Abstract：
BACKGROUND: Digitalization with minimal human resources could support self-management among women with gestational diabetes and improve maternal and neonatal outcomes.
OBJECTIVE: This study aimed to investigate if a periodic mobile application (eMOM) with wearable sensors improves maternal and neonatal outcomes among women with diet-controlled gestational diabetes without additional guidance from healthcare personnel.
METHODS: Women with gestational diabetes were randomly assigned in a 1:1 ratio at 24 to 28 weeks\' gestation to the intervention or the control arm. The intervention arm received standard care in combination with use of the periodic eMOM, whereas the control arm received only standard care. The intervention arm used eMOM with a continuous glucose monitor, an activity tracker, and a food diary 1 week/month until delivery. The primary outcome was the change in fasting plasma glucose from baseline to 35 to 37 weeks\' gestation. Secondary outcomes included capillary glucose, weight gain, nutrition, physical activity, pregnancy complications, and neonatal outcomes, such as macrosomia.
RESULTS: In total, 148 women (76 in the intervention arm, 72 in the control arm; average age, 34.1±4.0 years; body mass index, 27.1±5.0 kg/m2) were randomized. The intervention arm showed a lower mean change in fasting plasma glucose than the control arm (difference, -0.15 mmol/L vs -2.7 mg/mL; P=.022) and lower capillary fasting glucose levels (difference, -0.04 mmol/L vs -0.7 mg/mL; P=.002). The intervention arm also increased their intake of vegetables (difference, 11.8 g/MJ; P=.043), decreased their sedentary behavior (difference, -27.3 min/d; P=.043), and increased light physical activity (difference, 22.8 min/d; P=.009) when compared with the control arm. In addition, gestational weight gain was lower (difference, -1.3 kg; P=.015), and there were less newborns with macrosomia in the intervention arm (difference, -13.1 %; P=.036). Adherence to eMOM was high (daily use >90%), and the usage correlated with lower maternal fasting (P=.0006) and postprandial glucose levels (P=.017), weight gain (P=.028), intake of energy (P=.021) and carbohydrates (P=.003), and longer duration of the daily physical activity (P=.0006). There were no significant between-arm differences in terms of pregnancy complications.
CONCLUSIONS: Self-tracking of lifestyle factors and glucose levels without additional guidance improves self-management and the treatment of gestational diabetes, which also benefits newborns. The results of this study support the use of digital self-management and education tools in maternity care.
OBJECTIVE: This study aimed to investigate if a periodic mobile application (eMOM) with wearable sensors improves maternal and neonatal outcomes among women with diet-controlled gestational diabetes without additional guidance from healthcare personnel.
METHODS: Women with gestational diabetes were randomly assigned in a 1:1 ratio at 24 to 28 weeks\' gestation to the intervention or the control arm. The intervention arm received standard care in combination with use of the periodic eMOM, whereas the control arm received only standard care. The intervention arm used eMOM with a continuous glucose monitor, an activity tracker, and a food diary 1 week/month until delivery. The primary outcome was the change in fasting plasma glucose from baseline to 35 to 37 weeks\' gestation. Secondary outcomes included capillary glucose, weight gain, nutrition, physical activity, pregnancy complications, and neonatal outcomes, such as macrosomia.
RESULTS: In total, 148 women (76 in the intervention arm, 72 in the control arm; average age, 34.1±4.0 years; body mass index, 27.1±5.0 kg/m2) were randomized. The intervention arm showed a lower mean change in fasting plasma glucose than the control arm (difference, -0.15 mmol/L vs -2.7 mg/mL; P=.022) and lower capillary fasting glucose levels (difference, -0.04 mmol/L vs -0.7 mg/mL; P=.002). The intervention arm also increased their intake of vegetables (difference, 11.8 g/MJ; P=.043), decreased their sedentary behavior (difference, -27.3 min/d; P=.043), and increased light physical activity (difference, 22.8 min/d; P=.009) when compared with the control arm. In addition, gestational weight gain was lower (difference, -1.3 kg; P=.015), and there were less newborns with macrosomia in the intervention arm (difference, -13.1 %; P=.036). Adherence to eMOM was high (daily use >90%), and the usage correlated with lower maternal fasting (P=.0006) and postprandial glucose levels (P=.017), weight gain (P=.028), intake of energy (P=.021) and carbohydrates (P=.003), and longer duration of the daily physical activity (P=.0006). There were no significant between-arm differences in terms of pregnancy complications.
CONCLUSIONS: Self-tracking of lifestyle factors and glucose levels without additional guidance improves self-management and the treatment of gestational diabetes, which also benefits newborns. The results of this study support the use of digital self-management and education tools in maternity care.
摘要：
背景：用最少的人力资源进行数字化可以支持妊娠期糖尿病（GDM）妇女的自我管理，并改善母婴结局。
目的：调查使用可穿戴传感器的定期移动应用程序（eMOM）是否可以改善饮食控制的妊娠期糖尿病妇女的母婴结局。没有医疗人员的额外指导。
方法：在24-28周以1:1的比例将妊娠糖尿病妇女随机分配到干预组或对照组。干预部门接受了标准护理和定期eMOM，而控制臂只接受标准护理。干预部门使用了带有连续葡萄糖监测仪的eMOM，一个活动追踪器,和食物日记1周/月直到交付。主要结果是空腹血糖从基线到35-37周的变化。次要结果包括毛细血管葡萄糖，体重增加,营养,身体活动,妊娠并发症,和新生儿结局，如巨大儿。
结果：总计，148名妇女(干预组76名，对照组72；平均年龄34.1±4.0岁；BMI27.1±5.0kg/m2）被随机分配。与对照组相比，干预组的空腹血糖平均变化较低（差异：-0.15mmol/L（-2.7mg/mL）;p=0.022），毛细血管空腹血糖水平较低（差异：-0.04mmol/L（-0.7mg/mL）;p=.002）。干预组还增加了蔬菜的摄入量（差异：11.8g/MJ；p=.043），减少了他们的久坐行为（差异：-27.3分钟/天；p=.043），与对照组相比，轻度体力活动增加（差异：22.8分钟/天；p=.009）。此外,妊娠期体重增加较低（差异：-1.3kg；p=.015），干预组中患有巨大儿的新生儿较少（差异：-13.1％；p=0.036）。对eMOM的依从性很高(每日使用>90%)，使用与较低的产妇空腹（p=.0006）和餐后血糖水平（p=.017）相关，体重增加（p=.028），能量（p=.021）和碳水化合物（p=.003）的摄入量，以及较高的日常体力活动持续时间（p=.0006）。在妊娠并发症方面，手臂之间没有显着差异。
结论：在没有额外指导的情况下，对生活方式和血糖的自我跟踪可以改善自我管理和GDM的治疗，这也有利于新生儿。这项研究的结果支持在产妇保健中利用数字自我管理和教育工具。
目的：调查使用可穿戴传感器的定期移动应用程序（eMOM）是否可以改善饮食控制的妊娠期糖尿病妇女的母婴结局。没有医疗人员的额外指导。
方法：在24-28周以1:1的比例将妊娠糖尿病妇女随机分配到干预组或对照组。干预部门接受了标准护理和定期eMOM，而控制臂只接受标准护理。干预部门使用了带有连续葡萄糖监测仪的eMOM，一个活动追踪器,和食物日记1周/月直到交付。主要结果是空腹血糖从基线到35-37周的变化。次要结果包括毛细血管葡萄糖，体重增加,营养,身体活动,妊娠并发症,和新生儿结局，如巨大儿。
结果：总计，148名妇女(干预组76名，对照组72；平均年龄34.1±4.0岁；BMI27.1±5.0kg/m2）被随机分配。与对照组相比，干预组的空腹血糖平均变化较低（差异：-0.15mmol/L（-2.7mg/mL）;p=0.022），毛细血管空腹血糖水平较低（差异：-0.04mmol/L（-0.7mg/mL）;p=.002）。干预组还增加了蔬菜的摄入量（差异：11.8g/MJ；p=.043），减少了他们的久坐行为（差异：-27.3分钟/天；p=.043），与对照组相比，轻度体力活动增加（差异：22.8分钟/天；p=.009）。此外,妊娠期体重增加较低（差异：-1.3kg；p=.015），干预组中患有巨大儿的新生儿较少（差异：-13.1％；p=0.036）。对eMOM的依从性很高(每日使用>90%)，使用与较低的产妇空腹（p=.0006）和餐后血糖水平（p=.017）相关，体重增加（p=.028），能量（p=.021）和碳水化合物（p=.003）的摄入量，以及较高的日常体力活动持续时间（p=.0006）。在妊娠并发症方面，手臂之间没有显着差异。
结论：在没有额外指导的情况下，对生活方式和血糖的自我跟踪可以改善自我管理和GDM的治疗，这也有利于新生儿。这项研究的结果支持在产妇保健中利用数字自我管理和教育工具。
