Healthy Adaptation to Pregnancy, Postpartum and Parenthood

Percentage of eligible participants who provide informed consent and are enrolled in the study.

Percentage of enrolled participants who complete the 6-month postpartum assessment.

Acceptability assessed using a study-specific questionnaire developed for the HAP3 feasibility study and informed by the Attitudes towards Psychological Online Interventions Questionnaire (APOI). The questionnaire evaluates participants' perceptions, satisfaction, and acceptance of the HAP3 Family App. Higher scores indicate greater acceptability of the intervention. The questionnaire is currently undergoing psychometric evaluation and has not yet been formally validated.

Usability measured using the mHealth App Usability Questionnaire (MAUQ). Scores range from 1 (Strongly agree) to 7 (Strongly disagree). A higher overall mean score (closer to 7.0) indicates a more favorable evaluation of the mobile health application's usability.

Behavioural Change Towards Eating Behaviour (IBEB) questionnaire, a study-specific measure based on the Stages of Change framework. Higher scores indicate greater readiness and motivation to adopt healthy eating behaviors. A total score is calculated from the questionnaire items; score range will be determined following validation of the instrument.

Evaluated using the University of Rhode Island Change Assessment (URICA) scale. The URICA is a 32-item questionnaire scored on a 5-point Likert scale (1 = Strongly Disagree, 5 = Strongly Agree). It measures four subscales representing stages of behavior change: Precontemplation, Contemplation, Action, and Maintenance.

A composite Readiness to Change score is calculated using the formula: Contemplation + Action + Maintenance - Precontemplation. Composite scores typically range from a minimum of -2 to a maximum of 14. Higher composite scores indicate a greater readiness and overall motivation to change the target behavior.

Depressive symptoms assessed using the Edinburgh Postnatal Depression Scale (EPDS). Total scores range from 0 to 30, with higher scores indicating more severe depressive symptoms.

Anxiety symptoms assessed using the 6-item State-Trait Anxiety Inventory (STAI-6). Scores range from 20 to 80 after score transformation, with higher scores indicating greater anxiety.

tress symptoms assessed using the Stress subscale of the Depression Anxiety Stress Scales-21 (DASS-21). Subscale scores range from 0 to 42 after standard scoring, with higher scores indicating greater stress.

Assessed using the Pregnancy-related Anxiety Questionnaire-Revised 2 (PRAQ-R2). The PRAQ-R2 is a 10-item self-report questionnaire scored on a 5-point Likert scale. Total scores are calculated by summing all items and range from a minimum of 10 to a maximum of 50. Higher scores indicate greater pregnancy-related anxiety.

Pregnancy-related anxiety among partners assessed using the Paternal Pregnancy-related Anxiety Scale (PPrAS). Higher scores indicate greater pregnancy-related anxiety.

Body weight measured in kilograms (kg) using standardized measurements at study visits and self-reported weight between visits (used for gastational weight gain (GWG) and postpartum weight retention (PPWR))

Body composition assessed using Bioelectrical Impedance Analysis (BIA).

The Three-Factor Eating Questionnaire-Revised 18-item (TFEQ-R18) evaluates three distinct domains of eating behavior: Cognitive Restraint (6 items evaluating conscious restriction of food intake to control weight), Uncontrolled Eating (9 items evaluating the tendency to lose control over eating when triggered by food cues), and Emotional Eating (3 items evaluating overeating in response to negative mood states). Raw item responses for each subscale are summed and linearly transformed to a standardized 0 to 100 scale. The overall outcome reports three separate subscale scores ranging from 0 to 100, where higher scores indicate greater cognitive control over food intake, a higher tendency to overeat impulsively, or a greater likelihood of eating in response to negative emotions, respectively.

The Body Image in Pregnancy and Postpartum Scale (BIPPS) evaluates multi-dimensional maternal body image dissatisfaction and physical anxieties distinct to the perinatal period. Individual questionnaire items are scored on a 5-point Likert scale (ranging from 1 to 5) and aggregated to generate an overall composite total score. Total scores range from 20 to 100, where higher scores indicate greater body image concerns, reflecting increased dissatisfaction or distress regarding physical appearance and structural bodily changes during pregnancy or postpartum phases.

Infant weight measured in kilograms (kg). Higher values indicate greater infant weight.

Infant length measured in centimeters (cm). Higher values indicate greater infant length.

Neonatal health status assessed using the APGAR score. Total scores range from 0 to 10, with higher scores indicating better neonatal health and adaptation after birth.

Infant development assessed using the Infant Development Inventory (IDI), a parent-reported measure of developmental attainment across the domains of language, self-help, motor, and social development. Higher scores indicate more advanced developmental attainment. The score range depends on the age-specific version administered.

Infant temperament assessed using the Infant Behavior Questionnaire-Revised Very Short Form (IBQ-R VSF) Negative Reactivity Subscale. Scores range from 1 to 7, with higher scores indicating greater infant negative reactivity, including distress, fearfulness, and difficulty in emotional regulation.

Body height measured in centimeters (cm) using standardized measurement procedures. Higher values indicate greater body height.

Exploratory assessment of factors associated with parental and child well-being, including sleep quality, physical activity, social support, body image, eating behaviors, parent-child bonding, parental self-efficacy, and birth-related post-traumatic stress symptoms using validated questionnaires (PSQI, PPAQ, OSSS-3, BIPPS, TFEQ, PPBS, SENR, and City BiTS-SF).

Sleep quality assessed using the Pittsburgh Sleep Quality Index (PSQI). Total scores range from 0 to 21, with higher scores indicating poorer sleep quality. A global score >5 is commonly used to indicate poor sleep quality.

Physical activity assessed using the Pregnancy Physical Activity Questionnaire-Short Form (PPAQ-SF). Scores are calculated as Metabolic Equivalent of Task (MET)-hours per week across activity domains. Higher scores indicate greater physical activity levels. No fixed minimum or maximum score is defined because scores depend on the participant's reported activity.

Social support assessed using the Oslo Social Support Scale (OSSS-3). Total scores range from 3 to 14, with higher scores indicating greater perceived social support. Scores of 3-8 indicate poor support, 9-11 indicate moderate support, and 12-14 indicate strong support.

Childbirth-related posttraumatic stress symptoms assessed using the City Birth Trauma Scale Short Form (City BiTS-SF). Total scores range from 0 to 24, with higher scores indicating more severe childbirth-related posttraumatic stress symptoms.

Parent-child bonding assessed using the Pre- and Postnatal Bonding Scale (PPBS). Total scores range from 8 to 40, with higher scores indicating stronger parent-child bonding.

Parenting self-efficacy assessed using the Self-Efficacy in the Nurturing Role (SENR) questionnaire. Total scores range from 16 to 112, with higher scores indicating greater parental self-efficacy in the nurturing role.

Perinatal events and pregnancy-, birth-, and postpartum-related pathology assessed using study-specific questions. Outcomes include the occurrence of maternal, fetal, neonatal, and obstetric complications. Higher scores are not inherently better or worse as responses consist of categorical clinical events and conditions.

Postpartum experience assessed using study-specific questions regarding breastfeeding and postpartum pain. Outcomes include breastfeeding status and pain-related experiences. Higher scores are not inherently better or worse because responses may be categorical or item-specific.