การเปรียบเทียบประสิทธิผลของความถี่ในการออกกำลังกายร่วมกับโปรแกรมการให้ความรู้และการติดตามผ่าน Line Application ต่อระดับน้ำตาลในเลือด พฤติกรรมการควบคุมอาหาร และระดับความเครียดในสตรีตั้งครรภ์ที่เป็นโรคเบาหวาน

Chaiyakit Udnan

Authors

Chaiyakit Udnan Somdejphrajaotaksinmaharaj Hospital

Keywords:

Education program, Gestational diabetes mellitus, Blood glucose levels, Exercise, Stress

Abstract

Objective: To compare the effectiveness of exercise frequency combined with an educational and monitoring program via the Line Application on blood glucose levels, dietary control behaviors, and stress levels among pregnant women with gestational diabetes mellitus.

Method: This quasi-experimental study with a matched-pair design included 50 pregnant women with Gestational Diabetes Mellitus Class A1 (GDM Class A1). Participants were allocated into Experimental Group 1 (exercising 3 days/week, n=25) and Experimental Group 2 (exercising ≥5 days/week, n=25). Both groups received an educational and health-monitoring program via the Line Application. Fasting Plasma Glucose (FPG) levels were measured at weeks 1, 3, and 5. Dietary control behaviors and stress levels (ST-20) were assessed at weeks 1 and 5. Data were analyzed using independent $t$-tests and two-way mixed repeated measures ANOVA.

Results: A statistically significant Time $\times$ Group interaction was observed for FPG levels (F=5.12, p-value=0.009). At week 5, Experimental Group 2 demonstrated a significantly lower mean FPG level (88.9±2.9 mg/dL) than Experimental Group 1 (94.9±12.4 mg/dL) (Mean difference=6.0 mg/dL, 95%CI: 0.8-11.1, p-value=0.023). Regarding health behaviors, both groups showed significant improvements in dietary control behaviors and reductions in stress levels compared to baseline (p-value<0.001), with stress scores decreasing to the lower boundary of the high-stress category. However, no statistically significant differences were found between the two groups regarding dietary control behaviors and stress levels (p-value>0.05).

Conclusions: Exercising ≥5 days/week combined with Line Application monitoring is significantly more effective in reducing FPG levels in pregnant women with GDM Class A1 than exercising 3 days/week. Meanwhile, the Line Application system supports dietary control behaviors and tends to help reduce stress. This integration demonstrates a synergistic effect for proactive disease management.

Keywords: Education program, Gestational diabetes mellitus, Blood glucose levels, Exercise, Stress

References

Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective. Curr Diab Rep. 2016;16(1):7.

Bagheri-Tirtashi A, Nasiri-Amiri F, Adib-Rad H, Nikbakht H, Faramarzi M, Kiani E. Effect of Stress Management Based Self-care Counseling on Glycemic Control in Women with Gestational Diabetes Mellitus: a Randomized Controlled Trial Study. BMC Pregnancy Childbirth. 2025;25(1):53.

American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S20-S42.

Sirirat S, Boriboonhirunsarn D, Ruangvutilert P, Yapan P. Prevalence of gestational diabetes mellitus among women with lower risk for gestational diabetes in Siriraj Hospital. Thai J Obstet Gynaecol. 2022;30(5):313-20.

He Y, Liu X, Yang X. Effects of Multidimensional Exercise Management on Self-efficacy, Blood Glucose Control and Delivery Outcomes in Pregnant Women with Gestational Diabetes Mellitus. Front Physiol. 2024;15:1407569.

Shu L, Jiang R, Wang F, Xu Y, Wang P, Ma Y, Pan J, Huang C. Effects of exercise on blood glucose levels and pregnancy outcomes in women with gestational diabetes mellitus: a meta-analysis and meta-regression. J Exerc Sci Fit. 2025;23(4):416-25.

Paulsen CP, Bandak E, Edemann-Callesen H, Juhl CB, Handel MN. The Effects of Exercise during Pregnancy on Gestational Diabetes Mellitus, Preeclampsia, and Spontaneous Abortion among Healthy Women-A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2023;20(12):6069.

The Royal Thai College of Obstetricians and Gynecologists. RTCOG Clinical Practice Guideline: Prenatal Care [Internet]. 2023. [เข้าถึงเมื่อ 1 พฤษภาคม 2568]. เข้าถึงได้จาก: https://www.rtcog.or.th/content/readfiles/20

American College of Obstetricians and Gynecologists. ACOG practice bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol 2018;131(2):e49-64.

สุชยา ลือวรรณ. Pregnancy with Diabetes Mellitus [Internet]. 2024 [เข้าถึงเมื่อ 1 พฤษภาคม 2568]. เข้าถึงได้จาก: https://w1.med.cmu.ac.th/obgyn/lessons/pregnancy-with-diabetes-mellitus/

Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale (NJ): Lawrence Erlbaum Associates; 1988.

The Royal Thai College of Obstetricians and Gynecologists. RTCOG Clinical Practice Guideline: Obesity in Pregnancy [Internet]. 2024. [เข้าถึงเมื่อ 1 พฤษภาคม 2568]. เข้าถึงได้จาก: https://www.rtcog.or.th/content/readfiles/5

American College of Obstetricians and Gynecologists. Physical Activity and Exercise During Pregnancy and The Postpartum Period: ACOG committee opinion, Number 804. Obstet Gynecol. 2020;135(4):e178-88.

Nunual N. The Effect of Health Behavior Program and Line Application Monitoring to Dietary and Exercise Behavior and The Blood Glucose in Pregnant Women at Risk for Gestational Diabetes Mellitus. J of Heal Re & Inn. 2023;6(2):e265772.

Mahatnirunkul S, Pumpaisalchai W, Tapanya P. The construction of Suan Prung Stress Test for Thai population. Bulletin of Suan Prung. 1997;13(3):1-20.

Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, et al. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care. 2016;39(11):2065-79.

Davenport MH, Ruchat SM, Sobierajski F, Poitras VJ, Gray CE, Yoo C, et al. Impact of Prenatal Exercise on Maternal Harms, Labour and Delivery Outcomes: A Systematic Review and Meta-analysis. Br J Sports Med. 2019;53(2):99-107.

Sellami M, Almuraikhy S, Naja K, Anwardeen N, Al-Amri HS, Prince MS, et al. Eight Weeks of Aerobic Exercise, but not Four, Improves Insulin Sensitivity and Cardiovascular Performance in Young Women. Sci Rep. 2025;15(1):1991.

Shu L, Jiang R, Wang F, Xu Y, Wang P, Ma Y, et al. Effects of Exercise on Blood Glucose Levels and Pregnancy Outcomes in Women with Gestational Diabetes Mellitus: A Meta-analysis and Meta-regression. J Exerc Sci Fit. 2025;23(4):416-25.

McCambridge J, Witton J, Elbourne DR. Systematic Review of the Hawthorne Effect: New Concepts are Needed to Study Research Participation Effects. J of Clin Epid. 2014;67(3):267-77.

Huang Z, Tan E, Lum E, Sloot P, Boehm BO, Car J. A Smartphone App to Improve Medication Adherence in Patients with Type 2 Diabetes in Asia: Feasibility Randomized Controlled Trial. JMIR Mhealth Uhealth. 2019;7(9):e14914.