Effect of the Pregnant+ Smartphone App on the Dietary Behavior of Women With Gestational Diabetes Mellitus: Secondary Analysis of a Randomized Controlled Trial

Lisa Garnweidner-Holme, Lena Henriksen, Liv Elin Torheim, Mirjam Lukasse, Lisa Garnweidner-Holme, Lena Henriksen, Liv Elin Torheim, Mirjam Lukasse

Abstract

Background: The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. A healthy diet and stable blood glucose levels during pregnancy can prevent adverse health outcomes for the mother and the newborn child. Mobile health may be a useful supplement to prenatal care, providing women with targeted dietary information concerning GDM.

Objective: We analyzed secondary data from a two-arm, multicentered, nonblinded randomized controlled trial to determine if a smartphone app with targeted dietary information and blood glucose monitoring had an effect on the dietary behavior of women with GDM.

Methods: Women with a 2-hour oral glucose tolerance test level of ≥9 mmol/L were individually randomized to either the intervention group receiving the Pregnant+ app and usual care or the control group receiving usual care only. Eligible women were enrolled from 5 diabetes outpatient clinics in the Oslo region, Norway, between October 2015 and April 2017. The Pregnant+ app promoted 10 GDM-specific dietary recommendations. A healthy dietary score for Pregnant+ (HDS-P+) was constructed from a 41-item food frequency questionnaire and used to assess the intervention effect on the dietary behavior completed at trial entry and at around gestation week 36. Dietary changes from baseline to week 36 were examined by a paired sample two-tailed t test. Between-group dietary differences after the intervention were estimated with analysis of covariance, with adjustment for baseline diet.

Results: A total of 238 women participated: 115 were allocated to the intervention group and 123 to the control group. Of the 238 women, 193 (81.1%) completed the food frequency questionnaire both at baseline and around gestational week 36. All the participants showed improvements in their HDS-P+ from baseline. However, the Pregnant+ app did not have a significant effect on their HDS-P+. The control group reported a higher weekly frequency of choosing fish meals (P=.05). No other significant differences were found between the intervention and control groups. There were no significant demographic baseline differences between the groups, except that more women in the intervention group had a non-Norwegian language as their first language (61 vs 46; P=.02).

Conclusions: Our findings do not support the supplementation of face-to-face follow-up of women with GDM with a smartphone app in the presence of high-standard usual care, as the Pregnant+ app did not have a beneficial effect on pregnant women's diet.

Trial registration: ClinicalTrials.gov NCT02588729; https://ichgcp.net/clinical-trials-registry/NCT02588729.

Keywords: diet; gestational diabetes mellitus; mHealth; mobile phone; randomized controlled trial.

Conflict of interest statement

Conflicts of Interest: None declared.

©Lisa Garnweidner-Holme, Lena Henriksen, Liv Elin Torheim, Mirjam Lukasse. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 04.11.2020.

Figures

Figure 1
Figure 1
Flow chart describing the process leading up to the final number included in the analysis of dietary behavior in the Pregnant+ study.

