1
|
Kurnaz D, Şenoğlu A, Karaçam Z. The impact of antenatal telehealth services on maternal and neonatal outcomes, a comparison of results before and during the COVID-19 pandemic: A systematic review and meta-analysis (The impact of telehealth services on maternal and neonatal outcomes). Midwifery 2024; 134:104017. [PMID: 38714075 DOI: 10.1016/j.midw.2024.104017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVE This review was conducted to examine the effectiveness of antenatal follow-up using telehealth in the pre-COVID-19 and active pandemic periods. DESIGN A systematic review and meta-analysis of randomized controlled trials. METHODS Searches were conducted from inception to September 2023 through PubMed, the Cochrane Library, EBSCO, Embase, Web of Science, all via Ovid SP, the National Thesis Center, TR Index, Turkiye Clinics, and DergiPark Academic. Data were combined in the meta-analysis. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool and quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation guidelines. RESULTS The meta-analysis examining the effectiveness of antenatal telehealth services included 35 studies with a total sample size of 16 033. The combined results of the studies revealed that antenatal telehealth services were similar to face-to-face follow-ups for many maternal and newborn health outcomes. Maternal outcomes included abortion, preterm delivery, gestational diabetes, weight gain, hypertensive disorders, maternal hospitalization, number of antenatal follow-ups, use of induction, vaginal and instrumental delivery, planned and emergency cesarean section, shoulder dystocia, episiotomy, perineal laceration, childbirth under the supervision of qualified personnel, breastfeeding problems and postpartum depression. Neonatal outcomes included an APGAR score of <7, neonatal hypoglycemia, hyperbilirubinemia, admission into the neonatal intensive care unit, respiratory distress syndrome, neonatal death, birth weight, low birth weight and macrosomia. However, statistically significant reductions in excessive weight gain (p<0.001) and a 1.23-fold increase in vaccination administration (p=0.001) were observed with telehealth services. Additionally, the effects of telehealth services on preterm and cesarean delivery rates were similar in the pre-pandemic and pandemic periods. CONCLUSION AND IMPLICATIONS FOR PRACTICE AND RESEARCH This review reveals that while antenatal telehealth services are comparable to face-to-face care in terms of multiple pregnancy, delivery, and neonatal outcomes, they contribute to improvements in preventing extreme weight gain and vaccination hesitancy. These findings suggest that the telehealth method can be used as an alternative to face-to-face monitoring in antenatal follow-ups.
Collapse
Affiliation(s)
- Döndü Kurnaz
- Assist. Prof. Dr. Döndü Kurnaz, PhD, Marmara University Faculty of Health Sciences Midwifery Department, Istanbul, Turkey.
| | - Ayşe Şenoğlu
- PhD., Ministry of Health Adana Provincial Directorate of Health Emergency Health Services, Adana,Turkey.
| | - Zekiye Karaçam
- Prof. Dr., Aydın Adnan Menderes University, Faculty of Health Sciences, Division of Midwifery, Aydın, Turkey.
| |
Collapse
|
2
|
Güneş Öztürk G, Akyıldız D, Karaçam Z. The impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancy: A systematic review and meta-analysis. J Telemed Telecare 2024; 30:607-630. [PMID: 35570738 DOI: 10.1177/1357633x221087867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Telehealth is an applicable, acceptable, cost-effective, easily accessible, and speedy method for pregnant women. This study aimed to examine the impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancies. METHODS Studies were selected from PubMed, Science Direct, Web of Science, EBSCO, Scopus, and Clinical Key databases according to the inclusion and exclusion criteria from January to February 2021. Cochrane risk-of-bias tools were used in the quality assessment of the studies. RESULTS Four observational and eight randomized controlled studies were included in this meta-analysis (telehealth: 135,875, control: 94,275). It was seen that the number of ultrasound (p < 0.01) and face-to-face visits (p < 0.01), fasting insulin (p < 0.01), hemoglobin A1C before delivery (p < 0.01), and emergency cesarean section rates (p = 0.05) were lower in the telehealth group. In the telehealth group, the women's use of antenatal corticosteroids (p = 0.03) and hypoglycemic medication at delivery (p = 0.03), the total of nursing interventions (p < 0.01), compliance with actual blood glucose measurements (p < 0.01), induction intervention at delivery (p = 0.003), and maternal mortality (p < 0.001) rates were higher. Two groups were similar in terms of the use of medical therapy, total gestational weight gain, health problems related to pregnancy, mode and complications of delivery, maternal intensive care unit admission, fetal-neonatal growth and development, neonatal health problems and mortality, follow-up, and care costs. DISCUSSION Telehealth and routine care yielded similar maternal/neonatal health and cost outcomes. It can be said that telehealth is a safe technique to work with in the management of high-risk pregnancies.
Collapse
Affiliation(s)
- Gizem Güneş Öztürk
- Division of Midwifery, Faculty of Health Science, Aydın Adnan Menderes University, Aydın, Turkey
| | - Deniz Akyıldız
- Division of Midwifery, Faculty of Health Science, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Zekiye Karaçam
- Division of Midwifery, Faculty of Health Science, Aydın Adnan Menderes University, Aydın, Turkey
| |
Collapse
|
3
|
Yue SW, Zhou J, Li L, Guo JY, Xu J, Qiao J, Redding SR, Ouyang YQ. Effectiveness of remote monitoring for glycemic control on maternal-fetal outcomes in women with gestational diabetes mellitus: A meta-analysis. Birth 2024; 51:13-27. [PMID: 37789580 DOI: 10.1111/birt.12769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 07/07/2023] [Accepted: 08/11/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND The current pandemic and future public health emergencies highlight the importance of evaluating a telehealth care model. Previous studies have reached mixed conclusions about the effectiveness of remote monitoring on glycemic control and maternal and infant outcomes in women with gestational diabetes mellitus (GDM). OBJECTIVES This meta-analysis aimed to evaluate the effectiveness of remote blood glucose monitoring for women with gestational diabetes mellitus and to provide evidence-based guidance on the management of women with gestational diabetes mellitus for policymakers and healthcare providers during situations such as pandemics or natural disasters. METHODS The Cochrane Library, PubMed, Web of Science, EBSCO, Embase, Medline, CINAHL databases, and ClinicalTrials.gov were systematically searched from their inception to July 10, 2021. Randomized controlled trials (RCTs) published in English with respect to remote blood glucose monitoring in women with GDM were included in the meta-analysis. Two independent reviewers performed data extraction and assessed the quality of the studies. Risk ratios, mean differences, 95% confidence intervals, and heterogeneity were calculated. RESULTS A total of 1265 participants were included in the 11 RCTs. There were no significant differences in glycemic control and maternal-fetal outcomes between the remote monitoring group and a standard care group, which included glycosylated hemoglobin (HbA1c), fasting blood glucose, mean 2-h postprandial blood glucose, caesarean birth, gestational weight gain, shoulder dystocia, neonatal hypoglycemia, and other outcomes. CONCLUSION This meta-analysis reveals that it is unclear if remote glucose monitoring is preferable to standard of care glucose monitoring. To improve glycemic control and maternal-fetal outcomes during the current epidemic or other natural disasters, the implementation of double-blind RCTs in the context of simulating similar disasters remains to be studied in the future.
