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

Abstract

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

Internet-Based Interventions for Preventing Premature Birth Among Pregnant Women: Systematic Review

“…Most studies in our review focused on verifying the effectiveness of BG control in women with GDM. The research demonstrated significant effects on both fasting BG and 2-hour BG levels in several studies [ 11 , 22 , 23 , 64 ], aligning with the findings from previous meta-analyses. However, variations were observed, such as in 1 study using a telemedicine system where HbA 1c levels were significantly lower in the experimental group [ 65 ].…”

“…Recent studies, including 1 study using WhatsApp with a chatbot for health promotion messages, have shown higher uptake rates for interventions [ 57 ]. Mobile apps, being more accessible than websites, have shown greater effectiveness for glycemic control [ 11 ]. Further studies should thus compare the efficacy of websites and mobile apps and explore the use of mobile instant messengers and apps in more depth.…”

“…Recently, internet-based interventions have been developed to provide health-related information to individuals who may not have direct access to medical facilities [ 9 ], offering accessibility and availability regardless of time and location [ 10 ]. In addition, internet-based interventions can enhance engagement with self-monitoring, promote health-related understanding, and increase knowledge and risk perception of disease as well as bolster self-efficacy in disease management [ 11 ].…”

Technology and health inequities in diabetes care: How do we widen access to underserved populations and utilize technology to improve outcomes for all?

“…During pregnancy, digital health technologies have been shown to provide educational and behavioural support for women with diabetes 101 . For example, recent meta‐analyses of digital health technologies have shown that web‐based interventions improve glycaemic control during pregnancy and improve several maternal and foetal outcomes including lower C‐section rates and macrosomia 102–104 . Despite these benefits of digital health technologies for pregnant women, inequities in access to and use of digital health technologies remains an issue adversely impacting the woman and her unborn child.…”

“… 101 For example, recent meta-analyses of digital health technologies have shown that web-based interventions improve glycaemic control during pregnancy and improve several maternal and foetal outcomes including lower C-section rates and macrosomia. 102 – 104 Despite these benefits of digital health technologies for pregnant women, inequities in access to and use of digital health technologies remains an issue adversely impacting the woman and her unborn child. Recommendation: There is an urgent need to develop culturally tailored digital health technologies for diverse populations of women of child-bearing age, including exploring options for subsidizing or providing low-cost digital health technologies to those in need, to reduce health inequities associated with diabetes and pregnancy.…”