Comparing the Efficacies of Telemedicine and Standard Prenatal Care on Blood Glucose Control in Women With Gestational Diabetes Mellitus: Randomized Controlled Trial

Exploring nurse and patient perspectives on WeChat-based prenatal education in Chinese public hospitals: a qualitative inquiry

BACKGROUND

With the increasing digitization of healthcare, WeChat has emerged as a popular platform for delivering prenatal education in China. While studies have shown its potential benefits, few investigations systematically explore how nurses implement WeChat-based prenatal education and how pregnant women engage with these interventions within public hospital settings. Understanding both provider and patient perspectives is critical for developing equitable, effective digital maternal care.

METHODS

A qualitative exploratory design was employed in four public hospitals in Shanxi Province, China. Seventeen obstetric nurses and eight pregnant women participated in semi-structured interviews between March and August 2024. Data were analyzed using thematic analysis to identify commonalities and divergences between nurse-driven and patient-driven experiences.

RESULTS

Nurses perceived WeChat as extending their professional reach beyond physical clinic hours and enhancing patient education, aligning with the Technology Acceptance Model constructs of perceived usefulness and ease of use. However, organizational constraints, digital training gaps, and blurred work-life boundaries posed challenges. Pregnant women similarly recognized WeChat's convenience for quick clarifications and access to nurse-vetted information, yet wide variations in digital health literacy led to uneven engagement. Cultural factors, such as extended family involvement and preferences for in-person consultations, further influenced both nurse and patient usage patterns. Despite these challenges, participants converged on WeChat's value as a complementary platform that could reduce clinic visits, offer immediate reassurance, and bolster continuity of care.

CONCLUSION

WeChat-based prenatal education holds significant promise for improving maternal health outcomes by facilitating frequent, real-time communication between nurses and expectant mothers. Nonetheless, the findings underscore the need for hospital-level policies, structured training programs, and culturally sensitive strategies to address privacy concerns, manage workloads, and reduce digital disparities. An integrated approach that combines nurse acceptance and patient digital literacy is essential to fully harness WeChat's potential in public hospital contexts.

IMPLICATIONS

The study highlights practical steps for enhancing digital prenatal interventions, including standardized protocols for WeChat-based interactions, comprehensive nurse training in eHealth communication, and tailored support for pregnant women with limited digital skills. Such interventions can inform wider policymaking on telehealth and guide technology developers in creating user-friendly, secure digital platforms that optimize maternal care and reduce health inequities.

CLINICAL TRIAL NUMBER

Not applicable.

Informatics Interventions for Maternal Morbidity: Scoping Review

BACKGROUND

Women have been entering pregnancy less healthy than previous generations, placing them at increased risk for pregnancy complications. One approach to ensuring effective monitoring and treatment of at-risk women is designing technology-based interventions that prevent maternal morbidities and treat perinatal conditions.

OBJECTIVE

This scoping review evaluates what informatics interventions have been designed and tested to prevent and treat maternal morbidity.

METHODS

MEDLINE, Embase, and Cochrane Library were searched to identify relevant studies. The inclusion criteria were studies that tested a medical or clinical informatics intervention; enrolled adult women; and addressed preeclampsia, gestational diabetes mellitus (GDM), preterm birth, Centers for Disease Control and Prevention-defined severe maternal morbidity, or perinatal mental health conditions. Demographic, population, and intervention data were extracted to characterize the technologies, conditions, and populations addressed.

RESULTS

A total of 80 studies were identified that met the inclusion criteria. Many of the studies tested for multiple conditions. Of these, 73% (60/82) of the technologies were tested for either GDM or perinatal mental health conditions, and 15% (12/82) were tested for preeclampsia. For technologies, 32% (28/87) of the technologies tested were smartphone or tablet applications, 26% (23/87) were telehealth interventions, and 14% (12/87) were remote monitoring technologies. Of the many outcomes measured by the studies, almost half (69/140, 49%) were patient physical or mental health outcomes.

CONCLUSIONS

Per this scoping review, most informatics interventions address three conditions: GDM, preeclampsia, and mental health. There may be opportunities to treat other potentially lethal conditions like postpartum hemorrhage using proven technologies such as mobile apps. Ample gaps in the literature exist concerning the use of informatics technologies aimed at maternal morbidity. There may be opportunities to use informatics for lesser-targeted conditions and populations.

Association of Digital Health Interventions With Maternal and Neonatal Outcomes: Systematic Review and Meta-Analysis

BACKGROUND

Gestational weight gain (GWG) is crucial to maternal and neonatal health, yet many women fail to meet recommended guidelines, increasing the risk of complications. Digital health interventions offer promising solutions, but their effectiveness remains uncertain. This study evaluates the impact of such interventions on GWG and other maternal and neonatal outcomes.

OBJECTIVE

This study aimed to investigate the effect of digital health interventions among pregnant women and newborns.

METHODS

A total of 2 independent researchers performed electronic literature searches in the PubMed, Embase, Web of Science, and Cochrane Library databases to identify eligible studies published from their inception until February 2024; an updated search was conducted in August 2024. The studies included randomized controlled trials (RCTs) related to maternal and neonatal clinical outcomes. The Revised Cochrane risk-of-bias tool for randomized trials was used to examine the risk of publication bias. Stata (version 15.1; StataCorp) was used to analyze the data.

RESULTS

We incorporated 42 pertinent RCTs involving 148,866 participants. In comparison to the routine care group, GWG was markedly reduced in the intervention group (standardized mean difference-0.19, 95% CI -0.25 to -0.13; P<.001). A significant reduction was observed in the proportion of women with excessive weight gain (odds ratio [OR] 0.79, 95% CI 0.69-0.91; P=.001), along with an increase in the proportion of women with adequate weight gain (OR 1.33, 95% CI 1.10-1.64; P=.003). Although no significant difference was reported for the proportion of individuals below standardized weight gain, there is a significant reduction in the risk of miscarriage (OR 0.66, 95% CI 0.46-0.95; P=.03), preterm birth (OR 0.8, 95% CI 0.75-0.86; P<.001), as well as complex neonatal outcomes (OR 0.93, 95% CI 0.87-0.99; P=.02). Other maternal and fetal outcomes were not significantly different between the 2 groups (all P>.05).

CONCLUSIONS

The findings corroborate our hypothesis that digitally facilitated health care can enhance certain facets of maternal and neonatal outcomes, particularly by mitigating excessive weight and maintaining individuals within a reasonable weight gain range. Therefore, encouraging women to join the digital health team sounds feasible and helpful.

TRIAL REGISTRATION

PROSPERO CRD42024564331; https://tinyurl.com/5n6bshjt.

SPARK: an mHealth intervention for self-management and treatment of gestational diabetes mellitus in Sweden - protocol for a randomised controlled trial

INTRODUCTION

Gestational diabetes mellitus (GDM) is increasingly becoming a serious public health challenge. Innovative, effective and scalable lifestyle interventions to support women with GDM to manage their condition and prevent adverse obstetric and neonatal outcomes as well as later morbidity are required. This study aims to evaluate whether a novel, multilingual and scalable mobile health (mHealth) intervention (SPARK; SmartPhone App for gestational diabetes patients suppoRting Key lifestyle behaviours and glucose control) can improve self-management and treatment of GDM and prevent adverse maternal and offspring outcomes.