Collapse
Affiliation(s)
- Shu-Wen Yue
- School of Nursing, Wuhan University, Wuhan, China
| | - Jie Zhou
- School of Nursing, Wuhan University, Wuhan, China
| | - Lu Li
- School of Nursing, Wuhan University, Wuhan, China
| | - Jin-Yi Guo
- School of Nursing, Wuhan University, Wuhan, China
| | - Jing Xu
- School of Nursing, Wuhan University, Wuhan, China
| | - Jia Qiao
- School of Nursing, Wuhan University, Wuhan, China
| | | | | |
Collapse
|
4
|
Aoyama K, Nakajima Y, Meguro S, Sato Y, Goto R, Hida M, Arimitsu T, Kasuga Y, Tanaka M, Itoh H. Efficacy and safety of a telemedicine system in subjects with gestational diabetes mellitus (TELEGLAM): Study protocol for a randomized controlled trial. Heliyon 2023; 9:e22504. [PMID: 38034604 PMCID: PMC10687028 DOI: 10.1016/j.heliyon.2023.e22504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
Background Strict glycemic control is important to prevent perinatal complications in patients with gestational diabetes mellitus (GDM). Patients often require insulin injection, and frequent hospital visits are necessary to adjust the dose of insulin, which is considered burdensome for pregnant patients. Telemedicine may reduce the burden of hospital visits, and previous studies have reported its safety in GDM patients. This study aimed to evaluate the efficacy of telemedicine in GDM patients, focusing on patient satisfaction and health economic indicators. Methods This is a single-center, two-arm, randomized, open-label parallel-group study. Subjects will be selected from the patient population attending the Department of Endocrinology, Metabolism, and Nephrology, Keio University School of Medicine, Japan. Patients diagnosed with GDM by an oral glucose tolerance test (OGTT) by 29 weeks and 6 days of gestation who have undergone self-monitoring of blood glucose (SMBG) and insulin injection are eligible for inclusion. In the intervention group, telemedicine will be administered using the MeDaCa telemedicine system developed by the Medical Data Card, Inc., Tokyo, Japan. Subjects in the control group will be examined face-to-face every 2-3 weeks, as usual. We set health economic indicators and patient satisfaction as the primary endpoints, and will perform a cost-consequence analysis. Glycemic control indicators and perinatal outcomes will be evaluated as secondary endpoints. Conclusions Eligible patients are currently being recruited. Recruitment will be completed when the expected number of patients are enrolled.
Collapse
Affiliation(s)
- Kazuki Aoyama
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Yuya Nakajima
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Shu Meguro
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Rei Goto
- Graduate School of Business Administration, Keio University, Yokohama, Japan
| | - Mariko Hida
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Arimitsu
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Yoshifumi Kasuga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
5
|
Absalom G, Zinga J, Margerison C, Abbott G, O'Reilly S, van der Pligt P. Associations of a current Australian model of dietetic care for women diagnosed with gestational diabetes and maternal and neonatal health outcomes. BMC Health Serv Res 2023; 23:971. [PMID: 37684621 PMCID: PMC10485944 DOI: 10.1186/s12913-023-09924-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/16/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a significant public health burden in Australia. Subsequent strain on healthcare systems is widespread and current models of care may not be adequate to provide optimal healthcare delivery. This study aimed to assess a current model of dietetic care with maternal and neonatal outcomes. METHODS Hospital medical record data from The Women's Hospital, Melbourne, for women with GDM (n = 1,185) (July 2105-May 2017) was retrospectively analysed. Adjusted linear and logistic regression were used to analyse associations between the number of dietitian consultations and maternal and neonatal health outcomes. RESULTS Half of all women (50%) received two consultations with a dietitian. 19% of women received three or more consultations and of these women, almost twice as many were managed by medical nutrition therapy (MNT) and pharmacotherapy (66%) compared with MNT alone (34%). Higher odds of any maternal complication among women receiving 3 + consultations compared to those receiving zero (OR = 2.33 [95% CI: 1.23, 4.41], p = 0.009), one (OR = 1.80 [95% CI: 1.09, 2.98], p = 0.02), or two (OR = 1.65 [95% CI: 1.04, 2.60], p = 0.03) consultations were observed. Lower odds of infant admission to the Neonatal Intensive Care Unit (NICU) were observed among women receiving one (OR = 0.38 [95% CI: 0.18, 0.78], p = 0.008), two (OR = 0.37 [95% CI: 15 0.19, 0.71], p = 0.003), or three + consultations (OR = 0.43 [95% CI: 0.21, 0.88], p = 0.02), compared to no consultations. CONCLUSION The optimal schedule of dietitian consultations for women with GDM in Australia remains largely unclear. Alternate delivery of education for women with GDM such as telehealth and utilisation of digital platforms may assist relieving pressures on the healthcare system and ensure optimal care for women during pregnancy.
Collapse
Affiliation(s)
- Gina Absalom
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Julia Zinga
- Department of Nutrition & Dietetics, Royal Women's Hospital, Parkville, VIC, Australia
| | - Claire Margerison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Sharleen O'Reilly
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Paige van der Pligt
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
| |
Collapse
|
6
|
Laursen SH, Boel L, Udsen FW, Secher PH, Andersen JD, Vestergaard P, Hejlesen OK, Hangaard S. Effectiveness of Telemedicine in Managing Diabetes in Pregnancy: A Systematic Review and Meta-Analysis. J Diabetes Sci Technol 2023; 17:1364-1375. [PMID: 35533131 PMCID: PMC10563542 DOI: 10.1177/19322968221094626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Strict monitoring of blood glucose during pregnancy is essential for ensuring optimal maternal and neonatal outcomes. Telemedicine could be a promising solution for supporting diabetes management; however, an updated meta-analysis is warranted. This study assesses the effects of telemedicine solutions for managing gestational and pregestational diabetes. METHODS PubMed, EMBASE, Cochrane Library Central Register of Controlled Trials, and CINAHL were searched up to October 14, 2020. All randomized trials assessing the effects of telemedicine in managing diabetes in pregnancy relative to any comparator without the use of telemedicine were included. The primary outcome was infant birth weight. A meta-analysis comparing the mean difference (MD) in birth weight across studies was applied, and subgroup and sensitivity analyses were performed. The revised Cochrane tool was applied to assess the risk of bias, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS From a total of 18 studies, ten (totaling 899 participants) were used to calculate the effect on infant birth weight. The results nonsignificantly favored the control (MD of 19.34 g; [95% confidence interval, CI -47.8; 86.47]), with moderate effect certainty. Heterogeneity was moderate (I2 = 37.39%). Statistically significant secondary outcomes included differences in two-hour glucose tolerance postpartum (gestational diabetes; two studies: standardized mean difference 9.62 mg/dL [95% CI: 1.95; 17.28]) that favored the control (GRADE level, very low) and risk of shoulder dystocia (four studies: log odds -1.34 [95% CI: -2.61; -0.08]) that favored telemedicine (GRADE, low). CONCLUSIONS No evidence was found to support telemedicine as an alternative to usual care when considering maternal and fetal outcomes. However, further research is needed, including economic evaluations.
Collapse
Affiliation(s)
- Sisse H. Laursen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- University College of Northern Denmark, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Lise Boel
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Flemming W. Udsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Pernille H. Secher
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jonas D. Andersen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Ole K. Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| |
Collapse
|
7
|
Eysenbach G, Chen D, Xu P, Wang X, Zhang W, Mao M, Zheng Q, Jin Y, Feng S. Web-Based Interventions for Pregnant Women With Gestational Diabetes Mellitus: Systematic Review and Meta-analysis. J Med Internet Res 2023; 25:e36922. [PMID: 36656629 PMCID: PMC9896357 DOI: 10.2196/36922] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 11/30/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022] Open
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.
