Mobile health as a primary mode of intervention for women at risk of or diagnosed with gestational diabetes mellitus: a scoping review

Abstract

Introduction: Prevention and management of GDM and its associated adverse outcomes are important to maternal and infant health. Women with GDM report high burden of disease management and barriers to lifestyle change post-delivery which mHealth interventions may help to overcome. Evidence suggests apps could help GDM prevention and management, however, less is known about broader applications of mHealth from preconception to interconception and whether relevant behavior change techniques (BCT) are incorporated.Objective: To map the extent of knowledge related to the use of mHealth as primary mode of intervention for the prevention and management of GDM and its long-term implications among women at risk of or diagnosed with GDM. We also sought to understand if mHealth for women at risk of or diagnosed with GDM incorporated relevant behavior change theory and techniques.Inclusion criteria: Studies, published in English, considered for inclusion focused on mHealth use as primary mode of intervention for the prevention and management of GDM and its long-term implications. Telehealth or telemedicine were excluded as these have been reviewed elsewhere. Methods: Six databases were searched during March 2021; MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Ovid), Cochrane Database (Wiley), Scopus, and TRIP. No limits were applied to database exploration periods to ensure retrieval of all relevant studies. Also gray literature; Open Grey, ISRCTN Registry, ClinicalTrials.gov, EU Clinical Trials register, and ANZCTR. Two reviewers independently screened abstracts and assessed full texts against the inclusion criteria. Data were extracted using an adapted version of the JBI results extraction instrument. Data are presented in narrative form accompanied by tables and figures. Results: This review identified 2166 sources, of which 96 full-texts were screened. Thirty eligible reports were included, covering 25 different mHealth interventions. Over half (14/25) were for selfmanaging blood glucose during pregnancy. Common features included tracking blood glucose levels, real-time feedback, communication with professionals and educational information. Few (6/25) mHealth were designed for postpartum use and none for interconception use. Five for postpartum use supported behavior change to reduce risk of type 2 diabetes and included additional features such as social support functions and integrated rewards. Early development and feasibility studies used mixed Created by XMLmind XSL-FO Converter. methods to assess usability and acceptability. Later stage evaluations of effectiveness typically used randomized controlled trial designs to measure clinical outcomes such as glycemic control and reduced body weight. Three mHealth interventions were developed using behavior change theory. Most mHealth incorporated two BCTs shown to be optimal when combined and those delivering behavior change interventions included a wider range. Nevertheless, only half of the 26 techniques listed in a published behavior change taxonomy were tried. Conclusion: mHe...

Gestational diabetes mellitus, follow-up of future maternal risk of cardiovascular disease and the use of eHealth technologies—a scoping review

“…Twelve reviews in total were included [39][40][41][42][43][44][45][46][47][48][49][50], of which one scoping review [39], one overview of other reviews [44], five systematic reviews [42,45,46,48,49], and five systematic reviews with meta-analyses [40,41,43,47,50]. Two of the reviews focused primarily on mHealth (mobile Health)/eHealth [39,43], while the others mainly assessed lifestyle interventions.…”

“…Twelve reviews in total were included [39][40][41][42][43][44][45][46][47][48][49][50], of which one scoping review [39], one overview of other reviews [44], five systematic reviews [42,45,46,48,49], and five systematic reviews with meta-analyses [40,41,43,47,50]. Two of the reviews focused primarily on mHealth (mobile Health)/eHealth [39,43], while the others mainly assessed lifestyle interventions. Of the two mHealth/ eHealth reviews, the scoping review merely presented the existing literature and noted good engagement for app usage, but also a lack of studies where mHealth was the primary mode of intervention postpartum [39].…”

“…Two of the reviews focused primarily on mHealth (mobile Health)/eHealth [39,43], while the others mainly assessed lifestyle interventions. Of the two mHealth/ eHealth reviews, the scoping review merely presented the existing literature and noted good engagement for app usage, but also a lack of studies where mHealth was the primary mode of intervention postpartum [39]. In their systematic review and meta-analysis, Halligan et al [43] found that the results of the meta-analysis favored intervention compared to standard care for the outcomes of weight and BMI, but the results were not statistically significant.…”

Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review

“…On the basis of the mapped literature, the nature, content, and structure of digital therapeutics are major determinants of their uptake and effectiveness across countries [ 1 , 4 , 13 , 19 , 40 , 63 , 100 , 102 , 189 , 191 - 194 , 200 , 205 , 230 , 246 , 265 , 266 ]. The design of digital therapeutics needs to be driven by the needs and expectations of patients [ 56 , 61 , 66 , 68 , 84 , 100 , 102 , 117 , 118 , 122 , 132 , 136 , 140 , 141 , 168 , 177 , 189 , 191 - 194 , 200 , 202 , 208 , 214 - 216 , 221 , 230 , 233 , 250 , 266 , 273 , 274 ] while acknowledging that patient needs may shift with time and disease progression [ 140 ]. They need to have clear aims and a position in the health care pathway that is understood by patients and professionals, with comprehensive and trusted information provided about the qualities and services of the devices and targeted health condition [ 56 , 57 , 93 , 118 , 142 , 174 , 177 , 178 , …”

Telehealth in the Prenatal and Postpartum Periods

“…(2020) found that telehealth interventions for pregnant women with gestational diabetes mellitus were associated with improvements in glycemic control and reductions in cesarean, macrosomia, pregnancy-induced hypertension or preeclampsia, and preterm birth compared to women in standard care. There is rising interest and an increase in research being conducted on mobile health technologies, including mobile apps, to self-manage blood glucose during pregnancy (fewer for the postpartum period) and interventions to improve clinical outcomes such as glycemic control ( Edwards et al., 2022 ). Hanach et al.…”