Effectiveness of a Nurse-Led Web-Based Health Management in Preventing Women With Gestational Diabetes From Developing Metabolic Syndrome

Abstract

Background Women with gestational diabetes mellitus (GDM) are more likely to develop metabolic syndrome (MS). However, the effectiveness of web-based health management in preventing women at high risk of GDM from developing MS has rarely been studied. Purpose The aim of this study was to evaluate the longitudinal effects of nurse-led web-based health management on maternal anthropometric, metabolic measures, and neonatal outcomes. Methods A randomized controlled trial was conducted from February 2017 to February 2018, in accordance with the Consolidated Standards of Reporting Trials guidelines. Data were collected from 112 pregnant women at high risk of GDM who had been screened from 984 potential participants in northern Taiwan. Participants were randomly assigned to the intervention group (n = 56) or the control group (n = 56). The intervention group received a 6-month nurse-led, web-based health management program as well as consultations conducted via the LINE mobile app. Anthropometric and metabolic measures were assessed at baseline (Time 0, prior to 28 weeks of gestation), Time 1 (36–40 weeks of gestation), and Time 2 (6–12 weeks of postpartum). Maternal and neonatal outcomes were assessed at delivery. Clinical trial was registered. Results Analysis using the general estimating equation models found that anthropometric and metabolic measures were significantly better in the intervention group than the control group and varied with time. At Time 1, the levels of diastolic pressure (β = −4.981, p = .025) and triglyceride (TG; β = −33.69, p = .020) were significantly lower in the intervention group than the control group, and at Time 2, the incidence of MS in the intervention group was lower than that in the control group (χ2 = 6.022, p = .014). The number of newborns with low birth weight in the intervention group was lower than that in the control group (χ2 = 6.729, p = .012). Conclusion/Implications for Practice This nurse-led, web-based health management was shown to be effective in improving MS outcomes and may play an important role and show feasible clinical value in changing the current pregnancy care model.

Internet-Based Interventions for Preventing Premature Birth Among Pregnant Women: Systematic Review

“…The 26 studies included in this review were conducted across various countries, with the largest number from the United States (6/26, 23% studies [ 29 - 34 ]), followed by China (4/26, 15% studies [ 35 - 38 ]), Taiwan (3/26, 11% studies [ 39 - 41 ]), Switzerland (2/26, 8% studies [ 42 , 43 ]), and the United Kingdom (2/26, 8% studies [ 44 , 45 ]). In addition, 1 study each was conducted in Australia [ 46 ], Canada [ 47 ], Iran [ 48 ], Ireland [ 49 ], the Netherlands [ 50 ], Norway [ 51 ], Spain [ 52 ], Sweden [ 53 ], and Thailand [ 54 ].…”

“…In addition, 1 study each was conducted in Australia [ 46 ], Canada [ 47 ], Iran [ 48 ], Ireland [ 49 ], the Netherlands [ 50 ], Norway [ 51 ], Spain [ 52 ], Sweden [ 53 ], and Thailand [ 54 ]. The publication years spanned from 1996 to 2022, with most studies (14/26, 54%) [ 32 - 34 , 40 - 46 , 49 , 51 - 53 ] published between 2010 and 2019, 42% (11/26) of the studies [ 29 , 31 , 35 - 39 , 47 , 48 , 50 , 54 ] published from 2020 to the time of the review, and 4% (1/26) of the studies [ 30 ] published before 2000. Among these, one study was published in Chinese [ 35 ] and another in Persian [ 48 ], with the remaining studies all written in English.…”

“…With regard to research design, 81% (21/26) of the studies used a randomized controlled experimental design [ 30 - 39 , 42 - 46 , 49 - 54 ], whereas 19% (5/26) of the studies used a quasi-experimental design [ 29 , 40 , 41 , 47 , 48 ]. The focus of these studies varied, with 8% (2/26) of the studies targeting pregnant women diagnosed with anxiety or depression [ 46 , 53 ], 27% (7/26) focusing on pregnant women with GDM or at risk of GDM [ 29 , 35 , 37 - 39 , 47 , 52 ], and 8% (2/26) involving women experiencing preterm labor [ 42 , 43 ]. Of the 26 studies, 1 (4%) was dedicated to pregnant smokers [ 44 ], 2 (8%) were dedicated to pregnant women using drugs or alcohol [ 30 , 34 ], and 1 (4%) was dedicated to those experiencing insomnia [ 31 ].…”

“…Education was the focus of 11% (3/26) of the studies, with 1 (33%) study focusing on diabetes diet education [ 29 ] and 2 (33%) studies focusing on general pregnancy health education [ 36 , 54 ]. Five studies targeted health behavior interventions, including diabetes dietary intake and exercise management [ 38 , 39 ], prenatal weight management behavior [ 32 , 33 ], and health care for substance abuse and risky sexual behavior [ 34 ]. Three studies explored self-help groups, including a web-based community for nonspecific pregnant women [ 41 ], a group for pregnant women with substance abuse [ 30 ], and a support group for smoking cessation [ 44 ].…”

“…Overall, 54% (14/26) of the studies used websites for intervention delivery [ 29 , 32 , 33 , 40 , 42 - 47 , 49 - 51 , 53 ], whereas 19% (5/26) of the studies used instant messaging only [ 35 , 36 , 38 , 39 , 48 , 54 ]. Various other methods were used in individual studies, such as computerizing intervention authoring systems [ 34 ], a mix of websites or mobile apps [ 31 ], social network services [ 41 ], offline and instant messengers [ 37 ], Internet of Things and instant messengers [ 38 ], telemedicine systems and SMS text messaging [ 52 ], and electronic voice bulletin boards using mobile devices [ 30 ].…”