Collapse
Affiliation(s)
| | - Dandan Chen
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Ping Xu
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xiaojuan Wang
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Wei Zhang
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Minna Mao
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Qiong Zheng
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ying Jin
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Suwen Feng
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| |
Collapse
|
8
|
Cantor AG, Jungbauer RM, Totten AM, Tilden EL, Holmes R, Ahmed A, Wagner J, Hermesch AC, McDonagh MS. Telehealth Strategies for the Delivery of Maternal Health Care : A Rapid Review. Ann Intern Med 2022; 175:1285-1297. [PMID: 35878405 DOI: 10.7326/m22-0737] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Telehealth strategies to supplement or replace in-person maternity care may affect maternal health outcomes. PURPOSE To conduct a rapid review of the effectiveness and harms of telehealth strategies for maternal health care given the recent expansion of telehealth arising from the COVID-19 pandemic, and to produce an evidence map. DATA SOURCES Systematic searches of MEDLINE, the Cochrane Library, CINAHL, Embase, and Scopus for English-language studies (January 2015 to April 2022). STUDY SELECTION Randomized controlled trials (RCTs) and observational studies of maternal care telehealth strategies versus usual care. DATA EXTRACTION Dual data extraction and risk-of-bias assessment of studies, with disagreements resolved through consensus. DATA SYNTHESIS 28 RCTs and 14 observational studies (n = 44 894) were included. Maternal telehealth interventions supplemented in-person care for most studies of mental health and diabetes during pregnancy, primarily resulting in similar, and sometimes better, clinical and patient-reported outcomes versus usual care. Supplementing in-person mental health care with phone- or web-based platforms or mobile applications resulted in similar or better mental health outcomes versus in-person care. A reduced-visit prenatal care schedule using telehealth to replace in-person general maternity care for low-risk pregnancies resulted in similar clinical outcomes and higher patient satisfaction versus usual care. Overall, telehealth strategies were heterogeneous and resulted in similar obstetric and patient satisfaction outcomes. Few studies addressed disparities, health equity, or harms. LIMITATIONS Interventions varied, and evidence was inadequate for some clinical outcomes. CONCLUSION Replacing or supplementing in-person maternal care with telehealth generally results in similar, and sometimes better, clinical outcomes and patient satisfaction compared with in-person care. The effect on access to care, health equity, and harms is unclear. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42021276347).
Collapse
Affiliation(s)
- Amy G Cantor
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Department of Family Medicine, and Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (A.G.C.)
| | - Rebecca M Jungbauer
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., A.M.T., R.H., A.A., J.W., M.M.)
| | - Annette M Totten
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., A.M.T., R.H., A.A., J.W., M.M.)
| | - Ellen L Tilden
- Department of Obstetrics and Gynecology and School of Nursing, Oregon Health & Science University, Portland, Oregon (E.L.T.)
| | - Rebecca Holmes
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., A.M.T., R.H., A.A., J.W., M.M.)
| | - Azrah Ahmed
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., A.M.T., R.H., A.A., J.W., M.M.)
| | - Jesse Wagner
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., A.M.T., R.H., A.A., J.W., M.M.)
| | - Amy C Hermesch
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (A.C.H.)
| | - Marian S McDonagh
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., A.M.T., R.H., A.A., J.W., M.M.)
| |
Collapse
|
9
|
Guo P, Jin Y, Xiang Z, Chen DD, Xu P, Wang X, Zhang W, Mao M, Zheng Q, Feng S. Web-based interventions for pregnant women with gestational diabetes mellitus: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e061151. [PMID: 35768118 PMCID: PMC9244690 DOI: 10.1136/bmjopen-2022-061151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Pingping Guo
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yin Jin
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenzhen Xiang
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dan Dan Chen
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Ping Xu
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojuan Wang
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Zhang
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minna Mao
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiong Zheng
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Suwen Feng
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
10
|
Birati Y, Yefet E, Perlitz Y, Shehadeh N, Spitzer S. Cultural and Digital Health Literacy of App and Web Based Systems Designed for Pregnant Women with Gestational Diabetes Mellitus: A Scoping Review (Preprint). J Med Internet Res 2022; 24:e37844. [PMID: 36240008 PMCID: PMC9617190 DOI: 10.2196/37844] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/03/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
Collapse
Affiliation(s)
- Yosefa Birati
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Enav Yefet
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Department of Obstetrics and Gynecology, Baruch Padeh Medical Center Poriya, Tiberias, Israel
| | - Yuri Perlitz
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Department of Obstetrics and Gynecology, Baruch Padeh Medical Center Poriya, Tiberias, Israel
| | - Naim Shehadeh
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel
| | - Sivan Spitzer
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| |
Collapse
|
11
|
Bertini A, Gárate B, Pardo F, Pelicand J, Sobrevia L, Torres R, Chabert S, Salas R. Impact of Remote Monitoring Technologies for Assisting Patients With Gestational Diabetes Mellitus: A Systematic Review. Front Bioeng Biotechnol 2022; 10:819697. [PMID: 35310000 PMCID: PMC8929763 DOI: 10.3389/fbioe.2022.819697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/31/2022] [Indexed: 12/20/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Ayleen Bertini
- Metabolic Diseases Research Laboratory (MDRL), Interdisciplinary Center for Research in Territorial Health of the Aconcagua Valley (CIISTe Aconcagua), Center for Biomedical Research, Universidad de Valparaíso, Valparaíso, Chile
- Programa de Doctorado en Ciencias e Ingeniería para La Salud, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
- *Correspondence: Rodrigo Salas, ; Ayleen Bertini,
| | - Bárbara Gárate
- School of Biomedical Engineering, Faculty of Engineering, Universidad de Valparaíso, Valparaíso, Chile
| | - Fabián Pardo
- Metabolic Diseases Research Laboratory (MDRL), Interdisciplinary Center for Research in Territorial Health of the Aconcagua Valley (CIISTe Aconcagua), Center for Biomedical Research, Universidad de Valparaíso, Valparaíso, Chile
- School of Medicine, Campus San Felipe, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Julie Pelicand
- Metabolic Diseases Research Laboratory (MDRL), Interdisciplinary Center for Research in Territorial Health of the Aconcagua Valley (CIISTe Aconcagua), Center for Biomedical Research, Universidad de Valparaíso, Valparaíso, Chile
- School of Medicine, Campus San Felipe, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville, Spain
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD, Australia
- Medical School (Faculty of Medicine), Sao Paulo State University (UNESP), São Paulo, Brazil
- Department of Pathology and Medical Biology, University of Groningen, Groningen, Netherlands
- University Medical Center Groningen (UMCG), Groningen, Netherlands
- Tecnologico de Monterrey, Eutra, The Institute for Obesity Research, School of Medicine and Health Sciences, Monterrey, Mexico
| | - Romina Torres
- Faculty of Engineering, Universidad Andres Bello, Viña Del Mar, Chile
| | - Steren Chabert
- School of Biomedical Engineering, Faculty of Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Millennium Institute for Intelligent Healthcare Engineering, Valparaíso, Chile
- Centro de Investigación y Desarrollo en INGeniería en Salud—CINGS, Universidad de Valparaíso, Valparaíso, Chile
| | - Rodrigo Salas
- School of Biomedical Engineering, Faculty of Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Millennium Institute for Intelligent Healthcare Engineering, Valparaíso, Chile
- Centro de Investigación y Desarrollo en INGeniería en Salud—CINGS, Universidad de Valparaíso, Valparaíso, Chile
- *Correspondence: Rodrigo Salas, ; Ayleen Bertini,
| |
Collapse
|
12
|
Nichols N, Muñoz K, San Miguel GG, Twohig MP. eHealth Education and Support for Pediatric Hearing Aid Management: Parent Goals, Questions, and Challenges. Am J Audiol 2022; 31:189-203. [PMID: 35196126 DOI: 10.1044/2021_aja-21-00098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate parent goals, questions, and challenges that emerged during coaching phone calls in an eHealth program designed to provide education and support for hearing aid management. METHOD Coaching phone calls were audio-recorded, transcribed, and qualitatively analyzed for emergent themes within the categories of goals, questions, and challenges. RESULTS Emergent themes revealed that parent goals were focused on self-efficacy, routines, device care, and child development. Emergent themes for questions revealed that parents asked questions related to the device care, audiology appointments, confirmation of learning, and child development. For challenges, emergent themes revealed parents' own struggles (e.g., with emotions), issues related to working with their audiologist, child factors, and anticipated challenges. CONCLUSIONS The eHealth intervention allowed parents to raise questions and discuss their challenges in a supportive environment. Supportive accountability helped participants identify and address barriers to hearing aid management based on their priorities and current challenges. Providing supplemental learning support, in addition to routine audiology visits, can help parents develop more effective hearing aid management routines.
