Periodic Mobile Application (eMOM) With Self-Tracking of Glucose and Lifestyle Improves Treatment of Diet-Controlled Gestational Diabetes Without Human Guidance: A Randomized Controlled Trial

Background Digitalization with minimal human resources could support self-management in women with gestational diabetes (GDM) and improve maternal and neonatal outcomes. Objective To investigate whether a periodic mobile application (eMOM) with wearable sensors improves maternal and neonatal outcomes for women with diet-controlled gestational diabetes, without additional guidance from healthcare personnel. Study Design Women with gestational diabetes were randomly assigned in a 1:1 ratio at weeks 24-28 to the intervention or the control arm. The Intervention arm received standard care and the periodic eMOM, while 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 weeks 35-37. 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; BMI 27.1 ± 5.0 kg/m2) were randomized. The Intervention arm showed a lower mean change in fasting plasma glucose compared to the control arm (difference: -0.15 mmol/L (-2.7 mg/mL); p = .022) and lower capillary fasting glucose levels (difference: -0.04 mmol/L (-0.7 mg/mL); p = .002). The Intervention arm also increased their intake of vegetables (difference: 11.8g/MJ; p = .043), decreased their sedentary behavior (difference: -27.3 min/day; p = .043), and increased light physical activity (difference: 22.8 min/day; p = .009) compared to 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 = 0.036). 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 carbohydrate (p = .003), and higher duration of the daily physical activity (p = .0006). There were no significant between-arm differences in terms of pregnancy complications. Conclusion Self-tracking of lifestyles and glucose without additional guidance improves self-management and the treatment of GDM, which also benefits newborns. The results of this study support the utilization of digital self-management and education tools in maternity care.