Prevention of hyperglycaemia in antenatal care using tailored communication strategies and mobile learning devices

Short title for our project is Gravid+ (Pregnancy+). Gestational diabetes (GDM), defined as diabetes diagnosed for the first time during pregnancy, has a prevalence of about 11% among ethnic Norwegians and 12-17% among them with a non-European background. Gestational diabetes is associated with increased health risks for both mother and the unborn/newborn baby. In addition, have pregnant women with gestational diabetes an increased risk to develop Type 2 diabetes (T2DM) later in life. Changes in lifestyle such as increased physical activity and a healthy diet are the primary treatment of gestational diabetes for most women. These changes can also prevent T2DM. Standard communication of lifestyle changes has been mainly through verbal information accompanied by some leaflets. It is a challenge for health workers to individualize this information, in particular for women with an immigrant background. We have developed a new way for providing information to women with GDM (task 1). An App for smart telephone which gives women information about gestational diabetes, diet, physical activity and a graphical presentation of their blood glucose measurements which are being transferred from to the App via Bluetooth (BLE). Women can register their personal aims, their weight development and appointments. The App includes information about their hospital and has links to relevant websites such as the Diabetic organization where there are recipes and other information. The App has been developed for IOS and Android telephones and is produced in Norwegian, Somali and Urdu. We have investigated the effect of our app through a randomized controlled trial at 5 hospitals. We started recruiting in the autumn of 2015 and finished spring 2017. Women fill out questionnaires electronically at inclusion (Q1), at 36 weeks (Q2) and around 3 months postpartum. We have reached our aim and include 238 women (Q1), 200 have filled out Q2 and 161 Q3. Of the women who completed Q1, 75 have provided us with the result for the main outcome for the study is the two hour blood glucose level at routine Oral Glucose Tollerance Test postpartum (OGTT). Spring 2017 the guidelines for follow-up of women with GDM were changed and OGTT is no longer part of routine care. This made it difficult to motivate women to take this test, which in addition is an uncomfortable experience for most. Our secondary outcomes are not threatened as they are collected from the woman?s medical record at the hospital. So far we have published a paper on the development of the app, our RCT protocol in BMJ Open and women?s and midwives? experience of the app and participation in the study. We have a paper under review which explored women?s knowledge of GDM shortly after diagnosis with data from Q1. This study compared women with Norwegian as their mother tongue to women who did not have Norwegian as their mother tongue. Over half of our participants did not have Norwegian as their mother tongue. The PhD student in the project is working on the final paper of her doctoral work. This paper presents the effect of the Pregnant+ app compared to standard care, including main and secondary outcomes. The PhD candidate expects to defend her thesis in the course of 2019. At the moment the complete app is not available for the public. We are working with an update of the content of the information in the app and will make the complete app available for the public after that. As keeping the app available and updated costs money we are investigating who can take over the app in the long run. We have started a collaboration with researchers at the Monash university in Melbourne (Australia). They will translate the app to English and will test this and the Urdu version among pregnant women with GDM in Melbourne. The previous postdoctoral student in our project, now associate professor at OsloMet, has started two studies on the nutritional data of the project. Our collaborators from Aker University Hospital are aiming to publish two papers on the physical activity data.

-

The growing prevalence of Type 2 diabetes mellitus (T2DM) is regarded as one of the main public health challenges in Norway. Also gestational diabetes mellitus (GDM) is on the increase in pregnant women overall, but the higher prevalence of these metabol ic disturbances in several immigrant groups is a particular concern. The proposed project aims to develop and assess the feasibility and effect of tailored nutrition communication strategies and appropriate mobile learning devices aimed at prevention of h yperglycaemia in pregnant women. An app will be developed. This will be novel in primarily using visual material, audio messages given in selected languages and limited use of text to increase its suitability for women with low health literacy skills and non-native Norwegian speakers. The second element is structured conversations between the midwives and the pregnant women that will take place in the consulting room using digital learning objects (pictures, videos and audio files) on a tablet. This will include simple tools to assess the current diet, a strategy to identify the most appropriate dietary behaviours to target and setting personal goals, and elements to raise risk awareness and motivation for change. The same communication strategies and dig ital tools, adopted to normal and GDM pregnancies respectively, will be tested in two settings: 1) a randomised controlled trial of GDM women attending diabetic outpatient clinics (secondary prevention), and 2) a feasibility study of an intervention study delivered through antenatal care at Mother and Child Health Centres (primary prevention).