Effectiveness of Whatsapp Messages in Gestational Weight Gain

Obesity has become an epidemic all over the world. As a result of the Turkey Demographic and Health Survey (TDHS) conducted in our country in 2018, 29% of women were found to be overweight and 30% were obese. It has been determined that there is a major relationship between maternal obesity and excessive gestational weight gain (GWG) . In the prevention of maternal obesity; In 2009, the American Institute of Medicine (IOM) presented the recommendations of the American Institute of Medicine (IOM) according to the pregnancy-onset body mass index (BMI) groups in order to prevent excessive gestational weight gain (GKA) of women and to reduce the negative health consequences that may develop in the mother and baby. According to the pre-pregnancy BMI published by the American Institute of Medicine (IOM), the intended weight gain during pregnancy has also been adopted by ACOG . In recent studies; According to the recommendations of the IOM guideline of 2009, it has been determined that 43%-73% of women have excessive WHA . In societies where the prevalence of maternal obesity is rapidly increasing, weight management strategies focus especially on pregnancy and postpartum period . Pregnancy period; This is the best time for women to make an effort to develop healthy lifestyle behaviors. A combination of effective weight control interventions, healthy eating, increased physical activity, and behavioral therapy is used to prevent excessive SCA during pregnancy. While these interventions are sent in face-to-face formats; some individuals may perceive attending these sessions as a burden, possibly limiting pre-program participation. Computer and internet technology offers innovative and alternative distribution channels that can appeal to people looking for more comfortable and anonymous environments. Computer and Internet-based programs can be acceptable and successful if structured similarly to personal treatment programs . As a result; Rapid increases in internet access have become a viable and logical situation for health intervention. Based on all this, are the interventions for healthy eating and physical activity via whatsapp, an online phone application that is widely used by everyone today, effective in appropriate gestational weight gain? Based on this question, the research was planned.

Study; investigates the effectiveness of WhatsApp, an online phone application, by using motivational interviewing techniques in providing appropriate gestational weight gain in pregnant women. This experimental type study will be conducted with pregnant women who are registered in Ordu University Training and Research Hospital, Obstetrics and Gynecology Polyclinic, and who meet the research criteria. According to studies in the literature, it is stated that 30-40% of pregnant women adhere to the IOM guideline recommendation . At the beginning of the study, the rate of those who adhered to the IOM weight gain guide was accepted as 40% and it was aimed to increase this rate from 40 to 70% with messages containing internet and whatsapp. At the beginning of the study, at the significance level of alpha = 0.05, the sample size required to achieve 80% power was determined as 48 pregnant women for each group and a total of 96 women. After the pregnant women who are suitable for the study are determined, the consent form, the Individual Identification Form, the Scale of Healthy Life Behaviors in Pregnants, the Physical Activity Questionnaire in Pregnancy, and the Weight Monitoring Chart to be used in the research will be filled using the face-to-face interview technique. At the first meeting, women's height and pregnancy starting weight will be recorded and BMI will be calculated. For women who do not remember their initial pregnancy weight, pregnancy- puerperal follow-up forms will be used and weight measurements up to the first 10 weeks of pregnancy will be discussed. Filling out the forms will take an average of 10-15 minutes. Collection of research data; determination of pregnant women suitable for the study, randomization phase, intervention and follow-up phases. The pre-test data of all pregnant women who participated in the study at first were simultaneously 12-18. will be collected at the week of pregnancy and then randomization will be done. After the determination of the women participating in the study and the collection of pre-test data, randomization will be made by drawing lots. In addition, randomization will be ensured by ensuring homogeneity between the BMI status of the women in the intervention and control groups. Information messages about healthy nutrition and physical activity will be sent to the intervention group pregnant women via whatsapp. The study will continue 3 times a week until the 37th week and once a week after the 37th week. In order to remind the control group once a month for routine prenatal care and to prevent them from leaving the study. message will be sent. Pre-test data of intervention and control groups 12-18. and post-test data will be collected at 36-38 weeks of gestation. For data analysis; The analysis of the data obtained in the research will be done with the statistical package program. Descriptive statistics in data analysis (socio-demographic characteristics of pregnant women and their spouses, family characteristics, pregnancy/obstetric characteristics); will be displayed as numbers and percentages. Kruskal-Wallis analysis of variance in order to determine the relationship between the mean BMI levels of pregnant women and their age groups, education levels, education levels of their spouses, income status, number of children, gestational week, pregnancy planning status, pre-pregnancy BMI, number of receiving antenatal care during pregnancy, Then, it will be analyzed using the Tukey HSD test and Tamhane 2 test, which are "post hoc" multiple comparison methods. Again, BMI levels of pregnant women will be evaluated by analysis of variance (ANOVA) in order to determine the relationship between their average score and the duration of marriage, their spouse's occupation, the place where they live most, and the number of pregnancies, and then the Tukey HSD test and Tamhane 2 test, which are "post hoc" multiple comparison methods.

96 pregnant women who met the criteria for inclusion in the study and volunteered to participate in the study were divided into control and intervention groups by the statistical unit, using the randomization technique, using a simple random numbers table. Randomization was achieved by ensuring homogeneity between the BMI status of the women in the intervention and control groups.

All pregnant women participating in the study were divided into intervention and control groups by applying randomization. Pre-test data of both groups will be collected before 18th gestational week, and post-test data will be collected after 37th gestational week. Pregnant women assigned to the initiative group were added to a group established via Whatsapp. Information messages will be sent via Whatsapp on Mondays, Wednesdays and Fridays for the first 10 weeks / three times a week (up to the 28th week), and reminder messages will be sent once a week on Wednesdays between the 29th-36th weeks. When necessary, individual messages will be sent to the pregnant women and special directions will be given according to their weight gain rates.

In the same way, a Whatsapp group will be set up to the control group and messages will be sent once a month about the subjects included in antenatal care up to 37 weeks. Topics included in routine maintenance will be included.

Informative messages will be sent to the initiative group on Mondays, Wednesdays and Fridays for the first 10 weeks / three times a week (up to the 28th week), and reminder messages will be sent once a week on Wednesdays between the 29th-36th weeks.

Gestational weight gain rate in line with IOM guideline, Thanks to the intervention, it is expected that the average weight gain of the pregnant women in the intervention group will be lower than the control group.

Compliance with the IOM guideline 2009,Thanks to the intervention, it is expected that the pregnant women in the intervention group will have higher rates of appropriate weight gain according to the 2009 IOM guideline compared to the control group.

Compliance status of the total weight gained until the 37th week of pregnancy according to the IOM guideline

Inclusion Criteria: Between the ages of 18-45, Using Whatsapp, Having a smart phone and using the internet, At least primary school graduate/literate, Does not have any chronic and psychological disorders, Having spontaneous pregnancy, Volunteer to participate in the research, Pregnancy below the 16th week of participation in the study, Not having any physical disability, Pregnant women with low pregnancies with low BMI and not morbidly obese were included in the study. Exclusion Criteria: Dropping out of research participation and initiative program, Low, Giving birth before 37 weeks, Having multiple pregnancy, Those who did not have a spontaneous pregnancy were not included in the study.