The Preliminary Efficacy of a Sleep Self-management Intervention Using a Personalized Health Monitoring Device during Pregnancy

The Effect of a Mobile App (eMOM) on Self-Discovery and Psychological Factors in Persons With Gestational Diabetes: Mixed Methods Study

BACKGROUND

Gestational diabetes is a type of diabetes that develops during pregnancy and increases the risk of developing type 2 diabetes later in life. The rising prevalence of gestational diabetes mellitus (GDM) highlights the need for more comprehensive treatment strategies, with a particular emphasis on supporting maternal self-management. We showed recently that a mobile app, eMOM, where glucose, nutrition, and physical activity are combined within a single app, significantly improves multiple clinical outcomes among persons with gestational diabetes.

OBJECTIVE

This study aims to explore the effects of the eMOM on maternal self-discovery and learning, autonomous motivation to manage GDM, and psychological well-being. Additionally, we examine the correlation between improved maternal clinical outcomes and change in autonomous motivation. We also assess the acceptance and usability of the eMOM app.

METHODS

Building upon the original randomized controlled trial (RCT), in which the intervention arm used a mobile app (eMOM), we conducted a mixed methods study that included an investigation of eMOM log files, semistructured interviews on self-discovery, and an examination of questionnaires assessing motivation (Treatment Self-Regulation Questionnaire and Perceived Competence Scale), depression (Edinburgh Postnatal Depression Scale), technology use and acceptance (Unified Theory of Acceptance of Use of Technology questionnaire), and usability (modified Software Usability Measurement Inventory). Additionally, we monitored participants' stress levels using wearable electrocardiographic devices (FirstBeat Bodyguard 2). A total of 148 individuals participated in the original RCTs, with 76 in the intervention arm and 72 in the control arm. From the intervention arm, 18 participants were randomly selected for interviews in this study.

RESULTS

Results show that the use rate of eMOM was high, and novel visualization supported self-discovery in persons with GDM. Most participants (17/18, 94%) indicated that the eMOM app helped to find the associations between their daily activities and glucose levels. Especially having nutrition visualized together with glucose was highly appreciated. Participants also reported learning about the associations between physical activity and glucose levels. No differences were observed between the intervention and control arms in autonomous motivation, depression, or stress. Furthermore, there were no correlations between improved clinical outcomes and changes in motivation. Accessibility and usability ratings were consistently high throughout the intervention.

CONCLUSIONS

The eMOM mobile app combining data from continuous glucose monitor, food diary, and physical activity tracker supports maternal self-discovery related to GDM without contributing to depression or adding extra stress. This encourages the use of such mobile apps in maternity care. Notably, motivational factors did not correlate with the positive outcomes observed in our prior RCT, suggesting that self-discovery has a greater impact on clinical results.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04714762; https://www.clinicaltrials.gov/study/NCT04714762.

The effect of aromatherapy applied to pregnant women on sleep quality and fatigue level: A randomized clinical trial

INTRODUCTION

Sleep disturbances and fatigue can negatively impact pregnancy. The purpose of this study is to assess changes in sleep quality and fatigue levels pre- and post-aromatherapy intervention using lavender oil inhalation in pregnant women in the third trimester.

MATERIALS AND METHODS

The research was conducted in the gynecology and obstetrics outpatient clinic of a training and research hospital between October 2022 and March 2023. The study was designed as a randomized controlled experimental trial with a pretest-posttest control group. The sample consisted of a total of 74 pregnant women (37 intervention and 37 control). Aromatherapy with lavender oil was applied to pregnant women in the intervention group for one month using the "Inhalation Application Form." "Personal Information Form", "Visual Analog Scale (VAS)", "Pittsburg Sleep Quality Index (PSQI)" and " Visual Analogue Scale for Fatigue (VASF)" were used to collect data. Percentage distributions, chi-square significance test, t-test in independent groups, and Mann-Whitney U and Wilcoxon tests were used to evaluate the data.

RESULTS

In the study, the post-test PSQI score average of the pregnant women in the intervention group who received lavender oil inhalation was 4.10±1.36, it was 5.45±2.48 in the control group. The post-test fatigue score average of the pregnant women in the intervention group was 65.91±7.02, it was 75.40±10.79 in the control group. A statistically significant difference was found between the post-test PSQI and VAS-F total score averages of the pregnant women in the intervention and control groups (p < 0.05).

CONCLUSION

The study findings indicate that aromatherapy applied via inhalation to pregnant women improved sleep quality and reduced fatigue levels. According to these findings, lavender oil aromatherapy can be recommended to improve sleep quality and reduce fatigue levels in pregnant women during the third trimester.

Sleep quality during pregnancy and fetal growth: A prospective cohort study

The aim of this study is to investigate the association between sleep quality during pregnancy and fetal growth. Pregnant women and their fetuses at 16-20 gestational weeks in Nantong Maternal and Child Health Hospital were recruited. Women were classified as having "good sleep quality" (Pittsburgh Sleep Quality Index score ≤ 5) and "poor sleep quality" (Pittsburgh Sleep Quality Index score > 5) according to the Pittsburgh Sleep Quality Index scores. The fetal growth was evaluated by three ultrasonographic examinations, birth weight and birth length. We used general linear model and multiple linear regression models to estimate the associations. A total of 386 pairs of mother and infant were included in the data analysis. After adjusting for gestational weight gain, anxiety and depression, fetuses in the good sleep quality group had greater abdominal circumference (p = 0.039 for 28-31+6 weeks gestation, p = 0.012 for 37-40+6 weeks gestation) and femur length (p = 0.014 for 28-31+6 weeks gestation, p = 0.041for 37-40+6 weeks gestation) at 28-31+6 weeks gestation and 37-40+6 weeks gestation, and increased femur length (p = 0.007) at 28-31+6 weeks gestation. Birth weights (p = 0.018) were positively associated with sleep quality. Poor sleep quality was associated with poor intrauterine physical development, decreased abdominal circumference and femur length, and lower birth weight after adjusting for confounding factors. Attention to the fetal growth of pregnant women with poor sleep quality has the potential to decrease the risk of adverse fetal outcomes.

A Descriptive Comparative Pilot Study: Association Between Use of a Self-monitoring Device and Sleep and Stress Outcomes in Pregnancy

Pregnancy is a challenging time for maintaining quality sleep and managing stress. Digital self-monitoring technologies are popular because of assumed increased patient engagement leading to an impact on health outcomes. However, the actual association between wear time of such devices and improved sleep/stress outcomes remains untested. Here, a descriptive comparative pilot study of 20 pregnant women was conducted to examine associations between wear time (behavioral engagement) of self-monitoring devices and sleep/stress pregnancy outcomes. Women used a ring fitted to their finger to monitor sleep/stress data, with access to a self-monitoring program for an average of 9½ weeks. Based on wear time, participants were split into two engagement groups. Using a linear mixed-effects model, the high engagement group showed higher levels of stress and a negative trend in sleep duration and quality. The low engagement group showed positive changes in sleep duration, and quality and experienced below-normal sleep onset latency at the start of the pilot but trended toward normal levels. Engagement according to device wear time was not associated with improved outcomes. Further research should aim to understand how engagement with self-monitoring technologies impacts sleep/stress outcomes in pregnancy.