Table 4.

The final intervention protocol

Sessions	Justification	Content	Time	Delivery type	Duration	Intervener
Session 1	knowledge education session	(1) What is GDM? (2) Adverse health outcomes of GDM? (3) Physical activity could prevent GDM. (4) The frequence, intensity,type, time of physical activity during pregnancy (5) Saftey precautions when doing physical activity (6) Healthy pregnancy weight gain	13–14+ 6 weeks’ gestation	face to face in groups with 8–10 participants at the antenatal clinic	about 30 min	Researcher, nurse and midwife
Session 2	exercise clinic visit	(1) the coach teach pregnant women how to exercise safely (2) the coach guide the participants to do physical activity together following the exercise video. (3) uploaded the exercise video to WeChat platform (4)teach the participants how to keep exercise diary and record everyday’s weight	13–14+ 6 weeks’ gestation	face to face in groups with 8–10 participants at the antenatal clinic	about 60 min	Researcher,coach, obstetricians, nurses, and midwife
Session 3	pregnancy-related symptom management	(1) Assessing and explaining the participant’s pregnancy-related symptoms, (2) strategies for managing symptoms such as muscle relaxation	15–16+ 6 weeks’ gestation	face to face in groups with 8–10 participants at the antenatal clinic	about 40 min	Researcher, nurses, and midwife
	group discussion	(1) Checking behavioral tracking, review, and feedback in the prior 2 weeks (2) Sharing self-management strategies from successful pregnant women (3) recalling previous successful experience, problem solving, and encouraging
Session 4	pregnancy related emotion management	(1)Assessing and explaining the participant’s pregnancy-related negative emotions (2)strategies for managing anxiety, or depression, such as positive self-talk	17–18+ 6 weeks’ gestation	online group discussion with 15–20 participants via Tencent Meeting	about 40 min	Researcher, nurses, midwife, and psychological consultant
	group discussion	(1) Checking behavioral tracking, review, and feedback in the prior 2 weeks (2) Sharing self-management strategies from successful pregnant women (3) recalling previous successful experience, problem solving, and encouraging
Session 5–13	group discussion	(1) positive feedback on gestational weight gain and physical activity in the prior 2 weeks (2) role model: sharing self-management strategies from successful pregnant women (3) problem solving, discuss the problems that arise when doing exercise and share solutions on how to keep active with each other (4) recall previous successful experience, guiding participants to recall previous successful behavior-change situations, discuss context and factors associated with success (5) Encourage:confirming participants have the capability for exercise and weight self-management	every two weeks from 19–20+ 6 to 37 weeks	face to face discussion at the antenatal clinic or online discussion via Tencent Meeting in groups with 8–10 participants	about 30 min	Researcher, nurses, and midwife

Note: GDM, gestational diabetes mellitus