METHODS/ANALYSES

SPARK is a multicentre two-arm randomised controlled trial recruiting women diagnosed with GDM in south-eastern Sweden. A total of 412 women will be randomised to either standard care (control) or the SPARK intervention. The SPARK online platform (accessed through a mobile app) provides a behaviour change programme for healthy eating, physical activity and glycaemic control. To increase reach, SPARK is available in Swedish, English, Arabic and Somali. SPARK also comes with a clinician portal where healthcare professionals monitor and intervene when glycaemic control is unsatisfactory (above certain cut-offs). Primary outcomes are glycaemic control that is, time in range and HbA1c, while diet, physical activity (ActiGraph), gestational weight gain, metabolic and inflammatory biomarkers in weeks 37-38, adherence to protocol for daily glucose sampling, as well as adverse obstetric and neonatal outcomes are secondary outcomes. Secondary outcomes also include cardiometabolic risk evaluation, physical activity and healthy eating behaviours 1 year postpartum. A health economic evaluation of SPARK vs standard care will also be conducted.

ETHICS AND DISSEMINATION

This study has been approved by the Swedish Ethical Review Authority (2021-06627-01; 2022-03842-02; 2023-05911-02). Results will be disseminated through scientific papers in peer-reviewed journals, posts in traditional and social media, and presentations at scientific and healthcare professionals' conferences.

TRIAL REGISTRATION NUMBER

This trial was registered at the ClinicalTrials.gov register platform (ID NCT05348863) 27 April 2022.

The Effect of Smartphone Application-Based Self-Management Interventions Compared to Face-to-Face Diabetic Interventions for Pregnant Women With Gestational Diabetes Mellitus: A Meta-Analysis

Background: Face-to-face diabetic interventions (FFIs) are the gold standard for diabetic care, and smartphone application (app)-based self-management interventions (SBIs) can be a potential alternative. A few previous reviews compared the effects of both practices. Objectives: This study is aimed at (1) comparing the effectiveness of FFIs and SBIs on maternal and neonatal outcomes in pregnant women with gestational diabetes mellitus (GDM) and (2) exploring potential covariates affecting those outcomes. Methods: Randomized controlled trials (RCTs) were retrieved from PubMed, EMBASE, CINAHL, Cochrane Library, Scopus, and Web of Science from inception to January 15, 2024. Meta-analyses, subgroup analyses, and metaregression analyses were conducted using the R software package meta, Version 4.3.1. Cochrane risk of bias Version 2 (RoB2) and grading of recommendations, assessment, development, and evaluation (GRADE) criteria were employed to appraise the quality of studies and certainty of outcomes. Results: We selected 15 RCTs from 2505 women with GDM across 11 countries for this review. The meta-analyses revealed that women in the SBIs can significantly reduce gestation weight gain (t = -2.45, p = 0.04) and macrosomia (t = -3.35, p = 0.02) when compared to those in the FFIs. We observed a higher likelihood of cesarean delivery when using generic apps (RR = 1.12, 95% confidence interval (CI): 0.59, 2.13) than GDM-specific apps (RR = 0.82, 95% CI: 0.64, 1.06). There was similar fasting plasma glucose, 2-h postprandial plasma glucose, hemoglobin A1c (HbA1c), cesarean section delivery rate, neonatal birthweight, large for gestational age, neonatal hypoglycemia, and neonatal intensive care unit admission between SBIs and FFIs. More than half (52%) were rated low risk based on RoB2. According to the GRADE criteria, very low to moderate evidence was found. Conclusions: SBIs can be considered an alternative management method for women with GDM to reap the benefits of smartphone apps. More high-quality RCTs are required to reaffirm the findings.

Self-care interventions among women with gestational diabetes mellitus in low and middle-income countries: a scoping review

BACKGROUND

Gestational diabetes mellitus (GDM) is a transitory form of diabetes occurring in pregnancy with maternal and neonatal health consequences if left untreated. GDM can, in most instances, be managed non-medically through self-care practices, such as eating healthy or engaging in physical activity. This is especially relevant in a global health context with scarce resources. There is no official definition of "GDM self-care"; hence, the content and delivery modes of such interventions may vary greatly. Therefore, this study aimed to landscape GDM self-care interventions in low- and middle-income countries according to the WHO's three dimensions of health.

METHODS

PubMed, Embase, Global Health Library, and Web of Science were searched for published intervention studies that compared the effect of a self-care intervention to standard care or had no comparator. Studies that targeted women with GDM that reported maternal health and/or neonatal health outcomes (physical, mental, and social health outcomes) and were conducted in low- and middle-income countries were included in the review.

RESULTS

Twenty-nine studies (randomised controlled trials and non-randomised studies) were included in the review. No studies were conducted in low-income countries, and studies were primarily conducted in Asia. Most interventions were complex and contained several interacting elements in relation to content, delivery mode, duration, and modality. Most interventions aimed to improve the physical health dimension (n = 28; 96.6%), whilst the mental health (n = 11; 37.9%) and social health dimensions (n = 9; 31.0%) were addressed to a lesser extent.

CONCLUSIONS

Current GDM self-care interventions in LMICs are complex, and the content of self-care interventions overlaps with lifestyle and non-pharmaceutical interventions. It is recommended that the scientific community use a standardised terminology for such interventions and that future GDM intervention studies, as a minimum, use the core outcome set for GDM when developing future studies.

SYSTEMATIC REVIEW REGISTRATION

OSF Registries (2 December 2022) [ https://doi.org/10.17605/OSF.IO/PJZQ3 ].

Nutritional guidance through digital media for glycemic control of women with gestational diabetes mellitus: a randomized clinical trial

OBJECTIVES

To compare the effectiveness of outpatient nutritional guidance supplemented by digital media with exclusively standard outpatient nutritional guidance in pregnant women with gestational diabetes mellitus (GDM).

METHODS

This was a randomized, patient-blinded clinical trial conducted at the Diabetes and Pregnancy outpatient clinic from February 2021 to January 2023. Pregnant women with GDM were randomly allocated into two groups: the control group received exclusively outpatient nutritional guidance, and the Intervention Group received outpatient nutritional guidance along with reminders via WhatsApp. Dietary intake (calories, carbohydrates, lipids, proteins, and fibers) was evaluated using 24 h dietary recalls. Glycemic control and the need for pharmacological treatment were also assessed.

RESULTS

A total of 81 women were included, 34 allocated to the control group, and 47 to the intervention group. Patients were followed for a period of 4-8 weeks. Significant differences were observed in some points of glycemic control between the two groups over the follow-up period. There were no statistical differences in pharmacological therapy (p=0.498); 188 24 h dietary recall were conducted in the control group and 290 in the intervention group. A statistically significant increase in lipid intake was observed in the intervention group over the follow-up period compared to the control group (p<0.001). No changes in calorie intake, other macronutrients, or fiber consumption were noted.

CONCLUSIONS

Glycemic control was significantly improved with the addition of frequent text reminders about dietary choices, and a significant increase in lipid intake was seen in all women, more so in the reminder group.

