Original Research

Pregnancy Exercise and Nutrition With

Smartphone Application Support
A Randomized Controlled Trial

Maria A. Kennelly, MRCPI, Kate Ainscough, MSc, Karen L. Lindsay, PhD, Elizabeth O’Sullivan, PhD,
Eileen R. Gibney, PhD, Mary McCarthy, PhD, Ricardo Segurado, PhD, Giuseppe DeVito, PhD,
Orla Maguire, PhD, Thomas Smith, PhD, Mensud Hatunic, MD,
and Fionnuala M. McAuliffe, MD, FRCOG
 INTRODUCTION

Gestational diabetes mellitus (GDM) is

Overweight and obese women often find it
“glucose intolerance first recognized during
difficult to change dietary and physical
pregnancy” and is associated with up to a
activity behaviors during pregnancy
70% risk of type 2 diabetes in later life

Mobile health or “mHealth” technologies

Recently published studies describing
are becoming commonplace to assist in the
combined nutrition and exercise
management of chronic illnesses and
interventions have reported only some
support behavior change
success in reducing GDM.
.

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 OBJECTIVE & HYPOTHESIS
OBJECTIVE HYPOTHESIS

To evaluate the effect of a healthy Lifestyle intervention would reduce the

lifestyle package (an antenatal behavior incidence of GDM per the International
change intervention supported by Association of Diabetes and Pregnancy
smartphone application technology) on Study Group diagnostic criteria
the incidence of gestational diabetes
mellitus (GDM) in overweight and obese
women.

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 METHODS AND MATERIAL
single-center randomized controlled trial 01
March 2013 to February 2016
With ethical approval and maternal
written consent conducted at the National
Maternity Hospital, Dublin,Ireland
. 02

04 Normality variable using histogram, primary

outcome analysis with x2, Independent-sample
t tests were used for comparison of means and
x2 and Fisher exact tests used to compare
Randomization was performed using a
categorical variables between the two groups
computer- generated sequence in a ratio of
one to one 03
.

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 METHODS AND MATERIAL
the control group received standard
05 antenatal care, which in Ireland does not
consist of any uniform advice on diet,
neither participants nor researchers were
exercise, or weight gain in pregnancy
blinded to the intervention or outcomes
(Double blind)
06

08
intervention group received standard
antenatal care plus a “Healthy Lifestyle
Singleton pregnant women between 10 and 15 Package

07
weeks of gestation with BMI between 25.0 and
39.9 and in possession of a smartphone were
recruited at their first antenatal visit.
.
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 INTERVENTION GROUP
PHASE 01 PHASE 02
This education session The nutritional component IS
was delivered at the first healthy eating in pregnancy.
study visit and centered Participants were encouraged to
on targeted nutrition and swap high glycemic index foods
physical activity advice. for low glycemic index alternatives
. and were informed about healthy
carbohydrate portions
Women were advised to
exercise per the American
College of Obstetricians and
Gynecologists’ guidance, that is
30 minutes of moderate exercise
5–7 days per week, divided into
two 15-minute or three 10-
minute.
2/27/2019
PHASE 03
The information received
at this education session
was reinforced through
the following delivery
channels: a smartphone
application, emails
every 2 weeks (sent by
the research team), and
two follow-up face-to-face
hospital visits at 28 and 34
weeks of gestation
PHASE 04
The last measured weight
taken before delivery,
Gestational diabetes mellitus
was confirmed if
at least one glucose value
was at or above the
following:
fasting 92 mg/dL or greater,
1 hour 180 mg/dL or
greater, and 2 hour 153
mg/dL or greater
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RESULT
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A B
intervention
incorporating dietary and
physical activity advice
with reinforcement
using mobile health
technology
did not lower the rate of
GDM
DISCUSSION
C D
Our results are consistent
with others; two recently
published large randomized
controlled trials were
unsuccessful in showing a
positive effect of a
behavioral lifestyle
intervention on GDM
multiple testing for
secondary and exploratory
efficacy outcomes gives
more reassurance that the
intervention effect on
exercise and glycemic load
is robust.
We note that this
interpretation of the
adjusted P values is in
contrast to a more
traditional Bonferroni
correction
 CONCLUSIONS

A mobile health-supported
did not
behavioral intervention
decrease the incidence of GDM.
 SIMILAR? OBJECTIVE & CONCLUSION?

Kesimpulan menjawab tujuan,

Baik grup kontrol dan perlakuan namun tujuan tidak tertulis di
memiliki karakteristik yang serupa introduction.

Treatment Effect? RANDOMISASI?

Primary outcome menunjukkan hasil
signifikan sebesar 0,001 dengan CI Dalam penelitian dilakukan,
95%, secondary outcome dan ditulis terdapat kriteria inklusi
yanglain tidak berbeda dan ekslusi namun tidak
CRITICAL disebutkan apa saja
DATA ANALYSIS
APPRAISAL SAMPEL?
Banyak data yang tidak memberi
nilai signifikan, terlalu banyak Equal, jumlah sampel di awal
outcomes yang dinilai dan di adjust? perekrutan tidak sama
Neonatal outcome dilakukan analisa dengan di akhir penelitian
yang sebelumnya tidak tetera tujuan karena berbagai hal
dilihatnya outcome neonatal

BLINDING?
NOT IMPORTANT AND NOT
APPLICABLE
Blinded baik partisipan maupun peneliti
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Thank You