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

10.1097/jnr.0000000000000456

Mei-Chen SU；An-Shine CHAO；Min-Yu CHANG；Yao-Lung CHANG；Chien-Lan CHEN；Jui-Chiung SUN

gestational diabetes mellitus ； health management ； metabolic syndrome ； nurse-led ； web-based

The Journal of Nursing Research

29卷6期（2021 / 12 / 01）

1 - 13

英文

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 (Time0, 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 Time1, 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 (X^2 = 6.022, p = .014). The number of newborns with low birth weight in the intervention group was lower than that in the control group (X^2 = 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.

1. Tung, C. T.,Lee, C. F.,Lin, S. S.,Lin, H.-M.(2014).The exercise patterns of pregnant women in Taiwan.The Journal of Nursing Research,22(4),242-249.
   連結：
2. Alberti, K. G.,Zimmet, P.,Shaw, J.,IDF Epidemiology Task Force Consensus Group(2005).The metabolic syndrome-A new worldwide definition.The Lancet,366(9491),1059-1062.
3. Allehdan, S. S.,Basha, A. S.,Asali, F. F.,Tayyem, R. F.(2019).Dietary and exercise interventions and glycemic control and maternal and newborn outcomes in women diagnosed with gestational diabetes: Systematic review.Diabetes & Metabolic Syndrome: Clinical Research & Review,13(4),2775-2784.
4. Bartholomew, M. L.,Soules, K.,Church, K.,Shaha, S.,Burlingame, J.,Graham, G.,Sauvage, L.,Zalud, I.(2015).Managing diabetes in pregnancy using cell phone/Internet technology.Clinical Diabetes,33(4),169-174.
5. Carolan-Olah, M.,Sayakhot, P.(2019).A randomized controlled trial of a web-based education intervention for women with gestational diabetes mellitus.Midwifery,68,39-47.
6. Chen, H.,Chai, Y.,Dong, L.,Niu, W.,Zhang, P.(2018).Effectiveness and appropriateness of mHealth interventions for maternal and child health: Systematic review.JMIR Mhealth Uhealth,6(1),Article e7.
7. Chen, L. H.,Chen, S. S.,Liang, L.,Wang, C. L.,Fall, C.,Osmond, C.,Veena, S. R.,Bretani, A.(2017).Relationship between birth weight and total cholesterol concentration in adulthood: A meta-analysis.Journal of Chinese Medical Association,80(1),44-49.
8. Cohen, J.(1988).Statistical power analysis for the behavioral sciences.Erlbaum.
9. Faul, F.,Erdfelder, E.,Lang, A. G.,Buchner, A.(2007).G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences.Behavior Research Methods,39,175-191.
10. Gilbert, L.,Gross, J.,Lanzi, S.,Quansah, D. Y.,Puder, J.,Horsch, A.(2019).How diet, physical activity and psychosocial wellbeing interact in women with gestational diabetes mellitus: An integrative review.BMC Pregnancy and Childbirth,19,Article No. 60.
11. Given, J. E.,Bunting, B. P.,O'Kane, M. J.,Dunne, F.,Coates, V. E.(2015).Tele-Mum: A feasibility study for a randomized controlled trial exploring the potential for telemedicine in the diabetes care of those with gestational diabetes.Diabetes Technology & Therapeutics,17(12),880-888.
12. Grotenfelt, N. E.,Wasenius, N.,Eriksson, J. G.,Huvinen, E.,Stach-Lempinen, B.,Koivusalo, S. B.,Rönö, K.(2020).Effect of maternal lifestyle intervention on metabolic health and adiposity of offspring: Findings from the Finnish Gestational Diabetes Prevention Study (RADIEL).Diabetes & Metabolism,46(1),46-53.
13. Hakkarainen, H.,Huopio, H.,Cederberg, H.,Pääkkonen, M.,Voutilainen, R.,Heinonen, S.(2016).The risk of metabolic syndrome in women with previous GDM in a long-term follow-up.Gynecological Endocrinology,32(11),920-925.
14. Homko, C. J.,Deeb, L. C.,Rohrbacher, K.,Mulla, W.,Mastrogiannis, D.,Gaughan, J.,Santamore, W. P.,Bove, A. A.(2012).Impact of a telemedicine system with automated reminders on outcomes in women with gestational diabetes mellitus.Diabetes Technology & Therapeutics,14(7),624-629.
15. Huvinen, E.,Eriksson, J. G.,Koivusalo, S. B.,Grotenfelt, N.,Tiitinen, A.,Stach-Lempinen, B.,Rönö, K.(2018).Heterogeneity of gestational diabetes (GDM) and long-term risk of diabetes and metabolic syndrome: Findings from the RADIEL study follow-up.Acta Diabetologica,55(5),493-501.
16. International Association of Diabetes and Pregnancy Study Groups Consensus Panel,Metzger, B. E.,Gabbe, S. G.,Persson, B.,Buchanan, T. A.,Catalano, P. A.,Damm, P.,Dyer, A. R.,de Leiva, A.,Hod, M.,Kitzmiler, J. L.,Lowe, L. P.,McIntyre, H. D.,Oats, J. J.,Omori, Y.,Schmidt, M. I.(2010).International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy.Diabetes Care,33(3),676-682.
