When Niki found out she was pregnant again it was a bit of a surprise. “I thought I was menopausal,” she reveals, “it was such a shock!” Niki was also a little embarrassed, she confesses. After all, she was working as a midwife, and is a trained nurse.
As a ‘geriatric mother’ – a rather unflattering term used for expectant mothers over the age of 35 – Niki decided to put herself forward for gestational diabetes screening. Although not always seen as a risk factor in itself, Niki’s experience as a midwife made her aware that age can increase the risk for the condition.
Unfortunately, her instincts proved correct.
What is gestational diabetes?
Gestational diabetes mellitus (GDM) is a high blood sugar condition that can develop during pregnancy as hormones and other factors interfere with insulin activity, which controls glucose levels. It can occur at any stage of pregnancy but is more common in the second or third trimester and can cause problems for both mother and baby during pregnancy and after birth.
GDM affects 4-5% of women in the UK[1], with high-risk groups including those with a BMI over 30, those having previously given birth to a baby weighing more than 4.5kg, and those who have had gestational diabetes previously, who have direct family with diabetes, or who have South Asian, Chinese, African-Caribbean or Middle Eastern family origin.
Globally, this translates to a prevalence of 14.2%[2]. However, a 2016 study looking at ethnic breakdown in the UK and Ireland[3] concludes that GDM is increasing in the UK. This may be due to higher rates of screening, lowering of diagnostic thresholds, and an increase in the proportion of women at risk, either due to ethnicity or increasing weight or age.
Most mothers will go on to have normal pregnancies with healthy babies. However, GDM can cause complications during delivery, and, in very rare cases, the loss of the baby. Additionally, having GDM increases the risk of the mother developing type 2 diabetes in the future.
Managing diabetes while pregnant
Controlling glucose levels can help expectant mothers avoid pregnancy complications, but monitoring is vital to ensure effective treatment. A glucose testing kit is usually provided for checking blood sugar levels, using a finger-pricking device to place a drop of blood on a testing strip.
Niki admits that she was quite anxious when she found out the results of her GDM screening: “I knew the importance of managing your blood sugar when you’re pregnant, and the implications of that made me quite anxious. I am not your typical GDM candidate. I have a BMI of 19, I’m fit. I think because my previous pregnancies were so low risk, this was a huge contrast.”
Managing GDM means eating regular meals, a balanced, high fibre diet, and close watch of portion sizes and sugary foods, plus daily physical activity. For expectant mothers, whose blood sugar levels don’t stabilise, treatments such as metformin tablets or insulin injections can be given.
The GDm-Health app
Niki had heard about an app that was designed for monitoring GDM pregnancies and thought this may be helpful for herself.
“I had never seen the app,” Niki tells us. “But after my diagnosis, at 26 weeks, I met with Sharon, the diabetic midwife. I downloaded it and she went through it with me in detail.”
Niki found the app simple to use.
“You take your blood sugar [reading] and then you input it into the app,” she explains. “You see immediately when you put the number in whether it’s high, within range, or whether it’s a bit low, using a ‘traffic light’ system.”
Any issues are flagged to clinical staff via the app, who can then respond immediately. Niki recalls one instance where she was quickly put on medication because her blood sugars were of concern.
The app also reduces the need for constant clinic visits, benefiting women who may find them inconvenient or stressful due to childcare needs or transportation issues.
Did Niki feel that the app gave her more control over her condition?
“Definitely. I think this was fantastic. You were part of your care – in control and involved in decision making,” she says.
Niki also found the app helpful in planning her day, by providing instant blood sugar readings, allowing her to adjust her levels as needed. A green traffic light would give her confidence that she could then go about her day.
The app Niki used was the GDm-Health (Gestational Diabetes Support) powered by Huma Therapeutics. This app allows women diagnosed with GDM, in consultation with their midwifery team, to upload and track blood glucose readings and display them in a list, diary view, or graph. The expectant mother receives care guidance and callbacks directly from their care team as needed.
Other features of the app include reminders and a log of previous readings, plus the ability for the user to annotate blood glucose data with meal tags, medication doses and other comments.
All personal data is encrypted and sent securely to the relevant hospital or clinic where the health team uses a web-app dashboard to review readings from their patients, prioritise callbacks and send feedback via text messages.
Royal Surrey County Hospital introduces GDm-Health
Mobile health applications like GDm-Health offer significant health team benefits, improving patient outcomes and experience while also reducing time and costs for the hospital and care teams.
In April 2019, the Royal Surrey County Hospital introduced the GDm-Health app to pregnant women diagnosed with GDM. The NHS-run hospital achieved a high adoption of the technology among the women within the first six months, with 95% regularly recording blood glucose readings via the app.
A year later, this number had increased to 98% as more women recognised the benefits of remote monitoring. GDm-Health has allowed the hospital to digitise its approach in managing pregnant women with diabetes, improving the effectiveness of its maternity services and clinicians.
The hospital reduced midwife appointments by 18% and diabetic specialist doctor appointments by 47%. There was also a reported increase in communication between the expectant mothers and their providers.
The future for mobile health
As a midwife herself, Niki is convinced that the app has huge benefit potential for the healthcare team, whom she knows well. “I think it’s the way forward in healthcare,” she says. “From my experience of working with women, it not only helps to reduce anxiety, but also increases participation proactively. It’s an integral part of your care, and if you want to be involved in your care, it’s a must.”
For Niki, the app was a game-changer, and she now has a healthy baby boy.
Annabelle Miles, marketing director at Huma Healthcare says:
“Feedback from patients like Niki is invaluable and means we can keep refining the app, making sure we are keeping the product patient-first and continuing to provide better patient care.”
For more information on Huma’s GDm-Health app, please download the paper below.
[i] https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/gestational-diabetes/
[ii] https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(21)00409-5/fulltext
[iii] https://www.ncbi.nlm.nih.gov/books/NBK401113/
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