Collapse
Affiliation(s)
- Natalie Nichols
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
| | - Karen Muñoz
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
| | | | | |
Collapse
|
13
|
Digital health interventions for gestational diabetes mellitus: A systematic review and meta-analysis of randomised controlled trials. PLOS DIGITAL HEALTH 2022; 1:e0000015. [PMID: 36812531 PMCID: PMC9931335 DOI: 10.1371/journal.pdig.0000015] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/21/2021] [Indexed: 12/29/2022]
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.
Collapse
|
14
|
Edwards KJ, Maslin K, Andrade J, Jones RB, Shawe J. Mobile health as a primary mode of intervention for women at risk of, or diagnosed with, gestational diabetes mellitus: a scoping review. JBI Evid Synth 2022; 20:2195-2243. [PMID: 35152244 DOI: 10.11124/jbies-21-00294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review was to map the knowledge related to the use of mHealth as a primary mode of intervention for the prevention and management of gestational diabetes mellitus and its long-term implications among women at risk of or diagnosed with gestational diabetes mellitus. We also sought to understand if mHealth for women at risk of or diagnosed with gestational diabetes mellitus incorporated relevant behavior change theory and techniques. INTRODUCTION Prevention and management of gestational diabetes mellitus and its associated adverse outcomes are important to maternal and infant health. Women with gestational diabetes mellitus report high burden of disease management and barriers to lifestyle change post-delivery, which mHealth interventions may help to overcome. Evidence suggests apps could help gestational diabetes mellitus prevention and management, however, less is known about broader applications of mHealth from preconception to interconception and whether relevant behavior change techniques are incorporated. INCLUSION CRITERIA Studies published in English that focused on mHealth use as primary mode of intervention for the prevention and management of gestational diabetes mellitus and its long-term implications were considered for inclusion. Telehealth or telemedicine were excluded as these have been reviewed elsewhere. METHODS Six databases were searched: MEDLINE (Ovid), CINAHL (EBSCO), Embase (Ovid), Cochrane Database (Wiley), Scopus, and TRIP. No limits were applied to database exploration periods to ensure retrieval of all relevant studies. Gray literature sources searched were OpenGrey, ISRCTN Registry, ClinicalTrials.gov, EU Clinical Trials Register, and ANZCTR. Two reviewers independently screened abstracts and assessed full texts against the inclusion criteria. Data were extracted using an adapted version of the JBI data extraction instrument. Data are presented in narrative form accompanied by tables and figures. RESULTS This review identified 2166 sources, of which 96 full texts were screened. Thirty eligible reports were included, covering 25 different mHealth interventions. Over half (n = 14) were for self-managing blood glucose during pregnancy. Common features included tracking blood glucose levels, real-time feedback, communication with professionals, and educational information. Few (n = 6) mHealth interventions were designed for postpartum use and none for interconception use. Five for postpartum use supported behavior change to reduce the risk of type 2 diabetes and included additional features such as social support functions and integrated rewards. Early development and feasibility studies used mixed methods to assess usability and acceptability. Later stage evaluations of effectiveness typically used randomized controlled trial designs to measure clinical outcomes such as glycemic control and reduced body weight. Three mHealth interventions were developed using behavior change theory. Most mHealth interventions incorporated two behavior change techniques shown to be optimal when combined and those delivering behavior change interventions included a wider range. Nevertheless, only half of the 26 techniques listed in a published behavior change taxonomy were tried. CONCLUSIONS mHealth for gestational diabetes mellitus focuses on apps to improve clinical outcomes. This focus could be broadened by incorporating existing resources that women value, such as social media, to address needs, such as peer support. Although nearly all mHealth interventions incorporated behavior change techniques, findings suggest future development should consider selecting techniques that target women's needs and barriers. Lack of mHealth interventions for prevention of gestational diabetes mellitus recurrence and type 2 diabetes mellitus suggests further development and evaluation is required.
Collapse
Affiliation(s)
- Katie J Edwards
- School of Nursing and Midwifery, University of Plymouth, Devon, UK The University of Plymouth Centre for Innovations in Health and Social Care: A JBI Centre of Excellence, Devon, UK School of Psychology, University of Plymouth, Devon, UK Royal Cornwall Hospital Trust, Truro, Cornwall UK
| | | | | | | | | |
Collapse
|
15
|
Adesina N, Dogan H, Green S, Tsofliou F. Effectiveness and Usability of Digital Tools to Support Dietary Self-Management of Gestational Diabetes Mellitus: A Systematic Review. Nutrients 2021; 14:nu14010010. [PMID: 35010884 PMCID: PMC8746603 DOI: 10.3390/nu14010010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022] Open
Abstract
Advice on dietary intake is an essential first line intervention for the management of gestational diabetes mellitus (GDM). Digital tools such as web-based and smartphone apps have been suggested to provide a novel way of providing information on diet for optimal glucose regulation in women with GDM. This systematic review explores the effectiveness and usability of digital tools designed to support dietary self-management of GDM. A systematic search of Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Scopus using key search terms identified 1476 papers reporting research studies, of which 16 met the specified inclusion criteria. The quality of the included studies was assessed using the ErasmusAGE Quality Score or the Mixed Methods Appraisal Tool (MMAT) version 2018. The findings show that the adoption of digital tools may be an effective approach to support self-management relating to healthy diet, health behaviour, and adherence to therapy in women with GDM as a usable intervention. However, there is a lack of evidence concerning the effectiveness of tools to support the dietary management of GDM. Consideration for ethnic specific dietary advice and evidence-based frameworks in the development of effective digital tools for dietary management of GDM should be considered as these aspects have been limited in the studies reviewed.