17. Mackillop, L.,Hirst, J. E.,Bartlett, K. J.,Birks, J. S.,Clifton, L.,Farmer, A. J.,Gibson, O.,Kenworthy, Y.,Levy, J. C.,Loerup, L.,Rivero-Arias, O.,Ming, W. K.,Velardo, C.,Tarassenko, L.(2018).Comparing the efficacy of a mobile phone-based blood glucose management system with standard clinic care in women with gestational diabetes: Randomized controlled trial.JMIR Mhealth Uhealth,6(3),Article e71.
18. McKenzie-Sampson, S.,Paradis, G.,Healy-Profitós, J.,St-Pierre, F.,Auger, N.(2018).Gestational diabetes and risk of cardiovascular disease up to 25 years after pregnancy: A retrospective cohort study.Acta Diabetologica,55,315-322.
19. National Institute for Health and Care Excellence(2015).Diabetes in pregnancy: Management from preconception to the postnatal period.
20. National Statistics, ROC. (2020). Statistical yearbook of interior. Fertility rates of childbearing age women. https://www.moi.gov.tw/files/site_stuff/321/2/year/year.html (Original work published in Chinese)
21. Nghiem-Rao, T. H.,Dahlgren, A. F.,Kalluri, D.,Cao, Y.,Simpson, P. M.,Patel, S. B.(2016).Influence of gestational age and birth weight in neonatal cholesterol response to total parenteral nutrition.Journal of Clinical Lipidology,10(4),891-897.e1.
22. Nouhjah, S.,Shahbazian, H.,Shahbazian, N.,Jahanfar, S.,Jahanshahi, A.,Cheraghian, B.,Mohammadi, Z. D.,Ghodrati, N.,Houshmandi, S.(2018).Early postpartum metabolic syndrome in women with or without gestational diabetes: Results from life after gestational diabetes Ahvaz cohort study.Diabetes& Metabolic Syndrome: Clinical Research & Review,12(3),317-323.
23. Pathirana, M. M.,Lassi, Z. S.,Ali, A.,Arstall, M. A.,Roberts, C. T.,Andraweera, P. H.(2021).Association between metabolic syndrome and gestational diabetes mellitus in women and their children: A systematic review and meta-analysis.Endocrine,71,310-320.
24. Puhkala, J.,Kinnunen, T. I.,Vasankari, T.,Kukkonen-Harjula, K.,Raitanen, J.,Luoto, R.(2013).Prevalence of metabolic syndrome one year after delivery in Finnish women at increased risk for gestational diabetes mellitus during pregnancy.Journal of Pregnancy,2013,Article 139049.
25. Puhkala, J.,Raitanen, J.,Kolu, P.,Tuominen, P.,Husu, P.,Luoto, R.(2017).Metabolic syndrome in Finnish women 7 years after a gestational diabetes prevention trial.BMJ Open,7(3),Article e014565.
26. Rao, U.,de Vries, B.,Ross, G. P.,Gordon, A.,Cochrane Pregnancy and Childbirth Group(2019).Fetal biometry for guiding the medical management of women with gestational diabetes mellitus for improving maternal and perinatal health.Cochrane Database Systematic Review,9,Article CD012544.
27. Rasekaba, T. M.,Furler, J.,Young, D.,Liew, D.,Gray, K.,Blackberry, I.,Lim, W. K.(2018).Using technology to support care in gestational diabetes mellitus: Quantitative outcomes of an exploratory randomised control trial of adjunct telemedicine for gestational diabetes mellitus (TeleGDM).Diabetes Research & Clinical Practice,142,276-285.
28. Reinbold, S.(2013).Using the ADDIE model in designing library instruction.Medical Reference Services Quarterly,32(3),244-256.
29. Shen, Y.,Li, W.,Leng, J.,Zhang, S.,Liu, H.,Li, W.,Wang, L.,Tian, H.,Chen, J.,Qi, L.,Yang, X.,Yu, Z.,Tuomilehto, J.,Hu, G.(2019).High risk of metabolic syndrome after delivery in pregnancies complicated by gestational diabetes.Diabetes Research and Clinical Practice,150,219-226.
30. von Storch, K.,Graaf, E.,Wunderlich, M.,Rietz, C.,Polidori, M. C.,Woopen, C.(2019).Telemedicine-assisted self-management program for Type 2 diabetes patients.Diabetes Technology & Therapeutics,21(9),514-521.
31. Wang, J.,Wen, D.,Liu, X.,Liu, Y.(2019).Impact of exercise on maternal gestational weight gain: An updated meta-analysis of randomized controlled trials.Medicine,98(27),Article e16199.
32. Werbrouck, A.,Schmidt, M.,Putman, K.,Benhalima, K.,Verhaeghe, N.,Annemans, L.,Simoens, S.(2019).A systematic review on costs and cost-effectiveness of screening and prevention of Type 2 diabetes in women with prior gestational diabetes: Exploring uncharted territory.Diabetes Research and Clinical Practice,147,138-148.
33. Xie, W.,Dai, P.,Qin, Y.,Wu, M.,Yang, B.,Yu, Y.(2020).Effectiveness of telemedicine for pregnant women with gestational diabetes mellitus: An updated meta-analysis of 32 randomized controlled trials with trial sequential analysis.BMC Pregnancy and Childbirth,20(1),Article No. 198.
34. Xu, Y.,Shen, S.,Sun, L.,Yang, H.,Jin, B.,Cao, X.(2014).Metabolic syndrome risk after gestational diabetes: A systematic review and meta-analysis.PLOS ONE,9(1),Article e87863.