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Session: Innovations in Infant, Pediatric, and Pregnancy Nutrition Research: New Tools and Methodologies (Poster Theater Flash Session 1)

(PTFS01-05-23) Efficacy of a Mobile App Intervention for Management of Gestational Diabetes: An Exploratory Randomized Controlled Trial

Saturday, July 22, 2023

10:17 AM – 10:21 AM ET

Location: Fairfax

Presenting Author(s)

Shristi Rawal, PhD (she/her/hers)

Assistant Professor
Rutgers University
Philadelphia, Pennsylvania, United States

Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

Co-Author(s)

JW

Jenna K. White, BS

Rutgers School of Public Health
JN

Jyoti Nepal, Masters in Public Health

Department of Research and Development, Dhulikhel Hospital-Kathmandu University Hospital, Nepal
SS

Shanti Subedi, MD

Department of Obstetrics and Gynecology, Nobel Medical College Teaching Hospital, Nepal
JD

Jean-francois Daneault, PhD

Assistant Professor
School of Health Professions, Rutgers University
Newark, New Jersey, United States
PS

Prabin R. Shakya, MS

Biomedical Knowledge Engineering Lab, Seoul National University
Seoul, Seoul-t'ukpyolsi, Republic of Korea
AS

Abha Shrestha

Department of Obstetrics and Gynecology, Dhulikhel Hospital, Kathmandu University Hospital, Nepal
AS

Archana Shrestha, PhD

Associate Professor
Department of Public Health, Kathmandu University School of Medical Sciences, Nepal, Institute for Implementation Science and Health, Nepal, Department of Chronic Disease Epidemiology, Yale School of Public Health
Dhulikhel, Bagmati, Nepal

Disclosure(s):

Shristi Rawal, PhD: No relevant financial relationship(s) with ineligible companies to disclose.

Objectives: South Asians are at disproportionately higher risk of gestational diabetes (GDM) and adverse maternal and fetal outcomes associated with GDM. We developed a culturally tailored mobile app (GDM-DH) intervention to support self-management of GDM with the objective of evaluating its impact on perinatal outcomes among Nepalese women with GDM in a pilot feasibility study.

Methods: This two-armed, parallel, assessor-blinded exploratory randomized control trial (RCT) enrolled participants from Dhulikhel Hospital in Nepal and randomly assigned them in a 1:1 fashion to one of two treatment conditions: either standard care alone, or GDM-DH app intervention + standard care. The intervention group used the GDM-DH app for up to 16 weeks (27±3 gestational weeks to delivery), which assisted them in self-management of GDM by providing education, reinforcing regular glucose monitoring, increasing self-efficacy for diet/lifestyle modification, and facilitating desired social support. Exploratory outcomes including glycemic control, labor induction, primary cesarean delivery, and birthweight were abstracted from medical records at delivery.

Results: Thirty participants each were randomized into treatment and control groups respectively. Sociodemographic and baseline clinical factors did not differ significantly between the two groups (mean age 29.8±4.1 years; mean baseline gestational weeks 27.4±2.1 weeks). Compared to the control group, the mean birthweight was significantly lower among the intervention group (2.7±0.6 kg vs 3.0±0.4 kg; p=0.03). The intervention group had lower rates of labor induction (45.2% vs. 53.1%) and lower average 2-hour postprandial glucose levels (123.9±28.1 mg/dL vs 131.2±35.4 mg/dL), with effect sizes that were medium but not statistically significant. We did not find any notable differences in fasting glucose values and rates of primary cesarean delivery.

Conclusions: Preliminary findings from this pilot RCT support the efficacy of our GDM-DH app to augment management of GDM and improve birthweight outcomes in Nepalese women. A larger adequately powered clinical trial is needed to further investigate the impact of GDM-DH on other perinatal outcomes.

Funding Sources: NIH/FIC