Collapse
Affiliation(s)
- Nurudeen Adesina
- Department of Rehabilitation and Sport Sciences, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK;
- Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK
| | - Huseyin Dogan
- Department of Computing and Informatics, Faculty of Science and Technology, Bournemouth University, Poole BH12 5BB, UK;
| | - Sue Green
- Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK;
| | - Fotini Tsofliou
- Department of Rehabilitation and Sport Sciences, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK;
- Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK
- Correspondence: ; Tel.: +44-1202-9615-83
| |
Collapse
|
16
|
Su MC, Chao AS, Chang MY, Chang YL, Chen CL, Sun JC. Effectiveness of a Nurse-Led Web-Based Health Management in Preventing Women With Gestational Diabetes From Developing Metabolic Syndrome. J Nurs Res 2021; 29:e176. [PMID: 34570053 DOI: 10.1097/jnr.0000000000000456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Women with gestational diabetes mellitus (GDM) are more likely to develop metabolic syndrome (MS). However, the effectiveness of web-based health management in preventing women at high risk of GDM from developing MS has rarely been studied. PURPOSE The aim of this study was to evaluate the longitudinal effects of nurse-led web-based health management on maternal anthropometric, metabolic measures, and neonatal outcomes. METHODS A randomized controlled trial was conducted from February 2017 to February 2018, in accordance with the Consolidated Standards of Reporting Trials guidelines. Data were collected from 112 pregnant women at high risk of GDM who had been screened from 984 potential participants in northern Taiwan. Participants were randomly assigned to the intervention group (n = 56) or the control group (n = 56). The intervention group received a 6-month nurse-led, web-based health management program as well as consultations conducted via the LINE mobile app. Anthropometric and metabolic measures were assessed at baseline (Time 0, prior to 28 weeks of gestation), Time 1 (36-40 weeks of gestation), and Time 2 (6-12 weeks of postpartum). Maternal and neonatal outcomes were assessed at delivery. Clinical trial was registered. RESULTS Analysis using the general estimating equation models found that anthropometric and metabolic measures were significantly better in the intervention group than the control group and varied with time. At Time 1, the levels of diastolic pressure (β = -4.981, p = .025) and triglyceride (TG; β = -33.69, p = .020) were significantly lower in the intervention group than the control group, and at Time 2, the incidence of MS in the intervention group was lower than that in the control group (χ2 = 6.022, p = .014). The number of newborns with low birth weight in the intervention group was lower than that in the control group (χ2 = 6.729, p = .012). CONCLUSION/IMPLICATIONS FOR PRACTICE This nurse-led, web-based health management was shown to be effective in improving MS outcomes and may play an important role and show feasible clinical value in changing the current pregnancy care model.
Collapse
Affiliation(s)
- Mei-Chen Su
- PhD, RN, Assistant Professor, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan, ROC
| | - An-Shine Chao
- MD, Associate Professor, Attending Physician, Department of Obstetrics and Gynecology, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan, ROC
| | - Min-Yu Chang
- MSN, RN, Supervisor, Department of Nursing, New Taipei Municipal TuCheng Hospital, and Adjunct Lecturer, Department of Nursing, Asia Eastern University of Science and Technology, New Taipei City, Taiwan, ROC
| | - Yao-Lung Chang
- MD, Associate Professor and Attending Physician, Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Chien-Lan Chen
- BSN, RN, Head Nurse, Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Jui-Chiung Sun
- PhD, RN, Assistant Professor, Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan, ROC
| |
Collapse
|
17
|
Eberle C, Stichling S. Effects of Telemetric Interventions on Maternal and Fetal or Neonatal Outcomes in Gestational Diabetes: Systematic Meta-Review. JMIR Diabetes 2021; 6:e24284. [PMID: 34448717 PMCID: PMC8433929 DOI: 10.2196/24284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/25/2020] [Accepted: 04/15/2021] [Indexed: 01/08/2023] Open
Abstract
Background In 2019, 1 of 6 births was affected by gestational diabetes mellitus (GDM) globally. GDM results in adverse maternal, fetal, and neonatal outcomes in the short and long term, such as pregnancy and birth complications, type 2 diabetes, metabolic syndrome, and cardiovascular disease. In the context of “transgenerational programming,” diabetes mellitus during pregnancy can contribute to “programming” errors and long-term consequences for the child. Therefore, early therapy strategies are required to improve the clinical management of GDM. The interest in digital therapy approaches, such as telemetry, has increased because they are promising, innovative, and sustainable. Objective This study aimed to assess the current evidence regarding the clinical effectiveness of telemetric interventions in the management of GDM, addressing maternal glycemic control, scheduled and unscheduled visits, satisfaction, diabetes self-efficacy, compliance, maternal complications in pregnancy and childbirth, as well as fetal and neonatal outcomes. Methods Medline via PubMed, Web of Science Core Collection, Embase, Cochrane Library, and CINAHL databases were systematically searched from January 2008 to April 2020. We included randomized controlled trials, systematic reviews, meta-analyses, and clinical trials in English and German. Study quality was assessed using “A MeaSurement Tool to Assess systematic Reviews” and “Effective Public Health Practice Project.” Results Our search identified 1116 unique studies. Finally, we included 11 suitable studies (including a total of 563 patients and 2779 patient cases): 4 systematic reviews or meta-analyses (1 of high quality and 3 of moderate quality), 6 randomized controlled trials (2 of high quality and 4 of moderate quality), and 1 low-quality nonrandomized controlled trial. We classified 4 “asynchronous interventions” and 3 “asynchronous and real-time interventions.” Our findings indicate that telemetric therapy clearly improves glycemic control and effectively reduces glycated hemoglobin A1c levels. Furthermore, in 1 study, telemetry proved to be a significant predictor for a better glycemic control (hazard ratio=1.71, 95% CI 1.11-2.65; P=.02), significantly fewer insulin titrations were required (P=.04), and glycemic control was achieved earlier. Telemetric therapy significantly reduced scheduled and unscheduled clinic visits effectively, and women were highly satisfied with the treatment (P<.05). From fetal and neonatal short-term outcomes, some improving tendencies in favor of telemetry were determined. No long-term outcomes were detected. Conclusions Telemetric interventions clearly improved glycemic control, notably glycated hemoglobin A1c levels, and reduced scheduled and unscheduled clinic visits effectively, which reinforces this digital approach in the treatment of GDM.
