Effects of mobile health management model on the prevention of gestational diabetes mellitus in pregnant women at risk of gestational diabetes: A randomized controlled trial

Abstract

Background

Gestational diabetes mellitus is a common pregnancy complication with rising incidence worldwide. Traditional interventions for gestational diabetes mellitus prevention often lack accessibility and personalization. Mobile health (mHealth) technologies, particularly smartphone apps, provide an innovative solution. They enable real-time, personalized care by tracking key health metrics, delivering user-specific dynamic feedback, and offering customized lifestyle plans. This approach addresses traditional limitations and presents a more effective, accessible gestational diabetes mellitus prevention strategy.

Objective

This study aimed to evaluate the effectiveness of a mobile health management model, based on a gestational diabetes prevention app, in preventing gestational diabetes mellitus and improving maternal and neonatal outcomes in pregnant women at risk of gestational diabetes mellitus.

Methods

In this randomized controlled trial, pregnant women at risk of gestational diabetes mellitus before 12 weeks of gestation were recruited from three tertiary hospitals in Beijing. Participants were randomly assigned to either a control group receiving standard care, or an intervention group receiving additional support via a mHealth model using the ‘Better Pregnancy’ app. A gestational diabetes mellitus risk group health management team was established, led by 3 diabetes specialist nurses, 1 doctor, 1 dietitian, 1 psychologist, and several volunteers. Outcomes included the incidence of gestational diabetes mellitus, oral glucose tolerance test values at 24 weeks of gestation, self-management ability, self-efficacy, perceived social support, pregnancy weight gain, delivery complications, and neonatal outcomes.

Results

A total of 246 pregnant women at risk of gestational diabetes mellitus were enrolled, including 124 in the control group and 122 in the intervention group. Compared to the control group, the intervention group had a lower incidence of gestational diabetes mellitus (18.9 % vs. 33.9 %), lower glucose tolerance test values (fasting: 4.47 ± 0.36 vs. 4.61 ± 0.51, 1-hour postprandial: 7.74 ± 1.54 vs. 8.29 ± 1.82, 2-hour postprandial: 6.85 ± 1.28 vs. 7.32 ± 1.64), and lower HbA1c levels (4.81 ± 0.32 vs. 4.98 ± 0.35). The intervention group also had reduced insulin use (0 % vs. 8.3 %) and hospitalizations rate due to poor blood glucose control (2.1 % vs. 14.5 %). Besides, the intervention group showed improved general self-efficacy, self-management, and perceived social support scores than the control group (P < 0.05). Multivariate logistic regression analysis showed that the intervention significantly reduced the risk of gestational diabetes mellitus (OR = 0.424, 95 % CI: 0.217–0.827, P = 0.012). Higher pre-pregnancy BMI and history of gestational diabetes mellitus were identified as risk factors for gestational diabetes mellitus incidence.

Conclusions

The mHealth management model significantly reduced fasting and postprandial blood glucose, HbA1c levels, and gestational diabetes mellitus incidence in pregnant women at risk of gestational diabetes mellitus, while improving self-efficacy, social support, and self-management abilities. Additionally, the intervention was associated with a significant reduction in the hospitalization rate due to poor blood glucose control. However, its impact on certain maternal and neonatal outcomes, such as gestational weight gain and neonatal hypoglycemia rates, remains inconclusive. Limitations include potential selection bias and reliance on self-reported data. Future research should further explore the long-term impact of this model on maternal and infant health.

Registration

This study was registered at the Chinese Clinical Trial Registry (ChiCTR2200057889) on March 20, 2022, and participant recruitment was initiated in August 2022.

Social media abstract: Mobile health model reduces gestational diabetes risk and improves maternal & neonatal outcomes in at-risk pregnant women.