WeChat mini-program, a preliminary applied study of the gestational blood glucose management model for pregnant women with gestational diabetes mellitus

BACKGROUND

The mHealth has been increasing in pregnancy. However, the WeChat mini-program based gestational glucose management model for gestational diabetes mellitus (GDM) during pregnancy has not been established.

METHODS

56 GDM pregnant women were selected. The control group received routine pregnancy health care, and the experimental group received WeChat mini-program GDM women's blood glucose management model, Intervention from diagnosis of GDM to delivery. Two-hour postprandial glucose, self-management ability, maternal and infant outcomes, satisfaction and so on were collected, with an additional mHealth app usability questionnaire collected by the experimental group.

RESULTS

The WeChat mini-program GDM women's blood glucose management model reduced two-hour postprandial glucose, the birth weight of newborns and the incidence of other complications(P < 0.05). The model also improved self-management ability and blood glucose management satisfaction(P < 0.01). The mHealth app usability questionnaire score tends to be close to 1, which indicates that the WeChat mini-program has usability.

CONCLUSION

The WeChat mini-program blood glucose management model reduces two-hour postprandial glucose and improves the self-management ability, which verifies the feasibility and effectiveness of the blood glucose management model relying on the WeChat mini-program.

Ethnic differences in the effects of lifestyle interventions on adverse pregnancy outcomes among women with gestational diabetes mellitus: A systematic review and meta-analysis

AIMS

Lifestyle interventions are widely used among women with gestational diabetes mellitus (GDM). This study aimed to assess the ethnic disparities in the effectiveness of lifestyle interventions on reducing adverse pregnancy outcomes, particularly macrosomia and neonatal hypoglycemia among women with GDM.

METHODS

We systematically searched the PubMed/MEDLINE, Web of Science, and Cochrane Library databases from January 1, 2000, up to March 31, 2024, to identify randomized controlled trials (RCTs) examining the effects of lifestyle interventions in GDM patients. Subgroup analysis was performed to investigate heterogeneity across different ethnic groups (including Asians, Whites/Caucasians, Hispanics/ Latinos, and Unknown ethnicity). The random effects model was used to calculate the relative risk (RR) and 95% confidence interval (CI).

RESULTS

After applying inclusion and exclusion criteria, twenty-one studies comprising 4567 participants were included. Lifestyle interventions significantly reduced the incidence of macrosomia ((RR = 0.54; 95 % CI: 0.42-0.70, P < 0.001), with consistent effects observed across racial groups. Conversely, lifestyle interventions were associated with a significant reduction in the risk of neonatal hypoglycemia only among Asians (RR = 0.56; 95 % CI: 0.38-0.84, P = 0.004), while no significant effects were observed in Whites/Caucasians or Hispanics/Latinos (all P > 0.05). Sensitivity analyses confirmed the robustness of the findings.

CONCLUSIONS

Regardless of ethnic background, this study emphasizes the significant benefits of lifestyle interventions in reducing the risk of macrosomia among women with GDM. However, lifestyle interventions seem to reduce the risk of neonatal hypoglycemia only among Asians, which warrants further studies.

Implementing telemedicine for the care of women with gestational diabetes mellitus in a rural hospital: an observational retrospective study

INTRODUCTION

Gestational diabetes mellitus (GDM) can adversely impact pregnancy outcomes. LGA is a common complication of GDM. Telemedicine is increasingly used for the follow-up of chronic diseases. The objective of this study was to evaluate if implementing a telemedicine solution for GDM could decrease the frequency of large for gestational age (LGA) newborns in a rural hospital.

METHODS

This retrospective interrupted-time-series study was conducted in a rural French hospital. An LGA newborn was defined as a newborn with weight ≥ 90th percentile. The intervention period was defined as starting 45 days after the initial introduction of the telemedicine solution. The two timeframes were: 1 January 2015 to 28 April 2017 (baseline period) and 12 June 2017 to 31 December 2021 (intervention period).

RESULTS

Between 2015 and 2021, 14,382 single births were registered in the hospital and 1,981 births from women with GDM were included. The mean age of mothers was 31.71 ± 5.54 and 32.30 ± 5.14 in women with newborns with birthweights lower and higher than the 90th percentile respectively (p=0.09). LGA births were reduced from 76/533 (14.3%) in the baseline period to 170/1,448 (11.7%) in the intervention period. This reduction became statistically significant in the multivariate analysis (protective OR: 0.541, 95%CI [0.311 to 0.930],p=0.13). Obesity was associated with LGA (OR: 1.877, 95%CI [1.394 to 2.558]).

CONCLUSIONS

The implementation of a telemedicine solution for GDM care in a rural general hospital was associated with a decrease in the adjusted odds of LGA births.

A novel strategy for improving bowel preparation based on social software-enhanced education: A prospective, multicenter, randomized controlled study

BACKGROUND AND AIM

The compliance and timeliness of oral laxatives have always been the key factors restricting bowel preparation (BP). We have constructed a novel enhanced-educational content and process based on social software (SS) for BP to optimize these issues.

METHODS

A multicenter, prospective, randomized controlled study was conducted at 13 hospitals in China from December 2019 to December 2020. A total of 1774 enrollees received standard instructions for BP and were randomly assigned (1:1) to the SS group (SSG) that received a smartphone-based enhanced-education strategy starting 4 h before colonoscopy or the control group (CG).

RESULTS

A total of 3034 consecutive outpatient colonoscopy patients were assessed for eligibility, and 1774 were enrolled and randomly assigned. Ultimately, data from 1747 (SSG vs CG: 875 vs 872) enrollees were collected. The BP adequacy rate was 92.22% (95% CI: 90.46-93.98) in the SSG vs 88.05% (95% CI: 85.91-90.18) in the CG (P = 0.005), and the total Boston Bowel Preparation Scale scores (6.89 ± 1.15 vs 6.67 ± 1.15, P < 0.001) of those in the SSG were significantly higher than those in the CG. The average number of polyps detected in the SSG was considerably higher than that in the CG (0.84 ± 2.00 vs 0.53 ± 1.19, P = 0.037), and the average diameter of the polyps was significantly lower than that of the control group (4.0 ± 2.5 vs 4.9 ± 3.7, P < 0.001).

CONCLUSIONS

This SS-enhanced education strategy can improve the BP adequacy rate and increase the average number of polyps detected, especially those of small diameter.

Telemedicine and Gestational Diabetes Mellitus: Systematic Review and Meta-Analysis

Hyperglycemia known as gestational diabetes mellitus (GDM) can happen during pregnancy and poses a risk to the developing baby as well as the mother. Glycemic control, patient involvement, and diabetes management might all be improved via telemedicine (TM). Therefore, this study aimed to compare TM versus standard care for GDM in terms of maternal and fetal outcomes. The authors searched for randomized controlled trials (RCTs) contrasting TM with conventional care among gestational diabetes women across various databases including PubMed, the Cochrane Central Register of Controlled Studies, and Google Scholar from April 2010 to December 2023. This meta-analysis included a total of 2,192 pregnant women from 12 RCT studies and was analyzed by RevMan (version 5.4; Cochrane, London). Applying fixed and random effects was based on heterogeneity. There was a statistically significant difference in the effect on the control of blood glucose levels two-hour postprandial (MD = -0.45, 95%CI = (-0.84, -0.06), P = 0.02) and on the cesarean section effect (RR = 0.74, 95%CI = (0.63, 0.87), P < 0.001) when TM was compared to standard care for GDM. However, there was no statistically significant difference in the effect on other maternal or fetal outcomes such as HBA1c, fasting blood glucose, preterm birth, fetal macrosomia, or hypoglycemia. TM interventions are more successful than standard therapy in lowering the rate of cesarean section and decreasing the two-hour postprandial glucose level of GDM patients, which is essential for improving glycemic control and reducing cardiovascular disease.