Collapse
Affiliation(s)
- Claudia Eberle
- Medicine with Specialization in Internal Medicine and General Medicine, Fulda University of Applied Sciences, Fulda, Germany
| | - Stefanie Stichling
- Medicine with Specialization in Internal Medicine and General Medicine, Fulda University of Applied Sciences, Fulda, Germany
| |
Collapse
|
18
|
A Review of Prenatal Care Delivery to Inform the Michigan Plan for Appropriate Tailored Health Care in Pregnancy Panel. Obstet Gynecol 2021; 138:603-615. [PMID: 34352841 DOI: 10.1097/aog.0000000000004535] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To perform a literature review of key aspects of prenatal care delivery to inform new guidelines. DATA SOURCES A comprehensive review of Ovid MEDLINE, Elsevier's Scopus, Google Scholar, and ClinicalTrials.gov. METHODS OF STUDY SELECTION We included studies addressing components of prenatal care delivery (visit frequency, routine pregnancy assessments, and telemedicine) that assessed maternal and neonatal health outcomes, patient experience, or care utilization in pregnant individuals with and without medical conditions. Quality was assessed using the RAND/UCLA Appropriateness Methodology approach. Articles were independently reviewed by at least two members of the study team for inclusion and data abstraction. TABULATION, INTEGRATION, AND RESULTS Of the 4,105 published abstracts identified, 53 studies met inclusion criteria, totaling 140,150 participants. There were no differences in maternal and neonatal outcomes among patients without medical conditions with reduced visit frequency schedules. For patients at risk of preterm birth, increased visit frequency with enhanced prenatal services was inconsistently associated with improved outcomes. Home monitoring of blood pressure and weight was feasible, but home monitoring of fetal heart tones and fundal height were not assessed. More frequent weight measurement did not lower rates of excessive weight gain. Home monitoring of blood pressure for individuals with medical conditions was feasible, accurate, and associated with lower clinic utilization. There were no differences in health outcomes for patients without medical conditions who received telemedicine visits for routine prenatal care, and patients had decreased care utilization. Telemedicine was a successful strategy for consultations among individuals with medical conditions; resulted in improved outcomes for patients with depression, diabetes, and hypertension; and had inconsistent results for patients with obesity and those at risk of preterm birth. CONCLUSION Existing evidence for many components of prenatal care delivery, including visit frequency, routine pregnancy assessments, and telemedicine, is limited.
Collapse
|
19
|
Barbosa W, Zhou K, Waddell E, Myers T, Dorsey ER. Improving Access to Care: Telemedicine Across Medical Domains. Annu Rev Public Health 2021; 42:463-481. [PMID: 33798406 DOI: 10.1146/annurev-publhealth-090519-093711] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the past 20 years, the use of telemedicine has increased exponentially. Its fundamental aim is to improve access to care. In this review, we assess the extent to which telemedicine has fulfilled this promise across medical domains. Additionally, we assess whether telemedicine has improved related health outcomes. Finally, we determine who has benefited from this novel form of health care delivery. A review of the literature indicates that (a) telemedicine has improved access to care for a wide range of clinical conditions ranging from stroke to pregnancy; (b) telemedicine in select circumstances has demonstrated improved health outcomes; and (c) telemedicine has addressed geographical, but less so social, barriers to care. For telemedicine to fulfill its promise, additional evidence needs to be gathered on health outcomes and cost savings, the digital divide needs to be bridged, and policy changes that support telemedicine reimbursement need to be enacted.
Collapse
Affiliation(s)
- William Barbosa
- Department of Neurology, University of Rochester Medical Center, Rochester, New York 14642, USA;
| | - Kina Zhou
- School of Medicine and Dentistry, University of Rochester, Rochester, New York 14642, USA
| | - Emma Waddell
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - Taylor Myers
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - E Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, New York 14642, USA; .,Center for Health + Technology, University of Rochester Medical Center, Rochester, New York 14642, USA
| |
Collapse
|
20
|
Tian Y, Zhang S, Huang F, Ma L. Comparing the Efficacies of Telemedicine and Standard Prenatal Care on Blood Glucose Control in Women With Gestational Diabetes Mellitus: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e22881. [PMID: 33783365 PMCID: PMC8188321 DOI: 10.2196/22881] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/22/2020] [Accepted: 03/29/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) can usually be well controlled by health education and lifestyle management, resulting in better pregnancy outcomes. However, standard clinical prenatal care, which consists of clinic visits every 2 weeks, may not provide sufficient management for women with GDM. Telemedicine demonstrates a potential to fill this gap. OBJECTIVE The objective of this study was to investigate whether health education and lifestyle management delivered through a WeChat group chat was more effective in controlling blood glucose (BG) than standard clinical prenatal care among women with GDM. METHODS In this multicenter randomized controlled trial, women with GDM diagnosed by an oral glucose tolerance test between 23 and 30 (+6) gestational weeks were randomized to a WeChat group chat-based BG management group or a routine clinical prenatal care group. The primary outcome was the change in the glycemic qualification rate during the follow-up period in both groups. The secondary outcomes were pregnancy outcomes. RESULTS A total of 309 women with GDM participated in the trial, with 162 women randomized to the control group and 147 to the intervention group. No significant differences in baseline characteristics were found between the control and intervention groups. Participants were further divided into 4 groups according to gestational weeks at enrollment for further analysis. The glycemic qualification rate of the intervention group was higher than that of the control group at nearly all time points in Groups 1 to 3, among which 3 time points reached statistical significance: Group 1 at T3 (54.8% vs 83.3%) and Group 2 at T3 (62.5% vs 80.0%) and T7 (75.0% vs 100%). The glycemic qualification rate gradually increased as gestational weeks progressed in both groups, regardless of the intervention method. None of the pregnancy outcomes measured, including delivery mode, premature rupture of the membranes, preterm birth, infant's birth weight, and postpartum hemorrhage, were significantly different between the control and intervention groups. CONCLUSIONS This multicenter randomized controlled trial that assessed women with noninsulin-dependent GDM demonstrated that additional instant messaging platforms, such as WeChat, used for health education and lifestyle intervention in China tend to be more effective for BG control than standard clinical prenatal care alone. TRIAL REGISTRATION ClinicalTrials.gov NCT03748576; https://clinicaltrials.gov/ct2/show/NCT03748576.
Collapse
Affiliation(s)
- Ying Tian
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Suhan Zhang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Feiling Huang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Liangkun Ma
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| |
Collapse
|
21
|
Edwards KJ, Maslin K, Andrade J, Jones RB, Shawe J. mHealth as a primary mode of intervention for women at risk of, or diagnosed with, gestational diabetes: a scoping review protocol. JBI Evid Synth 2021; 19:660-668. [PMID: 33074991 DOI: 10.11124/jbies-20-00151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To synthesize current knowledge on the use of mHealth as a primary mode of intervention for the prevention and management of gestational diabetes mellitus and its long-term implications among women at risk of, or diagnosed with, gestational diabetes mellitus. INTRODUCTION Prevention and management of gestational diabetes mellitus and its associated adverse outcomes are of paramount importance to both maternal and infant health. However, women with experience of gestational diabetes mellitus report several barriers to effective disease management and lifestyle change. Supporting women through use of mHealth technology may help overcome these barriers. Recent evidence suggests mobile apps may be useful for the prevention and management of gestational diabetes mellitus, however, less is known about the broader application of mHealth from preconception to interconception. INCLUSION CRITERIA Studies considered for inclusion are those focused on the use of mHealth as the primary mode of intervention for the prevention and management of gestational diabetes mellitus and its long-term implications among women at risk of, or diagnosed with, gestational diabetes mellitus. Studies will be limited to those published in English, with no date restrictions. METHODS The following databases will be searched: MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Ovid), Cochrane Database (Wiley), Scopus, and TRIP. Unpublished studies and gray literature will be searched using Open Grey, ISRCTN Registry, ClinicalTrials.gov, EU Clinical Trials register, and ANZCTR. Two reviewers will independently screen abstracts. Reviewers will assess full texts of selected citations against the inclusion criteria. Any disagreements will be discussed with a third reviewer. Data will be extracted and presented in diagrammatic or tabular form with an accompanying narrative in line with review objectives.
