Effectiveness of telemedicine for pregnant women with gestational diabetes mellitus: an updated meta-analysis of 32 randomized controlled trials with trial sequential analysis

Xie, Weihua; Dai, Pinyuan; Qin, Yu; Wu, Ming; Yang, Bingquan; Yu, Xiaofang

doi:10.1186/s12884-020-02892-1

Cited by 125 publications

(122 citation statements)

References 35 publications

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“…Outpatient PNC (30) Outpatient breastfeeding support (24) Inpatient ANC (27) Inpatient childbirth care (34) Inpatient PNC (31) Surgical care (16) Neonatal care (small and sick newborns)…”

Section: Resultsmentioning

confidence: 99%

A double-edged sword—telemedicine for maternal care during COVID-19: findings from a global mixed-methods study of healthcare providers

et al. 2021

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IntroductionThe COVID-19 pandemic has led to a rapid implementation of telemedicine for the provision of maternal and newborn healthcare. The objective of this study was to document the experiences with providing telemedicine for maternal and newborn healthcare during the pandemic among healthcare professionals globally.MethodsThe second round of a global online survey of maternal and newborn health professionals was conducted, disseminated in 11 languages. Data were collected between 5 July and 10 September 2020. The questionnaire included questions regarding background, preparedness and response to COVID-19, and experiences with providing telemedicine. Descriptive statistics and qualitative thematic analysis were used to analyse responses, disaggregated by country income level.ResultsResponses from 1060 maternal and newborn health professionals were analysed. Telemedicine was used by 58% of health professionals and two-fifths of them reported not receiving guidelines on the provision of telemedicine. Key telemedicine practices included online birth preparedness classes, antenatal and postnatal care by video/phone, a COVID-19 helpline and online psychosocial counselling. Challenges reported lack of infrastructure and technological literacy, limited monitoring, financial and language barriers, lack of non-verbal feedback and bonding, and distrust from patients. Telemedicine was considered as an important alternative to in-person consultations. However, health providers emphasised the lower quality of care and risk of increasing the already existing inequalities in access to healthcare.ConclusionsTelemedicine has been applied globally to address disruptions of care provision during the COVID-19 pandemic. However, some crucial aspects of maternal and newborn healthcare seem difficult to deliver by telemedicine. More research regarding the effectiveness, efficacy and quality of telemedicine for maternal healthcare in different contexts is needed before considering long-term adaptations in provision of care away from face-to-face interactions. Clear guidelines for care provision and approaches to minimising socioeconomic and technological inequalities in access to care are urgently needed.

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“…Outpatient PNC (30) Outpatient breastfeeding support (24) Inpatient ANC (27) Inpatient childbirth care (34) Inpatient PNC (31) Surgical care (16) Neonatal care (small and sick newborns)…”

Section: Resultsmentioning

confidence: 99%

A double-edged sword—telemedicine for maternal care during COVID-19: findings from a global mixed-methods study of healthcare providers

et al. 2021

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“…In order to improve healthcare professionals to monitor patients’ health-related indicators and provide timely medical feedback and guidance to improve the physical and psychological status of patients, website-based systems or mobile terminal devices can be used. In a meta-analysis of 32 randomized controlled trials (RCTs), including 5108 patients with GDM (2581 instructed by telemedicine and 2527 controls), the role of remote communication technologies in improving pregnancy outcome was evaluated [ 206 ]. Most studies were conducted in China (21 studies, 65.6%).…”

Section: The Effects Of Diabetes In Pregnancy On the Newborn Infanmentioning

confidence: 99%

Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review

Ornoy

Becker

Weinstein-Fudim³

et al. 2021

IJMS

176

101

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In spite of the huge progress in the treatment of diabetes mellitus, we are still in the situation that both pregestational (PGDM) and gestational diabetes (GDM) impose an additional risk to the embryo, fetus, and course of pregnancy. PGDM may increase the rate of congenital malformations, especially cardiac, nervous system, musculoskeletal system, and limbs. PGDM may interfere with fetal growth, often causing macrosomia, but in the presence of severe maternal complications, especially nephropathy, it may inhibit fetal growth. PGDM may also induce a variety of perinatal complications such as stillbirth and perinatal death, cardiomyopathy, respiratory morbidity, and perinatal asphyxia. GDM that generally develops in the second half of pregnancy induces similar but generally less severe complications. Their severity is higher with earlier onset of GDM and inversely correlated with the degree of glycemic control. Early initiation of GDM might even cause some increase in the rate of congenital malformations. Both PGDM and GDM may cause various motor and behavioral neurodevelopmental problems, including an increased incidence of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Most complications are reduced in incidence and severity with the improvement in diabetic control. Mechanisms of diabetic-induced damage in pregnancy are related to maternal and fetal hyperglycemia, enhanced oxidative stress, epigenetic changes, and other, less defined, pathogenic mechanisms.

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“…Most of the systematic reviews and meta-analyses on the use of TM technologies for diabetes mellitus have demonstrated that TM tools help reduce the HbA1c value in individuals with type I, type II diabetes and GDM [7]. However, the effects of TM on other indices of glucose and pregnancy outcomes in patients with GDM remain uncertain [8].…”

Section: Discussionmentioning

confidence: 99%

Management of gestational diabetes during ‘COVID19 time’

Biase¹

2020

Ann Clin Endocrinol Metabol

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The measures put in place by many governments around the world to fi ght the spread of COVID-19 have drastically reduced visits to diabetes centres. To keep providing people with diabetes the professional support they need and reduce the inconvenience caused by the interruption of traditional assistance, the typical control visit can be carried out by virtual visit, telemedicine (TM) that should have the necessary characteristics to provide a correct execution. Especially this is important for pregnant women fi rst diagnosed with gestational diabetes mellitus (GDM), they have the necessity to frequent checks in a short time due to the pregnancy.

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Effectiveness of telemedicine for pregnant women with gestational diabetes mellitus: an updated meta-analysis of 32 randomized controlled trials with trial sequential analysis

Cited by 125 publications

References 35 publications

A double-edged sword—telemedicine for maternal care during COVID-19: findings from a global mixed-methods study of healthcare providers

A double-edged sword—telemedicine for maternal care during COVID-19: findings from a global mixed-methods study of healthcare providers

Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review

Management of gestational diabetes during ‘COVID19 time’

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