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Rachel A. Blair, MD








Medicine; Division of Endocrinology, Diabetes, and Hypertension


Rachel A. Blair, Christine E. Horn, Jennifer M. Dias, Marie E. McDonnell*, Ellen W. Seely*

Principal Investigator

Rachel A. Blair


Development and Usability of a Text Messaging Program for Women With Gestational Diabetes: Mixed Methods Study

Gestational diabetes mellitus (GDM) is a common condition, affecting 5%-10% of pregnancies in the United States, and has important implications for maternal and child health. Poorly controlled GDM can cause adverse fetal outcomes including preterm delivery, neonatal hypoglycemia, and fetal demise, as well as increased maternal risk for preeclampsia, Cesarean sections, and other complications.

The cornerstone of management relies on lifestyle modification and self-monitoring of blood glucose (SMBG), typically 4 times daily. Without the crucial information from SMBG, women and their clinicians cannot work together for optimal glucose control during pregnancy. However, many women have difficulty adhering to this intensive monitoring, and a study found that women with poor adherence to SMBG are more likely to have poor pregnancy outcomes including preeclampsia. Therefore, a mobile health intervention that could improve SMBG in GDM could be very impactful for women’s health.


Text messaging is an effective way to improve diabetes management, but has not been well studied in gestational diabetes mellitus (GDM).



This study aimed to assess usability and acceptability of a text messaging program (Text 4 Success) for women with GDM.



An automated 2-way texting program was developed. It included (1) reminders to check blood glucose levels, (2) positive feedback to user-reported glucose levels, (3) weekly educational messages, and (4) weekly motivational messages. Women were enrolled in the program and received messages for 2 weeks, then participated in semi-structured interviews. Data from glucose measuring devices were downloaded to assess adherence to self-monitoring of blood glucose (SMBG), measured as the percentage of recommended SMBG checks performed.



Ten women participated in the usability study. All 10 would recommend the program to other women with GDM. Participants liked the immediate feedback to glucose values. Suggestions included further flexibility of messages related to mealtimes and the ability to aggregate blood glucose data into a table or graph. Overall, adherence to SMBG testing was high at baseline. In comparing the week prior to the trial with the 2 weeks during the trial, there was a small but statistically insignificant difference (P=.48) in the percentage of recommended SMBG performed (median 93% [25th-75th IQR 89%-100%] vs median 97% [25th-75th IQR 92%-100%]).



Overall, women with GDM would recommend the Text 4 Success program and think it is helpful for GDM self-management. The program was usable and acceptable. The program may be better suited to those who have low levels of adherence to SMBG at baseline or to women at time of their diagnosis of GDM. Further study of text messaging to improve SMBG in GDM is needed.

Research Context