Scientific Production Dynamics in mHealth for Diabetes: Scientometric Analysis

BACKGROUND

The widespread use of mobile technologies in health care (mobile health; mHealth) has facilitated disease management, especially for chronic illnesses such as diabetes. mHealth for diabetes is an attractive alternative to reduce costs and overcome geographical and temporal barriers to improve patients' conditions.

OBJECTIVE

This study aims to reveal the dynamics of scientific publications on mHealth for diabetes to gain insights into who are the most prominent authors, countries, institutions, and journals and what are the most cited documents and current hot spots.

METHODS

A scientometric analysis based on a competitive technology intelligence methodology was conducted. An innovative 8-step methodology supported by experts was executed considering scientific documents published between 1998 and 2021 in the Science Citation Index Expanded database. Publication language, publication output characteristics, journals, countries and institutions, authors, and most cited and most impactful articles were identified.

RESULTS

The insights obtained show that a total of 1574 scientific articles were published by 7922 authors from 90 countries, with an average of 15 (SD 38) citations and 6.5 (SD 4.4) authors per article. These documents were published in 491 journals and 92 Web of Science categories. The most productive country was the United States, followed by the United Kingdom, China, Australia, and South Korea, and the top 3 most productive institutions came from the United States, whereas the top 3 most cited articles were published in 2016, 2009, and 2017 and the top 3 most impactful articles were published in 2016 and 2017.

CONCLUSIONS

This approach provides a comprehensive knowledge panorama of research productivity in mHealth for diabetes, identifying new insights and opportunities for research and development and innovation, including collaboration with other entities, new areas of specialization, and human resource development. The findings obtained are useful for decision-making in policy planning, resource allocation, and identification of research opportunities, benefiting researchers, health professionals, and decision makers in their efforts to make significant contributions to the advancement of diabetes science.

Couples' perceptions and experience of smartphone-assisted CenteringPregnancy model in southeast of China: a dyadic analysis of qualitative study

OBJECTIVES

The objectives of this study are to describe couples' experiences and perceived barriers to participation in the CenteringPregnancy model in southeast of China and to understand whether smartphones could play a potential role in this model.

DESIGN

This study employed a descriptive phenomenological qualitative study using semistructured dyadic interviews with women and their partners. The interviews were audiotaped, transcribed verbatim and subjected to thematic analysis.

SETTING

This study was conducted in two pilot prenatal clinics in southern China.

PARTICIPANTS

A purposive sample of 13 couples who underwent smartphone-assisted CenteringPregnancy were recruited. Data were collected until saturation through semistructured dyadic interviews between December 2022 and March 2023.

RESULTS

The study yielded four primary themes: (1) motivation for participation, (2) acceptance of CenteringPregnancy, (3) barriers and suggestions and (4) support for smartphone use of CenteringPregnancy.

CONCLUSIONS

CenteringPregnancy was well received by couples. Couples can access additional medical care and engage in intensive social interactions assisted by smartphones. However, certain objective challenges need to be acknowledged, including inadequate activity space, high demand for knowledge by couples and inflexible time for employed partners. Moreover, the risk that smartphones can lead to false expectations among couples needs to be noted.

The implementation of online and offline hybrid weight management approach for pregnant women based on the Fogg behavior model in Hainan, China: a pilot randomized controlled trial

OBJECTIVE

This study aimed at evaluating the effects of online and offline hybrid weight management approach based on the Fogg behavior model on total gestational weight gain and perinatal outcomes.

METHODS

Pregnant women in Hainan, the southernmost province of China, were recruited into a randomized controlled trial, which was designed to develop a WeChat platform for pregnancy weight management, and implement individualized and continuous pregnancy weight management services for pregnant women under the guidance of the Fogg behavior model. All pregnant women participating in the study were included in the full analysis set (FAS) for analysis. The pregnant women who completed the intervention and provided all outcome indicators were included in the per protocol set (PPS) for outcome evaluation.

RESULTS

Fifty-eight pregnant women were included in FAS analysis, and 52 pregnant women were finally included in PPS analysis. There was no statistically significant difference (P > 0.05) between the two groups at baseline. The gestational weight gain of the intervention group was significantly lower than that of the control group (P < 0.05). In the control group, the rate of appropriate weight gain during pregnancy was 48.26%, the rate of appropriate weight gain during pregnancy was 93.30% in the intervention group, with a statistically significant difference (P < 0.05). In the delivery outcomes, the cesarean section rate in the intervention group was significantly lower than that in the control group, and the differences were statistically significant (P < 0.05). The incidence of gestational diabetes mellitus and gestational hypertension in the intervention group was lower than those in the control group, and the differences were statistically significant (P < 0.05). The neonatal weight and incidence of macrosomia of the intervention group were lower than that of the control group, and the difference was statistically significant (P < 0.05).

CONCLUSIONS

This study combined the individualized and continuous pregnancy weight management of the online WeChat platform and offline consultation based on the Fogg behavior model, showing great potential in improving maternal and infant outcomes.

TRIAL REGISTRATION

The study was registered with www.chictr.org.cn/index.aspx , Chinese Clinical Trial Registry (ChiCTR2200066707, 2022-12-14, retrospectively registered).

Impact of mHealth-Enhanced Prenatal Education and Diet Recording on Gestational Diabetes Mellitus Prevention

Gestational Diabetes Mellitus (GDM) is a common metabolic disorder during pregnancy, raising significant health risks to both mother and child. With the advent of mobile health (mHealth) technologies, there is a growing potential to enhance GDM prevention strategies. This study investigates the impact of mobile-based prenatal education and diet recording on GDM prevention, utilizing the self-management application of the Peking Union Medical College Hospital mHealth-Enhanced Prenatal Care Program in Beijing, China. We retrospectively analyzed records from 1,666 pregnant women enrolled in the program from May 2021 to July 2022, with an average age of 32 years. Of these, 378 participants (22.7%) engaged actively in the program. Our analysis reveals that active participation in both prenatal education and diet recording from early pregnancy significantly reduces the incidence of GDM, with an odds ratio (OR) of 0.37, and a p-value of 0.034. This real-world study highlights the potential of mHealth applications to enhance prenatal care and establish more effective GDM prevention strategies.

Impact of mHealth interventions on maternal, newborn, and child health from conception to 24 months postpartum in low- and middle-income countries: a systematic review

BACKGROUND

Mobile health (mHealth) technologies have been harnessed in low- and middle-income countries (LMICs) to address the intricate challenges confronting maternal, newborn, and child health (MNCH). This review aspires to scrutinize the effectiveness of mHealth interventions on MNCH outcomes during the pivotal first 1000 days of life, encompassing the period from conception through pregnancy, childbirth, and post-delivery, up to the age of 2 years.

