Discussion
obesity, GDM [, macrosomia, placental disorders, GDM, overweight
OBESITY, PRE-ECLAMPSIA, OBESE, POSTPARTUM HEMORRHAGE, HYPERTENSIVE DISEASE, CHORIOAMNIONITIS, GESTATIONAL DIABETES MELLITUS, PLACENTAL DISORDERS, UTERINE RUPTURE, NEONATAL ASPHYXIA, GESTATIONAL HYPERTENSION, GDM, PROLONGED LABOR
In this study, our data showed that smartphone assisted weight management can help reduce the CS rate in overweight pregnant women, but not obese ones. The rate of postpartum hemorrhage is also lower in the intervention group, compared to the control group. However, the differences of gestational hypertension, GDM, neonatal asphyxia, and macrosomia are not significant between the two groups.Maternal obesity is an independent risk factor of adverse pregnancy outcomes, such as pre-eclampsia, CS and macrosomia. Both in Western countries and China, overweight and obese women were more likely to require a CS, compared with those of normal weight, and the risk of obesity is even higher than overweight [How smartphone assisted weight control can affect CS rate remains largely unclear. However, our data suggest that the App intervention might function via GWG restriction. Several studies showed excessive GWG resulted in higher CS rate. A meta-analysis, including 23 studies and over 1.3 million women, reported that GWG above Institute of Medicine (IOM) guidelines was associated with higher risk of CS for overweight women (OR, 1.29 [95% CI, 1.21–1.39]) and obese women (OR, 1.22 [95% CI, 1.05–1.42]) [In this study, the adherence we used is only a rough estimation of the frequency the participants used the App. Because we do not design a questionnaire to learn directly from them about the intensity they use the App and how strictly they follow the advice provided by the App, we do not exactly know how strong the App affects their lifestyle to control GWG. Nevertheless, the women who used the App more frequently had less GWG. This is consistent with other studies which try to explore the effects of digital health interventions on weight control [In addition to CS rate, we also found lower rate of postpartum hemorrhage in the intervention group than the control group. According to a recent systematic review and meta-analysis, six variables were found to be definite risk factors for postpartum hemorrhage, which were Asian race, a history of prior postpartum hemorrhage, preexisting or gestational diabetes mellitus, placental disorders and prolonged labor. Nine additional variables were likely its associated factors, such as Hispanic ethnicity, nulliparity, hypertensive diseases of pregnancy, multiple gestation, chorioamnionitis, uterine rupture, predelivery oxytocin exposure, induction of labor, and instrumented vaginal delivery [Although GWG is associated with GDM and excessive GWG increase the risk of GDM [