Collapse
Affiliation(s)
- Katie J Edwards
- School of Nursing and Midwifery, University of Plymouth, Devon, UK
| | - Kate Maslin
- School of Nursing and Midwifery, University of Plymouth, Devon, UK.,The University of Plymouth Centre for Innovations in Health and Social Care: A JBI Centre of Excellence, Plymouth, Devon, UK
| | | | - Ray B Jones
- School of Nursing and Midwifery, University of Plymouth, Devon, UK
| | - Jill Shawe
- School of Nursing and Midwifery, University of Plymouth, Devon, UK.,The University of Plymouth Centre for Innovations in Health and Social Care: A JBI Centre of Excellence, Plymouth, Devon, UK.,Royal Cornwall Hospitals NHS Trust, Truro, UK
| |
Collapse
|
22
|
Zahmatkeshan M, Zakerabasali S, Farjam M, Gholampour Y, Seraji M, Yazdani A. The use of mobile health interventions for gestational diabetes mellitus: a descriptive literature review. J Med Life 2021; 14:131-141. [PMID: 34104235 PMCID: PMC8169150 DOI: 10.25122/jml-2020-0163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/02/2021] [Indexed: 11/23/2022] Open
Abstract
This study attempted to review the evidence for or against the effectiveness of mobile health (m-health) interventions on health outcomes improvement and/or gestational diabetes mellitus (GDM) management. PubMed, Web of Science, Scopus, and Embase databases were searched from 2000 to 10 July 2018 to find studies investigating the effect of m-health on GDM management. After removing duplications, a total of 27 articles met our defined inclusion criteria. m-health interventions were implemented by smartphone, without referring to its type, in 26% (7/27) of selected studies, short message service (SMS) in 14.9% (4/27), mobile-based applications in 33.3% (9/27), telemedicine-based on smartphones in 18.5% (5/27), and SMS reminder system in 7.1% (2/27). Most of the included studies (n=23) supported the effectiveness of m-health interventions on GDM management and 14.3% (n=4) reported no association between m-health interventions and pregnancy outcomes. Based on our findings, m-health interventions could enhance GDM patients' pregnancy outcomes. A majority of the included studies suggested positive outcomes. M-health can be one of the most prominent technologies for the management of GDM.
Collapse
Affiliation(s)
- Maryam Zahmatkeshan
- Noncommunicable Diseases Research Center, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Somayyeh Zakerabasali
- Department of Health Information Management, Health Human Resources Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Farjam
- Noncommunicable Diseases Research Center, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
- Clinical Research Development Unit, Valie-Asr Hospital, Fasa University of Medical Sciences, Fasa, Iran
| | | | - Maryam Seraji
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Azita Yazdani
- Department of Health Information Management, Health Human Resources Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
23
|
Abstract
Telemedicine involves the use of technology to provide services to patients and share medical information. Telemedicine's use has increased as technology has advanced. It allows for medicine to be practiced from a distance to reach patients in rural or underserved areas. Telemedicine has widespread uses in high-risk obstetrics, including management of diabetes, diagnosis and management of hypertensive disorders of pregnancy, screening for fetal malformations with teleultrasound, delivering care to underserved areas, and more. The use of telemedicine to provide care to patients and information to health care providers at a distance has been well accepted by the patients and providers.
Collapse
Affiliation(s)
- Julie R Whittington
- University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 518, Little Rock, AR 72205, USA.
| | - Everett F Magann
- Department of OB/GYN, MFM Division, 4301 West Markham Street, Slot 518, Little Rock, AR 72205, USA
| |
Collapse
|
24
|
Xie W, Dai P, Qin Y, Wu M, Yang B, Yu X. Effectiveness of telemedicine for pregnant women with gestational diabetes mellitus: an updated meta-analysis of 32 randomized controlled trials with trial sequential analysis. BMC Pregnancy Childbirth 2020; 20:198. [PMID: 32252676 PMCID: PMC7137255 DOI: 10.1186/s12884-020-02892-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/24/2020] [Indexed: 12/17/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is now a global health problem. Poor blood glucose control during pregnancy may lead to maternal and neonatal/foetal complications. Recently, the development of information and communication technology has resulted in new technical support for the clinical care of GDM. Telemedicine is defined as health services and medical activities provided by healthcare professionals through remote communication technologies. This study aimed to update the systematic review of the effectiveness of telemedicine interventions on glycaemic control and pregnancy outcomes in pregnant women with GDM. Methods We searched the Web of Science, PubMed, Scopus, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Wan-fang Database, China Biology Medicine and VIP Database for randomized controlled trials (RCTs) related to the effectiveness of telemedicine interventions for GDM from database inception to July 31st, 2019. Languages were limited to English and Chinese. Literature screening, data extraction and assessment of the risk of bias were completed independently by two reviewers. Meta-analysis and trial sequential analysis were conducted in Stata 14.0 and TSA v0.9.5.10 beta, respectively. Results A total of 32 RCTs were identified, with a total of 5108 patients. The meta-analysis showed that telemedicine group had significant improvements in controlling glycated haemoglobin (HbA1c) [mean difference (MD) = − 0.70, P < 0.01], fasting blood glucose (FBG) (MD = -0.52, P < 0.01) and 2-h postprandial blood glucose (2hBG) (MD = -1.03, P = 0.01) compared to the corresponding parameters in the standard care group. In the telemedicine group, lower incidences of caesarean section [relative risk (RR) = 0.82, P = 0.02], neonatal hypoglycaemia (RR = 0.67, P < 0.01), premature rupture of membranes (RR = 0.61, P < 0.01), macrosomia (RR = 0.49, P < 0.01), pregnancy-induced hypertension or preeclampsia (RR = 0.48, P < 0.01), preterm birth (RR = 0.27, P < 0.01), neonatal asphyxia (RR = 0.17, P < 0.01), and polyhydramnios (RR = 0.16, P < 0.01) were found. The trial sequential analyses conclusively demonstrated that the meta-analytic results of the change in HbA1c, the change in 2hBG, the change in FBG, the incidence rates of caesarean section, pregnancy-induced hypertension or preeclampsia, premature rupture of membranes, premature birth, neonatal asphyxia, and polyhydramnios were stable. Conclusions Compared to standard care, telemedicine interventions can decrease the glycaemic levels of patients with GDM more effectively and reduce the risk of maternal and neonatal/foetal complications.
Collapse
Affiliation(s)
- Weihua Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Pinyuan Dai
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Yu Qin
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Ming Wu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Bingquan Yang
- Zhongda Hospital, Southeast University, Nanjing, China
| | - Xiaojin Yu
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.
