed to better capture women's daily experiences and exposures from late pregnancy through 1 year postpartum. The primary aims of PMOMS are to understand the contextual, psychosocial, and behavioral factors contributing to racial disparities in postpartum weight and cardiometabolic health, with a focus on the daily experiences of stress and racism, as well as contextual forms of stress (eg, neighborhood stress and structural racism).

Methods: PMOMS is a longitudinal observation study that is ancillary to an existing randomized control trial, GDM² (Comparison of Two Screening Strategies for Gestational Diabetes). PMOMS uses an efficient and cost-effective approach for recruitment by leveraging the infrastructure of GDM², facilitating enrollment of participants while consolidating staff support from both studies. The primary data collection method is ecological momentary assessment (EMA) and through smart technology (ie, smartphones and scales). The development of the study includes: (1) the pilot phase and development of the smartphone app; (2) feedback and further development of the app including selection of key measures; and (3) implementation, recruitment, and retention.

Results: PMOMS aims to recruit 350 participants during pregnancy, to be followed through the first year after delivery. Recruitment and data collection started in December 2017 and are expected to continue through September 2020. Initial results are expected in December 2020. As of early May 2019, PMOMS recruited a total of 305 participants. Key strengths and features of PMOMS have included data collection via smartphone technology to reduce the burden of multiple on-site visits, low attrition rate because of participation in an ongoing trial in which women are already motivated and enrolled, high EMA survey completion and the use of EMA as a unique data collection method to understand daily experiences, and shorter than expected timeframe for enrollment because of the infrastructure of the GDM² trial.

Conclusions: This protocol outlines the development of the PMOMS, one of the first published studies to use an ongoing EMA and mobile technology protocol during pregnancy and throughout 1 year postpartum to understand the health of childbearing populations and enduring racial disparities in postpartum weight and cardiometabolic health. Our findings will contribute to the improvement of data collection methods, particularly the role of EMA in capturing multiple exposures and knowledge in real time. Furthermore, the results of the study will inform future studies investigating weight and cardiometabolic health during pregnancy and the postpartum period, including how social determinants produce population disparities in these outcomes.

International registered report identifier (irrid): DERR1-10.2196/13569.

Keywords: body weight; ecological momentary assessment (EMA); health equity; health status disparities; maternal health; postpartum; pregnancy; remote sensing technology; wireless technology.

Figure 1

General flow of activities and data collection for the Postpartum Mothers Mobile Study (PMOMS), including the points where research activities for PMOMS and the Comparison of Two Screening Strategies for Gestational Diabetes (GDM²) trial intersect, as indicated by the arrows. Note that PMOMS replicates GDM² protocols for the postpartum assessments and final study visit. EMA: ecological momentary assessment.

Figure 2

Recreated screenshot of Postpartum Mothers Mobile Study app prompting a participant to complete their beginning of day survey.

Figure 3

Plot of the variogram 2γ(r), an increasing function of lag time r between pairs of observations of a specified outcome.

Figure 4

Left panel: a spaghetti plot of the variograms for confidence from random assessments of each of the Advancing Real-Time Data Collection with Adaptive Sampling and Innovative Technologies participants. Right panel: variograms for 4 select participants (A-D).

Figure 5

The 4-tier architecture of Postpartum Mothers Mobile Study application and technology infrastructure.

Figure 6

Recreated screenshot of Postpartum Mothers Mobile Study survey app requesting permission to collect geolocation data.