Review: Smartphone Apps May Improve Outcomes in Gestational Diabetes

Mobile health applications (mHealth apps) may improve health-related outcomes—specifically glycemic control—among patients with gestational diabetes (GD), according to a systematic literature review. Findings were published in BMC Pregnancy and Childbirth, and researchers noted more detailed studies are warranted.

In 2019, approximately 20 million live births (16%) had some form of hyperglycemia in pregnancy while around 84% of these mothers were diagnosed with GD, authors wrote. Maternal age, obesity, and gestational weight gain are all risk factors for GD. The condition itself is associated with increased risks of preeclampsia, caesarean sections, and other adverse pregnancy and birth outcomes.

mHealth apps have been introduced as early strategies to effectively improve GD management and “allow a more specific and individual management of patient care,” according to researchers.

To better understand the efficacy of GD-specific mHealth apps on health-related outcomes among these patients compared with control groups, investigators performed a systematic search of databases including MedLine, Embase, and others. A total of 6 studies were included in the final analysis; 408 patients with GD used the apps (intervention group) while 405 controls did not.

Five studies were 2-arm randomized controlled trials and 1 was a controlled clinical trial. In addition, “4 of the studies reported the majority of their participants being in the third trimester of pregnancy (mean [SD] gestational age in intervention groups: 29.1 [1.9] weeks, 30.9 [3.6] weeks, 31.2 [4.1] weeks and n = 88 [76.4%] being between 25th and 32nd gestational week),” authors wrote.

Researchers found that those with GD who used the apps showed significant improving trends in fasting blood glucose, 2-h postprandial blood glucose, off target blood glucose measurements, delivery mode (more vaginal deliveries and fewer [emergency] caesarean sections) and patient compliance, compared with control patients.

In the intervention group, trends towards lower birth rate and fewer incidents of macrosomia and hypoglycemia were seen, although findings were not statistically significant.

“Despite the limited data, the included studies indicated that GD-specific mHealth-Apps show a trend towards improving the management of GD,” researchers said.

However, more information on fasting blood glucose and glycated hemoglobin is needed, as each of these parameters was only investigated in 1 or 2 studies in the review. To improve knowledge on the efficacy of these apps, a standardized set of investigated outcomes, in addition to nutritional and physical activity outcomes, would be beneficial, authors noted.

The quality of 2 studies included was rated as weak, marking a limitation to the review; available literature on this topic was also limited, while the oldest study included was from 2016.

Based on the findings, researchers concluded mHealth apps enhance compliance, empower patients, and enable more intensive and closely monitored therapy. Overall, “despite the limited data, mHealth-Apps showed potential to improve the management of GD.”

Reference

Eberle C, Loehnert M, and Stichling S. Effectiveness of specific mobile health applications (mHealth-apps) in gestational diabetes mellitus: a systematic review. BMC Pregnancy Childbirth. Published online December 5, 2021. doi:10.1186/s12884-021-04274-7