METHODS

A comprehensive search was systematically conducted in May 2022 across databases, including PubMed, Cochrane Library, Embase, Cumulative Index to Nursing & Allied Health (CINAHL), Web of Science, Scopus, PsycINFO, and Trip Pro, to unearth peer-reviewed articles published between 2000 and 2022. The inclusion criteria consisted of (i) mHealth interventions directed at MNCH; (ii) study designs, including randomized controlled trials (RCTs), RCT variations, quasi-experimental designs, controlled before-and-after studies, or interrupted time series studies); (iii) reports of outcomes pertinent to the first 1000 days concept; and (iv) inclusion of participants from LMICs. Each study was screened for quality in alignment with the Cochrane Handbook for Systematic Reviews of Interventions and the Joanne Briggs Institute Critical Appraisal tools. The included articles were then analyzed and categorized into 12 mHealth functions and outcome domain categories (antenatal, delivery, and postnatal care), followed by forest plot comparisons of effect measures.

RESULTS

From the initial pool of 7119 articles, we included 131 in this review, comprising 56 RCTs, 38 cluster-RCTs, and 37 quasi-experimental studies. Notably, 62% of these articles exhibited a moderate or high risk of bias. Promisingly, mHealth strategies, such as dispatching text message reminders to women and equipping healthcare providers with digital planning and scheduling tools, exhibited the capacity to augment antenatal clinic attendance and enhance the punctuality of child immunization. However, findings regarding facility-based delivery, child immunization attendance, and infant feeding practices were inconclusive.

CONCLUSIONS

This review suggests that mHealth interventions can improve antenatal care attendance and child immunization timeliness in LMICs. However, their impact on facility-based delivery and infant feeding practices varies. Nevertheless, the potential of mHealth to enhance MNCH services in resource-limited settings is promising. More context-specific implementation studies with rigorous evaluations are essential.

Antenatal Care: A Comparative Review of Guidelines

Importance

Antenatal care plays a crucial role in safely monitoring and ensuring the well-being of both the mother and the fetus during pregnancy, ultimately leading to the best possible perinatal outcomes.

Objective

The aim of this study was to review and compare the most recently published guidelines on antenatal care.

Evidence Acquisition

A descriptive review of guidelines from the National Institute for Health and Care Excellence, the Public Health Agency of Canada, the World Health Organization, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists regarding antenatal care was conducted.

Results

There is a consensus among the reviewed guidelines regarding the necessary appointments during the antenatal period, the proper timing for induction of labor, the number and frequency of laboratory examinations for the assessment of mother's well-being, and management strategies for common physiological problems during pregnancy, such as nausea and vomiting, heartburn, pelvic pain, leg cramps, and symptomatic vaginal discharge. In addition, special consideration should be given for mental health issues and timely referral to a specialist, reassurance of complete maternal vaccination, counseling for safe use of medical agents, and advice for cessation of substance, alcohol, and tobacco use during pregnancy. Controversy surrounds clinical evaluation during the antenatal period, particularly when it comes to the routine use of an oral glucose tolerance test and symphysis-fundal height measurement for assessing fetal growth, whereas routine cardiotocography and fetal movement counting are suggested practices only by Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Of note, recommendations on nutritional interventions and supplementation are offered only by Public Health Agency of Canada and World Health Organization, with some minor discrepancies in the optimal dosage.

Conclusions

Antenatal care remains a critical factor in achieving positive outcomes, but there are variations depending on the socioeconomic status of each country. Therefore, the establishment of consistent international protocols for optimal antenatal care is of utmost importance. This can help provide safe guidance for healthcare providers and, consequently, improve both maternal and fetal outcomes.

Effects of glycated serum protein, homocysteine, and cystatin-C levels on pregnancy outcomes in patients with gestational diabetes mellitus

Objective

To explore the effects of serum glycated serum protein (GSP), homocysteine (Hcy) and cystatin-C (Cys-C) levels on pregnancy outcomes in patients with gestational diabetes mellitus (GDM).

Methods

Retrospective selection of 247 pregnant women who underwent normal prenatal examinations in The Yan'an People's Hospital from January 2020 to May 2022 were included in this retrospective study. Among them, 119 were pregnant women with diabetes (GDM-group) and 128 were pregnant women with normal blood glucose (Normal-group). The levels of serum GSP, HCY, CYS-C, and incidence of adverse pregnancy outcomes were compared between the two groups. The clinical value of levels of serum GSP, Hcy, and Cys-C in predicting adverse pregnancy outcomes were analyzed.

Results

Compared with the Normal-group, the overall incidence of adverse pregnancy outcomes, serum GSP, Hcy, and Cys-C levels in the GDM-group were significantly higher (p<0.05). Logistic regression analysis showed that the levels of GSP, Hcy, and Cys-C were independent risk factors for adverse pregnancy outcomes in the GDM-group (p<0.05). Receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) for diagnosing adverse pregnancy outcomes in pregnant women with GDM using serum GSP, Hcy, and CysC levels alone were 0.817, 0.843, and 0.775, respectively. The AUC of the three indicators combined was 0.921, indicating that this combination has a good predictive value for diagnosing adverse outcomes in GDM-complicated pregnancies.

Conclusions

GDM is associated with a high risk of adverse pregnancy outcomes. Levels of serum GSP, Hcy, and Cys-C are higher in patients with GDM. The higher the levels of GSP, Hcy, and Cys-C, the greater the risk of adverse pregnancy outcomes. Combining these three indicators can effectively predict maternal pregnancy outcomes.

Effect of Prenatal Care on Perinatal Outcomes of Pregnant Women with Diabetes Mellitus: A Systematic Review

Objective: to evaluate the effect of prenatal care (PC) on perinatal outcomes of pregnant women with diabetes mellitus (DM). Methods: systematic review developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines and conducted through the population, intervention, control, and outcomes (PICO) strategy. Clinical trials and observational studies were selected, with adult pregnant women, single-fetus pregnancy, diagnosis of DM, or gestational DM and who had received PC and/or nutritional therapy (NT). The search was carried out in PubMed, Scopus, and BIREME databases. The quality of the studies was evaluated using the tools of the National Heart, Lung and Blood Institute-National Institutes of Health (NHLBI-NIH). Results: We identified 5972 records, of which 15 (n=47 420 pregnant women) met the eligibility criteria. The most recurrent outcomes were glycemic control (14 studies; n=9096 participants), hypertensive disorders of pregnancy (2; n=39 282), prematurity (6; n=40 163), large for gestational age newborns (4; n=1556), fetal macrosomia (birth weight >4kg) (6; n=2980) and intensive care unit admission (4; n=2022). Conclusions: The findings suggest that PC interferes with the perinatal outcome, being able to reduce the risks of complications associated with this comorbidity through early intervention, especially when the NT is an integral part of this assistance.