References

    1. The World Health Organization. WHO recommendation on the diagnosis of gestational diabetes in pregnancy. Geneva, Switzerland: The WHO Reproductive Health Library; 2016. [2019-12-04]. .
    1. Rani PR, Begum J. Screening and Diagnosis of Gestational Diabetes Mellitus, Where Do We Stand. J Clin Diagn Res. 2016 Apr;10(4):QE01–4. doi: 10.7860/JCDR/2016/17588.7689.
    1. Medical Birth Registry Norway, The Medical Birth Registry Norway. 2018. [2019-12-04].
    1. Jenum AK, Diep LM, Holmboe-Ottesen G, Holme IMK, Kumar BN, Birkeland KI. Diabetes susceptibility in ethnic minority groups from Turkey, Vietnam, Sri Lanka and Pakistan compared with Norwegians - the association with adiposity is strongest for ethnic minority women. BMC Public Health. 2012 Mar 01;12:150. doi: 10.1186/1471-2458-12-150.
    1. Makgoba M, Savvidou MD, Steer PJ. An analysis of the interrelationship between maternal age, body mass index and racial origin in the development of gestational diabetes mellitus. BJOG. 2012 Feb;119(3):276–82. doi: 10.1111/j.1471-0528.2011.03156.x. doi: 10.1111/j.1471-0528.2011.03156.x.
    1. Schneider S, Hoeft B, Freerksen N, Fischer B, Roehrig S, Yamamoto S, Maul H. Neonatal complications and risk factors among women with gestational diabetes mellitus. Acta Obstet Gynecol Scand. 2011 Mar;90(3):231–7. doi: 10.1111/j.1600-0412.2010.01040.x. doi: 10.1111/j.1600-0412.2010.01040.x.
    1. Aziz S, Munim TF, Fatima SS. Post-partum follow-up of women with gestational diabetes mellitus: effectiveness, determinants, and barriers. J Matern Fetal Neonatal Med. 2018 Jun;31(12):1607–1612. doi: 10.1080/14767058.2017.1321630.
    1. Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The Pathophysiology of Gestational Diabetes Mellitus. Int J Mol Sci. 2018 Oct 26;19(11) doi: 10.3390/ijms19113342.
    1. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, Wapner RJ, Varner MW, Rouse DJ, Thorp JM, Sciscione A, Catalano P, Harper M, Saade G, Lain KY, Sorokin Y, Peaceman AM, Tolosa JE, Anderson GB, Eunice Kennedy Shriver National Institute of Child HealthHuman Development Maternal-Fetal Medicine Units Network A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009 Oct 01;361(14):1339–48. doi: 10.1056/NEJMoa0902430.
    1. American Diabetes Association Management of Diabetes in Pregnancy. Diabetes Care. 2017;40(Suppl 1):S114–S119. doi: 10.2337/dc17-S016.
    1. Schiavo R. Health communication: from theory to practice. 1st ed. San Francisco, CA: Jossey-Bass; 2007.
    1. Carolan M, Gill GK, Steele C. Women's experiences of factors that facilitate or inhibit gestational diabetes self-management. BMC Pregnancy Childbirth. 2012 Sep 18;12:99. doi: 10.1186/1471-2393-12-99.
    1. Borgen I, Garnweidner-Holme LM, Jacobsen AF, Fayyad S, Cvancarova Småstuen Milada, Lukasse M. Knowledge of gestational diabetes mellitus at first consultation in a multi-ethnic pregnant population in the Oslo region, Norway - a cross-sectional study. Ethn Health. 2019 Aug 16;:1–14. doi: 10.1080/13557858.2019.1655530.
    1. Frequently asked questions on global task force on digital health for TB and its work. World Health Organization. [2020-09-09].
    1. Chan KL, Chen M. Effects of Social Media and Mobile Health Apps on Pregnancy Care: Meta-Analysis. JMIR Mhealth Uhealth. 2019 Jan 30;7(1):e11836. doi: 10.2196/11836.
    1. Chen Q, Carbone ET. Functionality, Implementation, Impact, and the Role of Health Literacy in Mobile Phone Apps for Gestational Diabetes: Scoping Review. JMIR Diabetes. 2017 Oct 04;2(2):e25. doi: 10.2196/diabetes.8045.
