Participants
A total of 139 patients with GDM admitted to our hospital between July 2019 and February 2021 were enrolled in this study and randomly divided into two groups according to the numerical random table method. Among them, 79 patients were given the internet combined with exercise-based individualized nursing intervention as the observation group, while the rest were given routine nursing intervention only as the control group. This study was carried out with permission from the Ethics Committee of our hospital (Approval number: 2019-03G7002) and informed consent forms signed by all enrolled individuals.
Inclusion criteria were as follows: Age > 20; Patients meeting the diagnostic criteria of GDM according to the examination results in our hospital [17]; patients who were pregnant for the first time; patients with detailed case data; and those who or whose legal guardian signed informed consent forms based on voluntary participation.
The exclusion criteria were based on: Patients with comorbid chronic diseases; cardiovascular or cerebrovascular diseases or organ dysfunction; patients with drug allergies; consciousness disturbance or communication obstacle; and those with multiple pregnancies.
Nursing intervention
The control group was given routine nursing intervention. Specifically, the nursing staff was arranged to pay close attention to the patients' blood glucose and blood pressure levels, inform the patients and their families of daily precautions such as diet adjustment and moderate exercise. If necessary, the staff was required to urge the patients to take drugs according to the doctor's advice and call back the patients to understand their basic situation and provide corresponding guidance according to their condition.
The observation group was given the internet combined with exercise-based individualized nursing intervention. In brief, patients and their families were enabled to make an online appointment to raise questions and obtain answers through a network platform provided by the hospital. Specialists and nurses would formulate targeted nursing intervention measures according to each patient's own situation. At discharge time, each patient was instructed to receive reminders about daily precautions and exercise on the internet on time. In addition, the nursing staff were arranged to post guidance on psychology, physiology, and blood glucose control on the internet, and to pay real-time attention to the patients' requirements and blood glucose levels and thus take corresponding adjustment measures on time to ensure the continuity of patients' treatment in hospital and at home. Moreover, the patients were encouraged to maintain a good state of mind and were given practical assistance in lowering blood glucose. The staff was also arranged to design targeted exercise schemes for patients according to their gestational age, such as simple brisk walking, walking with raised arms, and maternity exercises. Patients were advised to stop the exercise when they had slight sweating. The patients were reminded to take a walk every day, 30 min each time, under the premise of ensuing heart rate < 120 times /min after exercise. Furthermore, the nursing staff was required to emphasize safety precautions to each patient before exercise and help patients avoid dangerous and violent actions in time to protect pregnant women and fetuses from being hurt. During exercise, timely water replenishing was necessary to prevent hypoglycemia.
The patients in both groups received the specified nursing intervention for 8 weeks, and the parameters were measured before the intervention and at 37 weeks gestation.
Assessment of blood glucose and other measurements
Blood glucose detection
Venous blood was sampled from each patient in the two groups, and their fasting blood glucose (FBG) and 2-h postprandial blood glucose (2 h PG) levels were measured via an automatic blood glucose analyzer.
Blood lipid detection
An automatic biochemistry analyzer was adopted for the determination of changes in patients' triglyceride (TG), total cholesterol (TC), glycated haemoglobin (HbA1c), low-density lipoprotein—cholesterol (LDL-C) and high-density lipoprotein—cholesterol (HDL-C) levels.
Blood pressure measurement
An ambulatory blood pressure detector was used for measuring changes in patients' systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP).
IR detection
The automatic biochemistry analyzer was used for measuring the fasting insulin (FINS), 1 h postprandial insulin (1 h INS), and 2 h INS, and then the homeostatic model assessment (HOMA)-IR index was calculated.
Outcome measures
The self-rating depression scale (SDS) [18] and self-rating anxiety scale (SAS) [19] were used to assess the patients' psychological state. SDS and SAS are the commonly used norm-referenced scales. Both are 20 item Likert scales, in which items tap psychological and physiological symptoms and are rated by respondents according to how each applied to them within the past week, using a 4-point scale ranging from 1 (none, or a little of the time) to 4 (most, or all of the time) [20].
Adverse pregnancy outcomes were measured by evaluating the incidence of risk events such as uterine pregnancy, polyhydramnios, and premature delivery.
Patients' nursing satisfaction was assessed by a self-made nursing satisfaction questionnaire of our hospital. The questionnaire had a total score of 100 points, with a score above 90 points indicating high satisfaction, a score between 71 and 90 points indicating moderate satisfaction, a score between 51- and 70-points indicating improvement requirement, and a score below 50 points denoting dissatisfaction. The overall satisfaction was calculated as follows = (number of patients with high satisfaction + number of patients with moderate satisfaction)/ total number of patients × 100%.
Statistical analysis
The data was analyzed using SPSS statistical software version 20 (IBM), and figures were drawn using Graphpad7. Enumeration data, expressed as a rate, was compared between the two groups using the chi-square test. Measurement data, expressed as the mean ± SD, was compared between the groups via the t-test. P < 0.05 value was considered as statistically significant.