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| ID | Type | Description | Link |
|---|---|---|---|
| B2B&ME+ | Other Grant/Funding Number | Health Research Board and Horizon Europe |
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| Name | Class |
|---|---|
| National Maternity Hospital, Ireland | OTHER |
| Aarhus University Hospital | OTHER |
| Liva Healthcare A/S | UNKNOWN |
| Western Norway University of Applied Sciences |
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Gestational diabetes mellitus (GDM) affects approximately 1 in 7 pregnancies globally and is associated with significant short and long-term health consequences for both mothers and infants. While lifestyle interventions during pregnancy can effectively reduce GDM risk and its complications, there is limited guidance on how to translate this evidence into routine antenatal and postpartum care. This project looks to address this gap by exploring the effectiveness of the B2B&Me+ programme within regular maternity services across four European countries and how best to implement it.
Women identified as being at higher risk of developing GDM using a GDM screening tool will receive access to the smartphone application that connects them with their health coach, who will provide personalised support about healthy eating, physical activity, mental wellbeing, and infant care from early pregnancy until 9 months after birth. The participants will be randomised initially to a specific referral pathway for the intervention.
While lifestyle interventions during pregnancy can effectively reduce GDM risk and its complications, there is limited guidance on how to translate this evidence into routine antenatal and postpartum care. Building on the successful Horizon2020-funded Bump2Baby and Me trial, this implementation project seeks to address this gap by testing the real-world effectiveness of the B2B&Me+ programme within regular maternity services across four European countries.
This is a hybrid type 3 implementation-effectiveness study using a non-randomised, ABA intervention design nested within a longitudinal cohort. As a type 3 hybrid, focus is primarily on implementation outcomes while also collecting effectiveness outcomes as they relate to uptake or fidelity of the intervention. The study will compare the delivery of the Monash machine learning GDM screening tool (MMLGDST)12 and mHealth coaching referral during a 3-month intervention block (B) with two 3-month blocks of usual care, before and after the intervention (A blocks).
Block A (Usual care phases): The research staff will briefly explain the data collection aspect of the study and provide an information leaflet. Women will be informed that the study involves collecting anonymised data from their medical records for research purposes, with no additional procedures or interventions beyond their standard care.
Within the intervention block (B), different referral methods will be tested every 2 weeks:
The intervention (B2B&Me+ programme) involved is a lifestyle intervention comprised of the following components:
I. A Bluetooth-enabled weighing scale that syncs with the app to facilitate self-monitoring of weight.
II. Synchronous coaching sessions conducted on a 1:1 basis between the mHealth coach and participants at enrolment and 6-8 weeks postpartum.
III. Asynchronous mHealth coaching that uses a combination of text and video messaging exchanges between the mHealth coach and participant.
IV. Automated push notifications are sent out to participants. V. Participants will receive personalised educational content from their mHealth coach during the asynchronous coaching sessions.