    1. Mackillop L, Hirst JE, Bartlett KJ, Birks JS, Clifton L, Farmer AJ, Gibson O, Kenworthy Y, Levy JC, Loerup L, Rivero-Arias O, Ming W, Velardo C, Tarassenko L. Comparing the Efficacy of a Mobile Phone-Based Blood Glucose Management System With Standard Clinic Care in Women With Gestational Diabetes: Randomized Controlled Trial. JMIR Mhealth Uhealth. 2018 Mar 20;6(3):e71. doi: 10.2196/mhealth.9512.
    1. Borgen I, Småstuen Milada Cvancarova, Jacobsen AF, Garnweidner-Holme LM, Fayyad S, Noll J, Lukasse M. Effect of the Pregnant+ smartphone application in women with gestational diabetes mellitus: a randomised controlled trial in Norway. BMJ Open. 2019 Nov 11;9(11):e030884. doi: 10.1136/bmjopen-2019-030884.
    1. Overdijkink SB, Velu AV, Rosman AN, van Beukering Monique Dm, Kok M, Steegers-Theunissen RP. The Usability and Effectiveness of Mobile Health Technology-Based Lifestyle and Medical Intervention Apps Supporting Health Care During Pregnancy: Systematic Review. JMIR Mhealth Uhealth. 2018 Apr 24;6(4):e109. doi: 10.2196/mhealth.8834.
    1. Dodd JM, Louise J, Cramp C, Grivell RM, Moran LJ, Deussen AR. Evaluation of a smartphone nutrition and physical activity application to provide lifestyle advice to pregnant women: The SNAPP randomised trial. Matern Child Nutr. 2018 Jan;14(1) doi: 10.1111/mcn.12502.
    1. Garnweidner-Holme LM, Borgen I, Garitano I, Noll J, Lukasse M. Designing and Developing a Mobile Smartphone Application for Women with Gestational Diabetes Mellitus Followed-Up at Diabetes Outpatient Clinics in Norway. Healthcare (Basel) 2015 May 21;3(2):310–23. doi: 10.3390/healthcare3020310.
    1. Hughson JP, Daly JO, Woodward-Kron R, Hajek J, Story D. The Rise of Pregnancy Apps and the Implications for Culturally and Linguistically Diverse Women: Narrative Review. JMIR Mhealth Uhealth. 2018 Nov 16;6(11):e189. doi: 10.2196/mhealth.9119.
    1. Borgen I, Garnweidner-Holme LM, Jacobsen AF, Bjerkan K, Fayyad S, Joranger P, Lilleengen AM, Mosdøl Annhild, Noll J, Småstuen Milada Cvancarova, Terragni L, Torheim LE, Lukasse M. Smartphone application for women with gestational diabetes mellitus: a study protocol for a multicentre randomised controlled trial. BMJ Open. 2017 Mar 27;7(3):e013117. doi: 10.1136/bmjopen-2016-013117.
    1. Holan S, Matheison M, Petersen K. A national clinical guideline for antenatal care. Short version. Norway, Oslo: Directorate for Health and Social Affairs; 2005.
    1. Henriksen T, Thordardson H, Strøm-Raoum E. Svangerskapsdiabetes. Website. 2014. [2019-12-13].
    1. Øverby Nina C, Hillesund ER, Sagedal LR, Vistad I, Bere E. The Fit for Delivery study: rationale for the recommendations and test-retest reliability of a dietary score measuring adherence to 10 specific recommendations for prevention of excessive weight gain during pregnancy. Matern Child Nutr. 2015 Jan;11(1):20–32. doi: 10.1111/mcn.12026.
    1. Wang N, Deng Z, Wen LM, Ding Y, He G. Understanding the Use of Smartphone Apps for Health Information Among Pregnant Chinese Women: Mixed Methods Study. JMIR Mhealth Uhealth. 2019 Jun 18;7(6):e12631. doi: 10.2196/12631.
    1. Lupton D, Pedersen S. An Australian survey of women's use of pregnancy and parenting apps. Women Birth. 2016 Aug;29(4):368–75. doi: 10.1016/j.wombi.2016.01.008.
    1. Kankanhalli A, Shin J, Oh H. Mobile-Based Interventions for Dietary Behavior Change and Health Outcomes: Scoping Review. JMIR Mhealth Uhealth. 2019 Jan 21;7(1):e11312. doi: 10.2196/11312.
    1. Hirst JE, Mackillop L, Loerup L, Kevat DA, Bartlett K, Gibson O, Kenworthy Y, Levy JC, Tarassenko L, Farmer A. Acceptability and user satisfaction of a smartphone-based, interactive blood glucose management system in women with gestational diabetes mellitus. J Diabetes Sci Technol. 2015 Jan;9(1):111–5. doi: 10.1177/1932296814556506.