Designing the future of prenatal care: an algorithm for a telemedicine-enhanced team-based care model

This study provides a conceptual exploration of an innovative telemedicine-enhanced team-based care (TETC) model, tailored to prenatal care, integrating a multidisciplinary team approach with advanced telemedicine technologies. The algorithm developed for TETC aims to optimize communication and coordination among healthcare professionals, including obstetricians, midwives, nutritionists, and mental health experts. This cohesive team structure ensures a comprehensive care plan encompassing all facets of maternal and fetal health. Leveraging telemedicine tools like video conferencing and digital health records, the model supports remote consultations and coordinated care, proving particularly advantageous during pandemics or in regions with limited healthcare access. Central to the TETC model is patient-centered care, focusing on personalized care plans attuned to the individual needs, health status, and socioeconomic backgrounds of pregnant women. This approach not only enhances accessibility and convenience by diminishing the necessity for physical consultations but also ensures continuity of care throughout pregnancy. This continuity is crucial for consistent health parameter tracking and early risk identification. The paper discusses the model's design, operational workflow, and ethical and legal considerations, providing implementation guidelines and potential applications. The TETC model, rooted in current technological capabilities and healthcare frameworks, underscores the need for close collaboration with healthcare professionals to adhere to medical standards and address real-world requirements effectively.

Effectiveness of mobile health interventions for pregnant women with gestational diabetes mellitus: a systematic review and meta-analysis

Gestational diabetes mellitus is a growing global health problem. Inadequate management during pregnancy can lead to maternal and foetal complications. Currently, mobile health (mHealth) delivers healthcare services, playing an increasingly important role in the management of blood glucose in GDM. This study aimed to systematically evaluate the effectiveness of mHealth intervention in pregnant women with GDM. Based on randomised controlled trials of mHealth application in GDM patients searched from the database, literature screening, data extraction, and quality evaluation were conducted independently by two researchers. Statistical analysis was performed using Review Manager 5.4 software. The review included 27 studies with a total of 3483 patients. The results showed a significant improvement in glycemic control. In addition, mHealth interventions could reduce the occurrence of adverse pregnancy outcomes and improve self-management ability. In a subgroup analysis, recording of delivery mode and WeChat combined phone call indicated significant differences with mHealth interventions. It was suggested that mHealth interventions imposed a positive effect on glycemic control and reduction of adverse pregnancy outcomes in GDM patients. Our results demonstrated that the application of mHealth interventions can act as an effective and feasible approach to self-management to promote the self-management level and awareness of GDM patients.

Gestational diabetes mellitus care re-imagined - A cost-minimisation analysis: Cost savings from a tertiary hospital, using a novel, digital-based gestational diabetes management model

BACKGROUND

Diagnosis of gestational diabetes mellitus (GDM) in a pregnancy has a significant impact on health service resources and represents a substantial financial and time impost on women.

AIM

To describe a cost-minimisation analysis conducted following the demonstration of clinically equivalent care of women using a novel, digital model for GDM management, compared with conventional care.

MATERIALS AND METHODS

A pre-implementation model of care was compared with the post-implementation model of care which included systematic development and delivery of education videos, use of the Commonwealth Scientific and Industrial Research Organisation 'M♡THer' smart phone app/portal and a dramatically reduced schedule of visits. The Mater Mothers' Hospital Brisbane cares for approximately 1200 women with GDM per annum, on which the cost estimates were based. Service costs were estimated using the resource method, where resource volumes and costs were gathered from experts within the health service. Patient costs were estimated using results from a short survey completed by a cohort of the study population.

RESULTS

Health service costs showed a modest saving of AU$17 441.78 (US$12 158.92) in the intervention group over a 12-month period. Cost savings for the woman were estimated at $566.56 (US$394.96) per patient after accounting for lost wages, childcare expenses, and travel expenses avoided. This reduction led to an overall saving of $679 872 (US$473 948.82) for the cohort of 1200 women, primarily due to the reduction in face-to-face visits.

CONCLUSION

Re-imagining GDM patient care by introducing a novel, digital-based GDM model of care has substantial positive cost implications for patients.

The preferences for the telemedicine and standard health care services from the perspective of the patients with schizophrenia

BACKGROUND

With the rapid development of telemedicine, has enabled new and various ways to deliver health care services for patients with schizophrenia. However, it is not clear that the newly emerged is better than the standard or not from the perspective of patients with schizophrenia. This study aims to explore their preferences between telemedicine and standard health care services and their associated factors.

METHODS

The cross-sectional study was conducted at the Ningan hospital's inpatient department in Yinchuan, and collected socio-demographic and clinical information, the preferences regarding telemedicine (WeChat, telephone, and Email), and the standard health care services (community health center and home visit). The socio-demographic and clinical characteristics associated with the five-health care service delivery ways were assessed by descriptive analysis, and the associated impact factors of preferences of patients with schizophrenia were analyzed by multiple logistic regression.

RESULTS

Among the 300 participants, most of them chose WeChat (46.3%), some of them tended to telephone (35.4%) and community health center (11.3%), and a few of them accepted home visits (4.7%), and Email (2.3%). There are so many associated factors that affected the patients with schizophrenia to choose their favorite health care services, of which age, gender, employment, residence, and duration of illness were the independent impact factors.

CONCLUSIONS

The cross-sectional study surveyed the preferences between telemedicine and standard health care services in patients with schizophrenia's opinion, disclosed independent impact factors, as well as compared the advantage and disadvantages of these. According to our findings, the best health care services should be based on the preferences of the patients with schizophrenia and adapt to realistic conditions. This provides valuable evidence to improve the health care situation, facilitate the continuity of health care services, and achieve holistic rehabilitative outcomes for the patients with schizophrenia.

Self-care educational guide for mothers with gestational diabetes mellitus: A systematic review on identifying self-care domains, approaches, and their effectiveness

Background

Gestational Diabetes Mellitus (GDM) is a common form of poor carbohydrate intolerance, prevalent among pregnant women and associated with unhealthy lifestyle behaviors. Given the dearth of information on self-empowerment among mothers with GDM, a self-care health education package needs to be developed to prevent related complications.

Objective

This review aimed to identify self-care approaches, domains, and their effectiveness for a proper self-care educational guide package for women with GDM.

Design

A systematic review using electronic literature databases published between January 2016 and December 2022 was conducted.

Data Sources

Web of Science, Scopus, and Ovid databases were used.

Review Methods

This review utilized the PICO (Population, Intervention, Comparison, and Outcomes) framework to screen the retrieved articles for eligibility in which mothers with GDM, educational materials, standard practice or intervention, and effectiveness were considered the PICO, respectively. The CIPP (Context, Input, Process, Product) model served as a framework for adopting the education development model. Mixed methods appraisal tool was used for quality assessment. Data extraction and synthesis without meta-analysis were presented as evidence tables.

Results

A total of 19 articles on GDM were included in the final analysis (16 Intervention studies, two qualitative studies, and one mixed-methods study). Four broad domains emerged from the analysis: 1) information or knowledge of GDM, 2) monitoring of blood glucose levels, 3) practice of healthy lifestyles, and 4) other non-specific activities. The majority of the articles employed a face-to-face approach in executing the educational group sessions, and most studies disclosed their positive effects on GDM management. Other methods of evaluating intervention effectiveness were described as improved self-care behavior, increased satisfaction score, enhanced self-efficacy, good glucose control, and better pregnancy outcome.

Conclusion

Knowledge or information about GDM, healthy diet, and exercise or physical activity was found to be the most applied domains of intervention. Framework domains based on the present review can be used in the future development of any interventional program for GDM women in enhancing health information reaching the targeted group in promoting self-efficacy.

PROSPERO registration number

CRD42021229610.

