Digitalization with minimal human resources could support self-management among women with gestational diabetes and improve maternal and neonatal outcomes. 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. 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. 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/m) 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; =.022) and lower capillary fasting glucose levels (difference, −0.04 mmol/L vs −0.7 mg/mL; =.002). The intervention arm also increased their intake of vegetables (difference, 11.8 g/MJ; =.043), decreased their sedentary behavior (difference, −27.3 min/d; =.043), and increased light physical activity (difference, 22.8 min/d; =.009) when compared with the control arm. In addition, gestational weight gain was lower (difference, −1.3 kg; =.015), and there were less newborns with macrosomia in the intervention arm (difference, −13.1 %; =.036). Adherence to eMOM was high (daily use >90%), and the usage correlated with lower maternal fasting (=.0006) and postprandial glucose levels (=.017), weight gain (=.028), intake of energy (=.021) and carbohydrates (=.003), and longer duration of the daily physical activity (=.0006). There were no significant between-arm differences in terms of pregnancy complications. 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.

中文翻译：

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具有自我跟踪血糖和生活方式功能的定期移动应用程序 (eMOM) 可在无需人工指导的情况下改善饮食控制妊娠糖尿病的治疗：一项随机对照试验

以最少的人力资源实现数字化可以支持妊娠期糖尿病妇女的自我管理，并改善孕产妇和新生儿的结局。本研究旨在调查带有可穿戴传感器的定期移动应用程序 (eMOM) 是否可以在没有医护人员额外指导的情况下改善饮食控制妊娠糖尿病女性的孕产妇和新生儿结局。患有妊娠糖尿病的女性在妊娠 24 至 28 周时以 1:1 的比例随机分配至干预组或对照组。干预组接受标准护理并结合定期使用 eMOM，而对照组仅接受标准护理。干预组使用带有连续血糖监测仪、活动追踪器和食物日记的 eMOM，直到分娩为止 1 周/月。主要结果是妊娠 35 至 37 周时空腹血糖从基线的变化。次要结局包括毛细血管葡萄糖、体重增加、营养、体力活动、妊娠并发症和新生儿结局，例如巨大儿。总共 148 名女性（干预组 76 名，对照组 72 名；平均年龄，34.1±4.0 岁；体重指数，27.1±5.0 kg/m）被随机分配。干预组的空腹血糖平均变化低于对照组（差异，-0.15 mmol/L vs -2.7 mg/mL；=.022），毛细血管空腹血糖水平较低（差异，-0.04 mmol/L vs -0.04 mmol/L） −0.7 毫克/毫升；=.002)。干预组还增加了蔬菜摄入量（差异，11.8 g/MJ；=.043），减少了久坐行为（差异，-27.3 分钟/天；=.043），并增加了轻度体力活动（差异，22.8 分钟） /d; =.009) 与控制臂相比。此外，妊娠期体重增加较低（差异，-1.3 kg；=.015），并且干预组中巨大儿新生儿较少（差异，-13.1%；=.036）。 eMOM 的依从性很高（每日使用 >90%），并且使用与较低的产妇空腹 (=.0006) 和餐后血糖水平 (=.017)、体重增加 (=.028)、能量摄入 (=.028) 相关。 021) 和碳水化合物 (=.003)，以及更长的日常体力活动持续时间 (=.0006)。妊娠并发症方面没有显着的组间差异。在没有额外指导的情况下自我跟踪生活方式因素和血糖水平可以改善自我管理和妊娠糖尿病的治疗，这也有利于新生儿。这项研究的结果支持在孕产妇护理中使用数字自我管理和教育工具。