Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Mar 8, 2020
Date Accepted: Sep 25, 2020
Effect of the Pregnant+ Smartphone App on Dietary Behavior of Women with Gestational Diabetes Mellitus: Secondary Analysis of a Randomized Controlled Trial
ABSTRACT
Background:
The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. A healthy diet and stable blood glucose levels during pregnancy 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-armed, 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 five 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 (FFQ) and used to assess intervention effect on the dietary behavior completed at trial entry and around gestation week 36. Dietary changes from baseline to week 36 were examined by a paired-sample t test. Between-group dietary differences postintervention 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 this, 193 (81%) completed the FFQ both at baseline and around gestational week 36. All the participants improved 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 had a non-Norwegian language as their first language in the intervention group (61 vs 46; P=.017).
Conclusions:
Our findings do not support the provision of dietary advice in a smartphone app in the presence of high-quality standard care of women with GDM. Clinical Trial: https://clinicaltrials.gov/ct2/show/NCT02588729
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