Web-Based Interventions for Pregnant Women With Gestational Diabetes Mellitus: Systematic Review and Meta-analysis

BACKGROUND

Effective management of gestational diabetes mellitus (GDM) is essential because it is one of the most prevalent diseases during pregnancy, and the consequent condition maternal hyperglycemia is closely related to considerable short- and long-term maternal and neonatal complications. Web-based interventions (WBIs), defined as therapeutic interventions offered via the web, have been implemented to assist in managing GDM owing to their advantages of high accessibility and efficiency, but findings across relevant studies are inconsistent.

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the effectiveness of WBIs on glycemic control among pregnant women with GDM; examine whether specific types of intervention interactivity, format, and technology have beneficial effects on maternal glycemic control; and comprehensively assess the efficacy of WBIs in maternal behavioral outcomes, cognitive and attitudinal outcomes, mental health, maternal and neonatal clinical outcomes, and medical service use and costs among pregnant women with GDM.

METHODS

PubMed, Embase, Cochrane Library, Web of Science, CINAHL, and PsycINFO were searched from their respective inception to November 19, 2022, to identify relevant randomized controlled trials and controlled clinical trials. The methodological quality of the included studies was assessed using the Effective Public Health Practice Project tool. Where possible, the data for all outcomes were meta-analyzed using the Stata software (version 12.0; StataCorp). Overall, 3 subgroup analyses and post hoc sensitivity analyses of maternal glycemic control parameters were performed.

RESULTS

Overall, 25 publications arising from 21 randomized controlled trials and controlled clinical trials were included. The overall meta-analyses on glycemic control parameters demonstrated that WBIs could significantly improve fasting blood glucose (standardized mean difference=-1.764, 95% CI -2.972 to -0.557; P=.004) and 2-hour postprandial blood glucose (standardized mean difference=-1.433, 95% CI -2.561 to -0.304; P=.01) compared with the control group, whereas no significant effect was found on glycated hemoglobin and 1-hour postprandial blood glucose. The results of the subgroup analyses indicated that mobile app-delivered interventions with a personalized format and interactive function showed more beneficial effects on maternal glycemic control. Moreover, WBIs could significantly enhance compliance with the self-monitoring of blood glucose; increase the rate of normal vaginal delivery; and decrease the chance of emergency cesarean, admission to the neonatal intensive care unit, and composite neonatal complications. GDM knowledge, risk perception of the disease, self-efficacy, satisfaction with care, and medical service use of the participants in the WBI group were also improved compared with the control group. However, the effectiveness of WBIs on other secondary outcomes was either nonsignificant or uncertain.

CONCLUSIONS

WBIs are a promising approach to GDM management. Personalized, interactive, and mobile app-delivered interventions seem more worthy of being recommended for future clinical practice. Further high-quality studies are required to verify these findings before making broad recommendations.

TRIAL REGISTRATION

PROSPERO CRD42022296625; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=296625.

Community-based non-pharmacological interventions for pregnant women with gestational diabetes mellitus: a systematic review

BACKGROUND

Non-pharmacological interventions are the first line of Gestational diabetes mellitus (GDM) management. Community-based interventions are cheaper, more accessible, with higher patient satisfaction.

OBJECTIVES

To systematically review community-based non-pharmacological interventions and evaluate their effectiveness for GDM.

SEARCH STRATEGY

Twelve bibliographic databases and reference list of related studies from inception until January 2022.

SELECTION CRITERIA

All primary studies of community-based non-pharmacological interventions for GDM reported in English which investigated any behavioural or clinical outcome(s).

DATA COLLECTION AND ANALYSIS

Data were extracted using modified Cochrane's data extraction template. Studies were evaluated using Cochrane Collaboration's risk of bias tool. Narrative synthesis was used to summarise findings. This study is registered with PROSPERO (CRD42021257634).

MAIN RESULTS

Twenty-seven studies involving 6,242 pregnant women with GDM investigated self-management programmes, medical nutrition/diet therapy, exercise/physical activity, combined diet and exercise, calcium plus vitamin D supplementation, and continuous glucose monitoring. Self-management programmes were more effective than routine care in improving self-efficacy, two-hour postprandial blood glucose, and lifestyle behaviours but were as effective as routine care in improving infant birth weight. Self-management programmes were superior to or as effective as usual care in improving fasting blood glucose, blood glucose control, glycated haemoglobin, macrosomia, and preterm delivery. Medical nutrition/diet therapy was more effective than usual care in improving postprandial blood glucose levels. Postprandial blood glucose levels were better improved by regular supervised exercise plus daily brisk walks or a daily walking intervention than routine obstetric care or no treatment. The effects of exercise/physical activity programmes were mostly inconsistent for other outcomes. Diet and exercise were superior to diet alone in reducing maternal weight gain although there were similar outcomes for other pregnancy and foetal outcomes. Limited or conflicting evidence was found for other outcomes and interventions including calcium and vitamin D supplementation and continuous glucose monitoring intervention.

CONCLUSIONS

Community-based non-pharmacological interventions are more effective than placebo; and are more or as effective as usual care. Self-management programmes and medical nutrition/diet therapy had the most promising GDM outcomes.

FUNDING

There was no funding for this study. The study design, data collection, data analysis and interpretation, and writing of this manuscript were not influenced externally by any funder.

Cultural and Digital Health Literacy Appropriateness of App- and Web-Based Systems Designed for Pregnant Women With Gestational Diabetes Mellitus: Scoping Review

BACKGROUND

The prevalence of women diagnosed with gestational diabetes mellitus (GDM) is increasing dramatically. Mobile technologies to enhance patient self-management offer many advantages for women diagnosed with GDM. However, to our knowledge, although mobile health (mHealth) and telemedicine systems for GDM management exist, evidence on their cultural and digital health literacy appropriateness levels is limited.

OBJECTIVE

This review aimed to search and assess the literature on mHealth and telemedicine systems designed for women diagnosed with GDM. Our assessment of these technologies focused on their cultural and digital health literacy appropriateness as well as the systems' effectiveness in improving glycemic control and maternal and infant outcomes.

METHODS

We conducted a scoping review using a framework adapted from Arksey and O'Malley. Four electronic databases were searched for relevant studies: PubMed, MEDLINE (EBSCO), Web of Science, and Scopus. The databases were searched between January 2010 and January 2022. The inclusion criteria were pregnant women diagnosed with GDM, use of telemedicine for monitoring and management, and vulnerable or disadvantaged patients. We used terms related to mobile apps and telemedicine: GDM, vulnerable populations, periphery, cultural appropriateness, and digital health literacy. Studies were screened and selected independently by 2 authors. We extracted the study data on a Microsoft Excel charting table and categorized them into final themes. The results were categorized according to the cultural and digital health literacy features presented.

RESULTS

We identified 17 studies that reported on 12 telemedicine and mHealth app interventions. We assessed the studies in three domains: cultural appropriateness, digital health literacy, and maternal and infant outcomes. In the literature, we found that existing digital technologies may improve glycemic control and diabetes self-management. However, there is a lack of assessment of cultural and digital health literacy appropriateness for pregnant women diagnosed with GDM. Considerations in app design regarding cultural appropriateness were found in only 12% (2/17) of the studies, and only 25% (3/12) of the interventions scored ≥3 out of 5 in our assessment of digital health literacy.

