A Randomized Controlled Trial to Evaluate the Effects of a Smartphone Application–Based Lifestyle Coaching Program on Gestational Weight Gain, Glycemic Control, and Maternal and Neonatal Outcomes in Women With Gestational Diabetes Mellitus: The SMART-GDM Study Diabetes Care 2021;44:456–463 | https://doi.org/10.2337/dc20-1216 OBJECTIVE SMART-GDM examined whether Habits-GDM, a smartphone application (app) coaching program, can prevent excessive gestational weight gain (EGWG) and improve glycemic control and maternal and neonatal outcomes in gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS In this randomized controlled trial, women diagnosed with GDM between 12 and 30 weeks were randomly assigned to usual care (control) or to additional support from Habits-GDM that integrated dietary, physical activity, weight, and glucose monitoring (intervention). The primary outcome was the proportion of participants with EGWG. Secondary outcomes included absolute gestational weight gain (GWG), glycemic control, and maternal, delivery, and neonatal outcomes. RESULTS In total, 340 women were randomized (170 intervention, 170 control; mean 6 SD age 32.0 6 4.2 years; mean BMI 25.6 6 5.6 kg/m 2 ). There were no statistically significant differences in the proportions of women with EGWG, absolute GWG, or maternal and delivery outcomes between experimental groups. Average glucose readings were lower in the intervention group (mean difference 20.15 mmol/L [95% CI 20.26; 20.03], P 5 0.011) as were the proportions of glucose above targets (premeal: 17.9% vs. 23.3%, odds ratio 0.68 [95% CI 0.53; 0.87], P 5 0.003; 2-h postmeal: 19.9% vs. 50%, 0.54 [0.42; 0.70], P < 0.001). When regarded as a composite (although not prespecified), the overall neonatal complications (including birth trauma, neonatal hypoglycemia, hyperbilirubinemia, respiratory distress, neonatal intensive care unit admission, and perinatal death) were significantly lower in the intervention group (38.1% vs. 53.7%, 0.53 [0.34; 0.84], P 5 0.006). CONCLUSIONS When added to usual care, Habits-GDM resulted in better maternal glycemic control and composite neonatal outcomes (nonprespecified) but did not reduce EGWG among women with GDM. 1 Department of Medicine, National University Hospital, Singapore 2 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 3 Department of Obstetrics and Gynecology, Na- tional University Hospital, Singapore 4 Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 5 Saw Swee Hock School of Public Health, National University of Singapore, Singapore 6 Department of Nursing, National University Hospital, Singapore 7 Department of Dietetics, National University Hospital, Singapore 8 Singapore Institute of Technology, Singapore Corresponding author: Tong Wei Yew, tong_ wei_yew@nuhs.edu.sg Received 21 May 2020 and accepted 4 October 2020 Clinical trial reg. no. NCT03249896, clinicaltrials .gov This article contains supplementary material online at https://doi.org/10.2337/figshare.13073030. © 2020 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More infor- mation is available at https://www.diabetesjournals .org/content/license. See accompanying article, p. 313. Tong Wei Yew, 1,2 Claudia Chi, 3 Shiao-Yng Chan, 3,4 Rob M. van Dam, 5 Clare Whitton, 5 Chang Siang Lim, 5 Pin Sym Foong, 5 Winni Fransisca, 2 Chieu Leng Teoh, 6 Jeannie Chen, 6 Su Tin Ho-Lim, 6 Su Lin Lim, 7 Kai Wen Ong, 7 Peck-Hoon Ong, 8 Bee Choo Tai, 5 and E Shyong Tai 1,2,5 456 Diabetes Care Volume 44, February 2021 EMERGING TECHNOLOGIES: DATA SYSTEMS AND DEVICES Downloaded from http://diabetesjournals.org/care/article-pdf/44/2/456/531850/dc201216.pdf by guest on 23 February 2022