    1. Skar JB, Garnweidner-Holme LM, Lukasse M, Terragni L. Women's experiences with using a smartphone app (the Pregnant+ app) to manage gestational diabetes mellitus in a randomised controlled trial. Midwifery. 2018 Mar;58:102–108. doi: 10.1016/j.midw.2017.12.021.
    1. Torbjørnsen Astrid, Ribu L, Rønnevig Marit, Grøttland Astrid, Helseth S. Users' acceptability of a mobile application for persons with type 2 diabetes: a qualitative study. BMC Health Serv Res. 2019 Sep 06;19(1):641. doi: 10.1186/s12913-019-4486-2.
    1. McCarroll R, Eyles H, Ni Mhurchu Cliona. Effectiveness of mobile health (mHealth) interventions for promoting healthy eating in adults: A systematic review. Prev Med. 2017 Dec;105:156–168. doi: 10.1016/j.ypmed.2017.08.022.
    1. Radhakrishnan K. The efficacy of tailored interventions for self-management outcomes of type 2 diabetes, hypertension or heart disease: a systematic review. J Adv Nurs. 2012 Mar;68(3):496–510. doi: 10.1111/j.1365-2648.2011.05860.x.
    1. Ming W, Mackillop LH, Farmer AJ, Loerup L, Bartlett K, Levy JC, Tarassenko L, Velardo C, Kenworthy Y, Hirst JE. Telemedicine Technologies for Diabetes in Pregnancy: A Systematic Review and Meta-Analysis. J Med Internet Res. 2016 Nov 09;18(11):e290. doi: 10.2196/jmir.6556.
    1. Kreps GL, Neuhauser L. New directions in eHealth communication: opportunities and challenges. Patient Educ Couns. 2010 Mar;78(3):329–36. doi: 10.1016/j.pec.2010.01.013.
    1. Arora S, Ford K, Terp S, Abramson T, Ruiz R, Camilon M, Coyne CJ, Lam CN, Menchine M, Burner E. Describing the evolution of mobile technology usage for Latino patients and comparing findings to national mHealth estimates. J Am Med Inform Assoc. 2016 Sep;23(5):979–83. doi: 10.1093/jamia/ocv203.
    1. Atakora L, Poston L, Hayes L, Flynn AC, White SL. Influence of GDM Diagnosis and Treatment on Weight Gain, Dietary Intake and Physical Activity in Pregnant Women with Obesity: Secondary Analysis of the UPBEAT Study. Nutrients. 2020 Jan 30;12(2) doi: 10.3390/nu12020359.
    1. Jelsma JGM, van Leeuwen KM, Oostdam N, Bunn C, Simmons D, Desoye G, Corcoy R, Adelantado JM, Kautzky-Willer A, Harreiter J, van Assche FA, Devlieger R, Timmerman D, Hill D, Damm P, Mathiesen ER, Wender-Ozegowska E, Zawiejska A, Rebollo P, Lapolla A, Dalfrà Maria G, Del Prato S, Bertolotto A, Dunne F, Jensen DM, Andersen LLT, Snoek FJ, van Poppel MNM. Beliefs, Barriers, and Preferences of European Overweight Women to Adopt a Healthier Lifestyle in Pregnancy to Minimize Risk of Developing Gestational Diabetes Mellitus: An Explorative Study. J Pregnancy. 2016;2016:3435791. doi: 10.1155/2016/3435791. doi: 10.1155/2016/3435791.
    1. Jones EJ, Roche CC, Appel SJ. A review of the health beliefs and lifestyle behaviors of women with previous gestational diabetes. J Obstet Gynecol Neonatal Nurs. 2009;38(5):516–26. doi: 10.1111/j.1552-6909.2009.01051.x.
    1. Garnweidner-Holme Lisa, Torheim LE, Henriksen L, Borgen I, Holmelid S, Lukasse M. Adherence to the Norwegian dietary recommendations in a multi-ethnic pregnant population prior to being diagnosed with gestational diabetes mellitus. Food Sci Nutr. 2020 Jul;8(7):3031–3040. doi: 10.1002/fsn3.1248. doi: 10.1002/fsn3.1248.
    1. Hillesund ER, Bere E, Sagedal LR, Vistad I, Øverby N C. Effect of a diet intervention during pregnancy on dietary behavior in the randomized controlled Norwegian Fit for Delivery study. J Dev Orig Health Dis. 2016 Oct;7(5):538–547. doi: 10.1017/S2040174416000258.

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