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

Boutheina Leblalta, Hanane Kebaili, Ruth Sim, Shaun Wen Huey Lee, Boutheina Leblalta, Hanane Kebaili, Ruth Sim, Shaun Wen Huey Lee

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.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright: © 2022 Leblalta et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Figures

Fig 1. Study flow.
Fig 1. Study flow.
Fig 2. Random effects meta-analysis of the…
Fig 2. Random effects meta-analysis of the mean difference in fasting plasma glucose (mmol/L), comparing digital health or routine care.
Fig 3. Random effects meta-analysis of the…
Fig 3. Random effects meta-analysis of the mean difference in 2-hour post prandial glucose (mmol/L), comparing digital health interventions or routine care.
Fig 4. Random effects meta-analysis of the…
Fig 4. Random effects meta-analysis of the mean difference in HbA1c (%), comparing digital health interventions or routine care.

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