JMIR Publications

ABSTRACT

Background:

Gestational diabetes mellitus (GDM) primarily depends on medical nutrition therapy (MNT) for management. Despite the critical role of dietary planning in GDM management, women often fail to sustain dietary changes and self-management due to inadequate support, particularly for complex regimens. Online interventions, valued for flexibility, are increasingly adopted to supplement clinical care and enhance self-management.

Objective:

This study aims to evaluate the benefits of WeMNT, a WeChat-based MNT intervention program developed from clinical knowledge and behavior change wheel (BCW), for women with GDM.

Methods:

This single-blind (outcome assessor blinded) parallel-group randomized controlled trial was conducted and recruited at a university hospital's obstetric clinic. The inclusion criteria included: singleton pregnancy at 24–28 weeks, GDM diagnosed by 75g oral glucose tolerance test, no insulin requirement, smartphone with WeChat and Chinese communication. Participants were 1:1 randomized via a random number table to intervention (n = 47) or control (n = 47) groups. The WeMNT intervention was designed via the BCW: (1) understand behavior by pinpointing women with GDM, analyzing meal habits, and noting capability (e.g., nutritional knowledge gap), opportunity (e.g., insufficient time due to busy work), and motivation issues (e.g., insufficient understanding of the importance of nutrition prescriptions)；(2) select behavioral supporting interventions; (3) determine content using BCTs. The primary outcomes measured in this study encompassed fasting blood glucose (FBG), 2-hour postprandial glucose (2hPG), glycosylated hemoglobin (HbA1c), and gestational weight gain (GWG). Secondary outcomes assessed included obstetric complications and neonatal parameters. A two-factor repeated measures analysis of variance was utilized to evaluate the effects of the intervention.

Results:

From March 2023 to October 2023, a total of 94 participants were enrolled in this study. Among the participants, 88 individuals (mean age: 32.18 years, SD: 5.12 years) successfully completed the study, comprising 44 in the intervention group and 44 in the control group. Over 84% of participants in the intervention group demonstrated sustained adherence as expected. After the intervention, the WeMNT group demonstrated significant reductions in 2hPG (adjusted mean difference: -0.83 mmol/L, 95% confidence interval [CI]: -1.41 to -0.24 mmol/L, P = .006), HbA1c (adjusted mean difference: -0.41%, 95% CI: -0.71 to -0.12%, P = .006), and GWG. Specifically, for overweight participants, the adjusted mean difference in total GWG was -2.86 kg (95% CI: -3.07 to -2.65 kg), and for obese participants, it was -2.56 kg (95% CI: -3.44 to -1.67 kg) compared to the control group. No unexpected maternal adverse events were observed among the participants. No significant effects were found on other health outcomes.

Conclusions:

The WeMNT program, a WeChat-based BCW-guided intervention, demonstrated reduced 2hPG, HbA1c and GWG in GDM management. Its integrated self-management framework provides robust evidence for clinical adoption as an effective patient-centered tool. Clinical Trial: Chinese Clinical Trial Registry ChiCTR2300078227, https://www.chictr.org.cn/showproj.html?proj=199247