Abstract
Good blood glucose control is important to reduce the risk of adverse effects on mothers and their offspring in women with gestational diabetes (GDM). This review examined the impact of using digital health interventions on reported glycaemic control among pregnant women with GDM and its impact on maternal and foetal outcomes. Seven databases were searched from database inception to October 31st, 2021 for randomised controlled trials that examined digital health interventions to provide services remotely for women with GDM. Two authors independently screened and assessed the studies for eligibility for inclusion. Risk of bias was independently assessed using the Cochrane Collaboration's tool. Studies were pooled using random effects model and presented as risk ratio or mean difference with 95% confidence intervals. Quality of evidence was assessed using GRADE framework. Twenty-eight randomised controlled trials that examined digital health interventions in 3,228 pregnant women with GDM were included. Moderate certainty of evidence showed that digital health interventions improved glycaemic control among pregnant women, with lower fasting plasma glucose (mean difference -0.33 mmol/L; 95% CI: -0.59 to -0.07), 2-hour post-prandial glucose (-0.49 mmol/L; -0.83 to -0.15) and HbA1c (-0.36%; -0.65 to -0.07). Among those randomised to digital health interventions, there was a lower need for caesarean delivery (Relative risk: 0.81; 0.69 to 0.95; high certainty) and foetal macrosomia (0.67; 0.48 to 0.95; high certainty). Other maternal and foetal outcomes were not significantly different between both groups. Moderate to high certainty evidence support the use of digital health interventions, as these appear to improve glycaemic control and reduce the need for caesarean delivery. However, more robust evidence is needed before it can be offered as a choice to supplement or replace clinic follow up. Systematic review registration: PROSPERO: CRD42016043009.
Highlights
This review examined the impact of using digital health interventions on reported glycaemic control among pregnant women with Gestational diabetes mellitus (GDM) and its impact on maternal and foetal outcomes
Gestational diabetes is the most common medical complication of pregnancy, affecting between 1% to 45% of pregnancies depending on population and diagnostic criteria
In this systematic review and meta-analysis, we assessed the use of digital health interventions to support the management of mothers with gestational diabetes and its impact on glycaemic control
Summary
Gestational diabetes mellitus (GDM) is an increasingly common diagnosis during pregnancy [1] and has a substantial effect on maternal and foetal morbidity including risk of developing preeclampsia, shoulder dystocia, caesarean delivery [2] as well as future health complications such as cardiovascular diseases, type 2 diabetes and cancer risk. [3] The prevalence of GDM was estimated to be 8% to 9% of all pregnancies, [4] and is rising due to an increased rate of obesity, changing threshold of GDM as well as lifestyle changes such as physical inactivity and the adoption of modern lifestyles. [5,6] Women with GDM have a significant increase lifetime risk of developing type 2 diabetes, and a three-fold increase in developing metabolic syndrome and cardio-vascular diseases. [7,8] Current guidelines have recommended the need for postpartum follow up and care, including continued support for lifestyle changes. [9,10] In women with GDM, medical nutrition therapy remains the mainstay treatment with daily self-monitoring of blood glucose (SMBG), aimed at normalizing blood glucose to reduce the risk of complications as well as improve maternal and foetal outcomes as well as risk for developing metabolic syndromes in the future. [11]Technological innovations have provided opportunities for novel approaches to improve the care of people with diabetes and women with GDM. [12,13,14] Some potential benefits of using technology include the ability to provide support and immediate feedback, reducing the distance barriers as well as reduce healthcare costs through resource pooling. [15] Existing literature reviews performed to date on digital health interventions, defined as electronic systems in medicine and other health professions designed to provide services remotely to manage illness and health risk and promote wellness is key towards universal health coverage, as it provides safe, timely and affordable access to health services for all. [16,17,18] The premise is that digital health interventions can facilitate training, surveillance, and service delivery, and more importantly empower users of digital health to make better informed decisions about their own health in new and innovative ways. [19,20,21,22] Some examples of digital health interventions used in diabetes care include telehealth, game-based support, mobile health (mHealth) as well as patient portals. [12,17] Digital health interventions can be an important solution especially for women with GDM, given the limited time clinicians have to manage and educate theseDigital health interventions use for gestational diabetes women who requires short-term adjustment to their therapy. [23] an updated review by Ming and colleagues of seven randomised controlled studies reported that telemedicine was useful to reduce HbA1c but not maternal and neonatal outcomes. Guo and colleagues recently conducted a randomised controlled study among 124 women with GDM and noted that digital health was effective in reducing maternal blood glucose compared to control. [26] Yew et al reported that the introduction of a smartphone based monitoring platform was effective in reducing maternal blood glucose as well as lower rate of pregnancies requiring insulin treatment compared to controls. [27] In light of these new developments and to address these important knowledge gaps, we conducted a systematic review and meta-analysis to investigate the efficacy of digital health interventions use to support women with GDM
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