JMIR Publications

ABSTRACT

Background:

Gestational diabetes mellitus (GDM) is a common complication and global health problem in pregnant women. According to the latest data from the International Diabetes Federation, the prevalence of GDM is estimated to be 14%, and affecting 6.2% of live births [1]. GDM is typically defined as carbohydrate intolerance, which is first recognized during pregnancy. Most recently, the preferred definition was modified to distinguish women with preexisting diabetes. Due to the changes in diabetogenic hormones during pregnancy, the deficient beta cell function is insufficient to overcome the insulin resistance, and then GDM occurs. The complications of hyperglycemia associated with GMD in pregnant females include increased risk of gestational hypertension, preeclampsia, and cesarean delivery [2]. For the fetus, the increased risk includes spontaneous abortion, fetal anomalies, fetal demise, macrosomia, neonatal hypoglycemia, shoulder dystocia, hyperbilirubinemia, and neonatal respiratory distress syndrome. The offspring later in life may also show increased risk of obesity, hypertension, and type 2 diabetes [2,3]. In order to prevent those complication, it is important to control tight glucose control during pregnancy. The poor glycemic control during pregnancy may increase the maternal complications, and lead to the risk of neonatal hypoglycemia [4]. Approximately half of women with GDM need insulin therapy, which requires close monitoring and intensive follow-up for controlling of persisting hyperglycemia [5]. Therefore, it is important to report promptly the blood glucose of pregnant women to healthcare professionals and get prompt scientific guidance. Currently, the standard care for women with GDM is mostly in-person management. The patients are responsible for monitoring and recording their own glycemic levels daily at home, then visit the health care professions during antenatal examination for review and consultation [6–7]. The major disadvantages of in-person management are the lagging information, inaccurate recording, and insufficient communication between the patient and healthcare professional. With the advancement of information and communication technology, telemedicine has been widely used as a new technical to provide and support the patient’s clinical care. In particularly, the technology has been applied to pregnancies complicated by diabetes, which shows the impact on reduction in the number of outpatient clinical visits [8-11]. Telemedicine presents opportunities to improve the health services and medical activities, such as remote evaluation, diagnosis, extending the reach of diabetes education, and even the treatment for women with GDM. Traditionally, it usually takes a well-predefined time slot to make face-to-face office visits. However, the flexible telemedicine applications can provide automated data analyses and transmission, feedback and decision support to patients. Also, the telemedicine is well accepted by patients complicated by diabetes, which allow patients to use automatic processing tools and get real-time advice from healthcare providers. More specifically, women with GMD can upload their bodyweight, blood glucose data, symptoms and signs in real-time via the web, save a lot of time to doctors and nurses. Meantime, the healthcare professionals can remotely monitor and evaluate the patients’ health-related parameters and give the patient medical feedback promptly through internet or mobile systems to provide health knowledge and guidance and help patients maintain good physical and psychological status [12, 13]. Our study aimed to evaluate the effects of telemedicine interventions on glycemic control, pregnancy outcomes in pregnant women with GDM and neonatal hypoglycemia. Our subgroup analyses of studies according to the patients’ adherence to telemedicine interventions were also carried out to determine the relationship between the degree of adherence and the clinical outcomes of GDM women and infant.

Objective:

To evaluate the effect of innovative healthcare delivery approach, telemedicine management on pregnant women with gestational diabetes mellitus (GDM) and the incidence of neonatal hypoglycemia.

Methods:

A total of 943 pregnant women diagnosed with GMD were recruited in the First People’s Hospital of Kunshan, China, between July 2018 and June 2019. GMD was diagnosed based on American Diabetes Association 2011 diagnostic criteria. All eligible patients were assigned into telemedicine management (TM) and standard care (SC) groups. The patients received telemedicine intervention were categorized further into three subgroups: high (213), moderate (168), and low (72) adherence groups respectively according to the patient’s adherence to the telemedicine intervention.  The digital health platform CloudWisdom was applied to collect patient’s information including GDM internet instruction, self-monitoring of blood glucose, diet control, and movement activity.

Results:

The maternal weight gain of GDM patients in TM group was significantly lower than that in SC group(p=0.014). TM group showed substantial improvements in controlling blood glucose (p< 0.001), and infant weight(p=0.024) compared to the corresponding parameters in the SC group. Both the gestational weight gain and the proportions of pregnant women with unsatisfactory glucose control were significantly lower in high adherence TM group compared with SC group (all p<0.05). The incidence of neonatal hypoglycemia and birth weight were remarkably lower in TM group with high adherence than that in SC group (all p<0.05). The gestational weight gain and unsatisfactory glucose control in moderate adherence telemedicine subgroup showed similar pattern as high adherence subgroup. However, there was no significant difference in the incidence of neonatal hypoglycemia and birth weight between moderate and high adherence subgroups. All above parameters in low adherence subgroup showed no statistical difference compared with that in SC group.

Conclusions:

Innovative use of telemedicine management has great potential in improving gestational weight gain, blood glucose control and infant outcomes. However, its advantage may lie in patient adherence to the telemedicine intervention.