A randomised controlled trial of an M-health behavioural lifestyle intervention to prevent gestational diabetes in overweight and obese pregnancy: PEARS trial

Interventions focusing on changing lifestyle behaviours may improve outcomes in overweight and obese pregnancies. Mobile Health (mHealth) technologies hold potential to support such interventions. The aim of this study was to assess the impact of a 'healthy lifestyle package' (an antenatal behavioral intervention) compared with usual care on the incidence of GDM in women with a BMI ≥ 25 kg/m2. This was an RCT of 565 women. Women were randomised to usual care, or 'healthy lifestyle package'. This package, grounded in behavior change theory, consisted of one education session on low GI diet and physical activity in pregnancy, a smartphone app reinforcing this and fortnightly motivational emails. The primary outcome was the incidence of GDM at 29 weeks of gestation. Other outcomes included gestational weight gain (GWG), birthweight, and large for gestational age (LGA). GDM incidence did not differ between intervention and control groups; 15.4% versus 14.1% P = 0.69. The intervention group had significantly less GWG compared to controls (11.3 ± 5.6 kg versus 12.6 ± 5.6 kg; P = 0.027). The intervention resulted in improvement in late pregnancy glucose homeostasis with attenuation in late pregnancy insulin resistance. Although there was no difference in birthweight between the two groups, fewer infants were born LGA in the intervention group compared to control 11/266 (4.1%) versus 24/ 275 (8.7%) P = 0.03. An m‐health‐supported behavioral intervention had no impact on the incidence of GDM in an at risk population. It did, however, have a positive impact on GWG, maternal glucose homeostasis and significantly reduced the number of infants born LGA.