CONCLUSIONS

mHealth and telemedicine can be an effective platform to improve the clinical management of women with GDM. Although studies published on the use of mHealth and telemedicine systems exist, there is a limited body of knowledge on the digital health literacy and cultural appropriateness of the systems designed for women diagnosed with GDM. In addition, as our study was restricted to the English language, relevant studies may have been excluded. Further research is needed to evaluate, design, and implement better tailored apps regarding cultural and digital literacy appropriateness for enhancing pregnant women's self-management as well as the effectiveness of these apps in improving maternal and infant health outcomes.

Nutrition-Education-Based Interventions in Gestational Diabetes: A Scoping Review of Clinical Trials

Cases of diabetes mellitus have seen a global increase in prevalence, but there are inherent differences in the pathology and management of different types of diabetes. Type 2 and gestational diabetes have the most similar pathophysiology. For that reason, many similar management strategies exist between type 2 and gestational diabetes, including nutrition-based interventions. Diabetes self-management education and medical nutrition therapy have been advanced as cost-effective interventions to manage hyperglycemia. Many of these interventions, however, were designed for type 2 diabetes and adapted for diabetes in gestation. Nutrition-education-based interventions in gestational diabetes have not been fully elucidated. We scrutinized this gap by conducting a scoping review of recently published peer-reviewed studies that evaluated clinical endpoints in cases of gestational diabetes with nutrition-education-based interventions. The search yielded 621 articles, and the 12 articles included were published between 2012 and 2022. The nutrition information varied across the heterogeneous diabetes self-management education, whereas the medical nutrition therapy studies were more consistent. Our literature search revealed similar outcomes across self-management education and medical nutrition therapy interventions implemented during the third trimester of pregnancies with diabetes. These results suggest that both generalized and personalized approaches to nutrition education in gestational diabetes can manage hyperglycemia and offset its adverse consequences.

Web-based interventions for pregnant women with gestational diabetes mellitus: a systematic review and meta-analysis protocol

INTRODUCTION

Gestational diabetes mellitus (GDM) is one of the most prevalent diseases during pregnancy, which is closely associated with many short-term and long-term maternal and neonatal complications and can incur heavy financial burden on both families and society. Web-based interventions have been used to manage GDM because of the advantages of high accessibility and flexibility, but their effectiveness has remained inconclusive. This systematic review and meta-analysis aims to comprehensively investigate the multidimensional effectiveness of web-based interventions for pregnant women with GDM, thereby aiding implementation decisions in clinical settings.

METHODS AND ANALYSIS

This systematic review protocol strictly adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Six electronic databases (PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase, CINAHL and PsycINFO) will be comprehensively searched from their inception to 26 January 2022 to identify randomised controlled trials and controlled clinical trials regarding the efficacy of web-based interventions for pregnant women with GDM on glycaemic control, behavioural outcomes, cognitive and attitudinal outcomes, mental health, maternal and neonatal clinical outcomes, and medical service utilisation and costs. Two reviewers will independently conduct the study selection, data extraction and quality assessment. The methodological quality of included studies will be assessed using the Effective Public Health Practice Project assessment tool. The overall meta-analyses for each of the interested outcomes will be performed if the outcome data are sufficient and provides similar effect measures, as well as subgroup analyses for glycaemic control indicators based on the different types of intervention format, interactivity and technology. We will conduct a qualitative synthesis for studies that cannot be quantitatively synthesised.

ETHICS AND DISSEMINATION

Ethics approval is not required for this review as no human participants will be involved. The results will be disseminated via a peer-reviewed journal or an academic conference.

PROSPERO REGISTRATION NUMBER

CRD42022296625.

Impact of Remote Monitoring Technologies for Assisting Patients With Gestational Diabetes Mellitus: A Systematic Review

Introduction: In Chile, 1 in 8 pregnant women of middle socioeconomic level has gestational diabetes mellitus (GDM), and in general, 5–10% of women with GDM develop type 2 diabetes after giving birth. Recently, various technological tools have emerged to assist patients with GDM to meet glycemic goals and facilitate constant glucose monitoring, making these tasks more straightforward and comfortable.

Objective: To evaluate the impact of remote monitoring technologies in assisting patients with GDM to achieve glycemic goals, and know the respective advantages and disadvantages when it comes to reducing risk during pregnancy, both for the mother and her child.

Methods: A total of 188 articles were obtained with the keywords “gestational diabetes mellitus,” “GDM,” “gestational diabetes,” added to the evaluation levels associated with “glucose level,” “glycemia,” “glycemic index,” “blood sugar,” and the technological proposal to evaluate with “glucometerm” “mobile application,” “mobile applications,” “technological tools,” “telemedicine,” “technovigilance,” “wearable” published during the period 2016–2021, excluding postpartum studies, from three scientific databases: PUBMED, Scopus and Web of Science. These were managed in the Mendeley platform and classified using the PRISMA method.

Results: A total of 28 articles were selected after elimination according to inclusion and exclusion criteria. The main measurement was glycemia and 4 medical devices were found (glucometer: conventional, with an infrared port, with Bluetooth, Smart type and continuous glucose monitor), which together with digital technology allow specific functions through 2 identified digital platforms (mobile applications and online systems). In four articles, the postprandial glucose was lower in the Tele-GDM groups than in the control group. Benefits such as improved glycemic control, increased satisfaction and acceptability, maternal confidence, decreased gestational weight gain, knowledge of GDM, and other relevant aspects were observed. There were also positive comments regarding the optimization of the medical team’s time.

Conclusion: The present review offers the opportunity to know about the respective advantages and disadvantages of remote monitoring technologies when it comes to reducing risk during pregnancy. GDM centered technology may help to evaluate outcomes and tailor personalized solutions to contribute to women’s health. More studies are needed to know the impact on a healthcare system.

Use of a smartphone-based, interactive blood glucose management system in women with gestational diabetes mellitus: A pilot study

AIMS

To determine patient satisfaction, impact on maternal and neonatal outcomes and resource utilisation of a smartphone-based, remote blood glucose level (BGL) monitoring platform with software surveillance inwomen with gestational diabetes (GDM) compared with historical controls.

METHODS

This intervention study prospectively enrolled 98 women with GDM to the NET-Health smartphone-based application and compared them to 94 historical controls. The application allows automatic, real-time BGL upload to a central server for software monitoring, with automatic alerts generated for out-of-range results. Data recorded included demographics, outcomes and occasions of service (OOS). A validated satisfaction questionnaire was completed post-delivery.

RESULTS

The groups had comparable baseline characteristics and no significant difference in maternal and neonatal outcomes. The NET-Health application intervention reduced resource utilisation, with 1.9 fewer OOS and 37 min less clinician time - equivalent to AUD$68 saved per woman (based on clinician time only) or AUD$23 after taking into account the cost of the application. Patient satisfaction was high.

CONCLUSIONS

Use of this smartphone-based application with software surveillance in women with GDM has high patient satisfaction and no differences in maternal or neonatal outcomes despite reduced resource utilisation. It is the first to demonstrate a financial benefit. Larger studies are needed.

Digital health interventions for gestational diabetes mellitus: A systematic review and meta-analysis of randomised controlled trials

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.