VI. Participants will receive automated push notifications referring to additional content available in the B2B&Me+ app.
VII. Participants will also have access to a virtual social network, through the mHealth coaching app, with other women participating in the study.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Block A (Usual care phases) | No Intervention | The comparator is usual care (Block A women) as provided at each participating maternity hospital | |
| Block B (Intervention phase) | Experimental | Women identified as being at risk and likely to benefit from lifestyle intervention will be invited to participate in the B2B&Me+ programme through one of four randomly allocated referral methods (randomisation at site level) that will be rotated every 2 weeks: i. Point-of-care (POC) active referral: Women will be directly offered the programme after their appointment, and they will be supported to commence the app sign-up process ii. POC with follow-up phone call: As above plus follow-up call within 48 hours to support enrolment iii. Leaflet with follow-up call: Women will receive an information leaflet about the programme and sign-up process plus a follow-up call within 48 hours to support enrolment iv. Leaflet provided: Women will receive only an information leaflet about the programme and sign-up process |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Life Style Intervention | Behavioral | The intervention consists of seven related components: I. A Bluetooth-enabled weighing scale that syncs with the app to facilitate self-monitoring of weight. II. Synchronous coaching sessions conducted on a 1:1 basis between the mHealth coach and participants. There will be 2 synchronous sessions, the first at enrolment and the second between 6-8 weeks postpartum. These sessions typically last 45-50 minutes in length with a follow-up summary video message of the goals discussed and, at the beginning of the mother's journey, the establishing of a change agreement. This is mediated through the live-video feature in the B2B&Me+ mHealth coaching app, but the length and thus number of these sessions is determined by the woman. If the woman is diagnosed with GDM, there will be an opportunity for a third 15-minute synchronous coaching session to review and adjust any lifestyle goals to align with the individual's diabetes management plan. III. Asynchronous mHealth coaching that uses a combi |
| Measure | Description | Time Frame |
|---|---|---|
| Penetration and participation rates in early pregnancy GDM screening and intervention | The primary analysis will compare penetration across the different blocks (A vs B), participation rates and different referral methods within Block B. This will be analysed using chi-square tests for categorical data and t-tests or ANOVA for continuous data. | Immediately following intervention. |
| Measure | Description | Time Frame |
|---|---|---|
| Maternal Weight and BMI at baby's birth | Maternal weight (kg) and Body Mass Index (gestational weight gain) | At birth of baby. |
| GDM incidence at baby's birth. | GDM incidence rate. |
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Inclusion Criteria:
Additional for the intervention group (Block B):
Exclusion Criteria:
Additional for the intervention group (Block B):
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Sharleen O'Reilly | Contact | 00353 1 716 7777 | sharleen.oreilly@ucd.ie |
| Name | Affiliation | Role |
|---|---|---|
| Sharleen O'Reilly | University College Dublin | Principal Investigator |
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| ID | Term |
|---|---|
| D016640 | Diabetes, Gestational |
| ID | Term |
|---|---|
| D011248 | Pregnancy Complications |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D003920 | Diabetes Mellitus |
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| OTHER |
| University of Agder | OTHER |
| Pomeranian Medical University Szczecin | OTHER |
| Fundación Pública Andaluza para la Investigación Biomédica Andalucía Oriental | OTHER |
| Deakin University | OTHER |
This study employs a hybrid type 3 implementation-effectiveness design using a non-randomised, ABA intervention approach nested within a longitudinal cohort. The study will compare the delivery of the Monash machine learning GDM screening tool (MMLGST) and mHealth coaching referral during a 3-month intervention block with two 3-month blocks of usual care before and after the intervention. Women identified as being at higher risk of developing GDM using the MMLGST will receive access to the smartphone application that connects them with their health coach, who will provide personalised support about healthy eating, physical activity, mental wellbeing, and infant care from early pregnancy until 9 months after birth. Implementation outcomes will be assessed using the RE-AIM framework, and cost-effectiveness analyses will be conducted from a healthcare system perspective.
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| At birth of baby |
| Adverse Birth Outcomes | Rates of adverse birth outcomes (pre-eclampsia, preterm birth, birth weight ≥4000g, birth trauma, neonatal respiratory distress, phototherapy, stillbirth/neonatal death, NICU admission or shoulder dystocia, caesarean section/interventions) | Until birth of last baby included. |
| Breastfeeding Initiation. | Breastfeeding initiation rates and on discharge | At discharge following birth of baby. |
| Healthcare Utilisation. | Healthcare utilisation and costs (hospital stays, specialist consultations) | At birth of baby. |
| Maternal weight and BMI at 9 months postpartum | Maternal weight (kg) and Body Mass Index. | At 9 months postpartum. |
| Breastfeeding Duration | Duration of breastfeeding. | Up to 9 months postpartum. |
| Diet quality | Quality of diet. | At 9 months postpartum. |
| Physical Activity | Measure of physical activity. | At 9 months postpartum. |
| Implementation Outcomes Evaluated | Evaluation of implementation outcomes per the RE-AIM frame work (Reach, Effectiveness, Adoption, Implementation, Maintenance) | At 9 months postpartum. |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |