Lifestyle change app boosts maternal health outcomes
Gestational diabetes affects 19 million pregnancies globally, according to the Diabetes Atlas(opens in new window), and is associated with multiple, adverse outcomes. It increases a woman’s risk of developing type 2 diabetes and can predispose her children to developing overweight or obesity. “Research has even shown impacts on brain development and metabolic function in offspring. Essentially, we’re dealing with an intergenerational cycle of metabolic risk that begins in the womb and, without intervention, perpetuates across generations,” explains Sharleen O’Reilly(opens in new window), professor in Human Nutrition at University College Dublin(opens in new window), and lead investigator for IMPACT DIABETES B2B(opens in new window) at Dublin’s National Maternity Hospital(opens in new window). Keeping an eye on diet and physical activity in pregnancy gives women and healthcare providers an opportunity to prevent maternal and child diabetes, so O’Reilly led the IMPACT DIABETES B2B project, part of a body of work being supported by the EU, to put in place an effective and user-friendly coaching system that would encourage uptake. “Pregnancy represents a unique window of opportunity – it’s one of the few times in life when women are highly motivated to make health changes and are regularly engaging with healthcare services,” notes O’Reilly.
Real-world maternity services benefiting from seamless digital intervention
IMPACT DIABETES B2B screened 4 386 women across four maternity hospitals: National Maternity Hospital in Dublin, Ireland; Southmead Hospital in Bristol, England; San Cecilio University Hospital in Granada, Spain; and Monash Medical Centre in Melbourne, Australia. The team identified at-risk women using the validated Monash gestational diabetes screening tool(opens in new window), which scores women based on factors such as age, body mass index, ethnicity, family history of diabetes, and past history of gestational diabetes. Women scoring 3 or higher were invited to participate. Of the 1 784 women invited, 865 (48 %) agreed to join the study, and after accounting for various exclusions, 804 women completed baseline assessments and were followed throughout the 18 months of the study. Women had 24/7 access to the ‘Bump2Baby and Me’ app and could look up resources, send an SMS or video message to their health coach, or communicate on the chat forum with other intervention women – even at 2 a.m. while feeding their baby! “They could send a quick video message to their health coach about their concerns rather than waiting for an appointment and possibly forgetting about what the issue was by the time the appointment came around,” says O’Reilly, adding: “They could set their own personalised goals – whether that was improving their diet, increasing physical activity, preparing for breastfeeding, or managing their recovery after birth.” The smartphone application was developed and is operated by Liva Healthcare(opens in new window), a Danish and British-based digital health company specialising in chronic disease prevention.
Significantly better metabolic health markers for participating women
Women receiving the mHealth coaching developed 30 % less gestational diabetes (14.0 % versus 19.7 % in the control group). At 12 months postpartum, women in the intervention group had better metabolic health markers – lower fasting glucose, insulin and triglycerides, and higher protective HDL cholesterol. “We also saw higher breastfeeding rates in the intervention group. Interestingly, both groups returned to their pre-pregnancy weight, suggesting that simply being part of the study, having scales at home, and being aware of their gestational diabetes risk had a positive effect,” explains O’Reilly. The Bump2Baby and Me app isn’t available to the general public yet as it still needs optimisation to enable its delivery across different countries and health systems. “I wanted to demonstrate that with the right digital tools and personalised support, we could make evidence-based prevention accessible during this critical 1 000-day period from conception to a child’s first birthday – supporting women with the right care at the right time and right place,” O’Reilly adds. “Thanks to this project, we now have good evidence and a detailed implementation toolkit that can help health systems to adopt this approach. Our research shows the benefit of moving from short-term, pregnancy-only programmes to longer-term support that recognises pregnancy as the beginning, not the end, of a critical health transition.”