| |
Collapse
|
25
|
Li SY, Ouyang YQ, Qiao J, Shen Q. Technology-supported lifestyle interventions to improve maternal-fetal outcomes in women with gestational diabetes mellitus: A meta-analysis. Midwifery 2020; 85:102689. [PMID: 32193015 DOI: 10.1016/j.midw.2020.102689] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/30/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The increasing incidence of gestational diabetes mellitus (GDM) is a global health problem. Lifestyle interventions have been recognized as effective measures to enhance maternal and child health. Traditional education approaches, personalized consultation and home visits to promote change in patients' lifestyle are limited by cost, lack of resources and inability to provide broad coverage. The increased use of technological approaches can cross these barriers. OBJECTIVES The meta-analysis aimed to evaluate the effectiveness of technology-supported lifestyle interventions for women with gestational diabetes mellitus. METHODS Databases that were reviewed included the Cochrane Library, PubMed, Web of Science, EBSCO, Embase, Medline, CINAHL and ClinicalTrials.gov. from inception to September 2019. Randomized controlled trials (RCTs) of technology-supported lifestyle interventions used for women with gestational diabetes mellitus (GDM) were identified. Two reviewers independently assessed each study using Cochrane Collaboration's tool. Maternal-fetal outcomes as well as weight gain in pregnancy and maternal blood glucose were presented as relative risks (RR) or a mean difference (MD). RESULTS Of the 3993 articles reviewed, ten RCTs involving 979 women were included. Technology-supported lifestyle interventions reduced pregnancy weight gain (MD = -1.55, 95% CI = [-1.81 to -1.29], P < 0.001) and mean (1-h and 2-h) postprandial blood glucose (MD = -0.31, 95% CI = [-0.58 to -0.03], P = 0.03), with low heterogeneity of 36% and 18%, respectively. No evidence of significant effect existed on other maternal-fetal outcomes, such as weeks of gestation at delivery, caesarean birth, pre-eclampsia/gestational hypertension, instrumental vaginal birth, premature delivery, newborn weight, neonatal hypoglycemia, large-for-gestational age, fetal macrosomia, NICU admission and respiratory morbidity (I2 ranging from 0% to 51%). No significant improvement was noted in glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG), with strong heterogeneity of 95% and 84%, respectively. CONCLUSIONS Technology-supported lifestyle interventions are associated with reducing pregnancy weight gain and mean (1-h and 2-h) postprandial blood glucose in women with GDM. Well-designed research studies are needed to identify the full potential of technology-supported lifestyle interventions, especially interventions guided by theoretical models.
Collapse
Affiliation(s)
- Su-Ya Li
- School of Health Sciences, Wuhan University, Wuhan, China
| | | | - Jia Qiao
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Quan Shen
- School of Health Sciences, Wuhan University, Wuhan, China
| |
Collapse
|
26
|
Lemelin A, Paré G, Bernard S, Godbout A. Demonstrated Cost-Effectiveness of a Telehomecare Program for Gestational Diabetes Mellitus Management. Diabetes Technol Ther 2020; 22:195-202. [PMID: 31603351 DOI: 10.1089/dia.2019.0259] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Prevalence of gestational diabetes mellitus (GDM) has increased steadily in recent years. Pregnant women with GDM are at risk for obstetrical and neonatal complications and require close multidisciplinary follow-up, which implies a significant use of hospital resources. Methods: A prospective noninferiority and controlled clinical trial was designed. The telehomecare (THCa) initiative is a clinical remote patient management project in women with GDM. The main objective was to evaluate the cost-effectiveness of THCa by assessing the direct costs, including the related reduction in medical visits. Secondary outcomes were to evaluate the impact of THCa on diabetes control, GDM-related complications, and patient satisfaction. Results: A total of 161 women were assigned to either an intervention group provided with a THCa system for transmission and online analysis of capillary glucose data (n = 80) or a control group receiving usual care in the clinic (n = 81). A decrease in medical visits by 56% (P < 0.001) in the THCa group was observed. There was no difference between the two groups in diabetes control or maternal and fetal complications. However, results showed a 10-fold increase in nursing interventions in THCa group (mainly by phone calls and e-mails). Satisfaction with care was high. Direct cost analysis revealed savings of 16% in patients followed by THCa compared with the control group. Conclusion: THCa monitoring significantly decreases medical visits and direct costs in GDM women without compromising pregnancy outcomes, quality of care, or patient satisfaction. THCa was shown to be cost-effective despite placing an additional burden on nursing time.
Collapse
Affiliation(s)
- Annie Lemelin
- Endocrinology Division, Medicine Department, Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Guy Paré
- Research Chair in Digital Health, HEC Montreal, Montreal, Canada
| | - Sophie Bernard
- Endocrinology Division, Medicine Department, Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Ariane Godbout
- Endocrinology Division, Medicine Department, Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| |
Collapse
|
27
|
Perspectives on Barriers and Facilitators in Caring for Women with Gestational Diabetes in Rural Appalachia. MCN Am J Matern Child Nurs 2019; 44:289-295. [PMID: 31259758 DOI: 10.1097/nmc.0000000000000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to explore perspectives of healthcare providers in rural Appalachia who care for pregnant women with gestational diabetes, including management facilitators and barriers. STUDY DESIGN AND METHODS Qualitative study with interviews and thematic analysis. Thematic analysis was conducted using the sort and sift method after inductive content analysis with open coding, identifying categories, and abstraction. RESULTS Twenty-one advanced practice nurses and 10 physicians participated in the study. Three themes were identified: rural healthcare challenges including limited resources and lack of adherence to recommendations, cultural influences including normalization of diabetes and food culture, and collaborative care including accessible resources and patient motivation. CLINICAL IMPLICATIONS The themes provide insight into the perceived barriers and facilitators of healthcare providers caring for women with gestational diabetes in rural Appalachia. Consistent, evidence-based communication with cultural consideration supports effective education and care of women with gestational diabetes. Healthcare providers' knowledge of local resources, accessible electronic medical records, and communication among the various team members enhance collaboration in diabetic management in the rural setting.
Collapse
|
28
|
Kim SS, Darwish S, Lee SA, Sprague C, DeMarco RF. A randomized controlled pilot trial of a smoking cessation intervention for US women living with HIV: telephone-based video call vs voice call. Int J Womens Health 2018; 10:545-555. [PMID: 30288127 PMCID: PMC6161719 DOI: 10.2147/ijwh.s172669] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background People living with HIV smoke at a rate three times that of the general population. This randomized controlled pilot trial tested the feasibility and acceptability of a video-call smoking cessation intervention in women living with HIV and its preliminary efficacy compared with a voice-call smoking cessation intervention. The study focused on women due to a paucity of studies among this population, and women are less likely than men to quit smoking when provided with conventional treatment. Methods Participants in both arms received an HIV-tailored smoking cessation intervention comprising eight 30-minute weekly counseling sessions in conjunction with active nicotine patches for 8 weeks. The only difference between the two arms was the delivery mode of the intervention: via either telephone-based video or voice call. Survival analysis and a Cox proportional hazard regression model were performed to identify factors predicting 6-month prolonged abstinence from smoking. Results A video-call intervention was almost 30% less feasible than a voice-call intervention because women in their 50s and 60s or poorer women living in some southern states did not have access to video-call equipment. However, those who received the video-call intervention were more likely to complete the study than those who had the voice-call intervention. There was no difference in the acceptability of the two interventions. A survival analysis revealed that those in the video arm were significantly more likely to maintain smoking abstinence over the 6-month follow-up period than those in the voice arm (log rank χ2=4.02, P<0.05). Conclusion Although a video-call intervention is less feasible than a voice-call intervention, the former seems to outperform the latter in achieving long-term smoking abstinence for women living with HIV, which may offer an advantage over establishing therapeutic alliance and visually monitoring their adherence to nicotine patches. Clinical trial registration ClinicalTrials.gov NCT02898597.
Collapse
Affiliation(s)
- Sun S Kim
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA,
| | - Sabreen Darwish
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA,
| | - Sang A Lee
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA,
| | - Courtenay Sprague
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA, .,Department of Conflict Resolution, Global Governance and Human Security, John W. McCormack Graduate School of Policy and Global Studies, Boston, MA, USA.,Wits Reproductive Health and HIV Institute, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rosanna F DeMarco
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA,
| |
Collapse
|