Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.
Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
BMC Pregnancy Childbirth. 2020 Apr 6;20(1):198. doi: 10.1186/s12884-020-02892-1.
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.
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.
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.
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.
妊娠期糖尿病（GDM）现在是一个全球性的健康问题。妊娠期间血糖控制不佳可能导致母婴/胎儿并发症。最近，信息和通信技术的发展为 GDM 的临床护理提供了新的技术支持。远程医疗定义为医疗保健专业人员通过远程通信技术提供的医疗服务和医疗活动。本研究旨在更新关于远程医疗干预对 GDM 孕妇血糖控制和妊娠结局影响的系统评价。
我们从数据库建立到 2019 年 7 月 31 日，在 Web of Science、PubMed、Scopus、Cochrane 对照试验中心注册数据库、中国国家知识基础设施、万方数据库、中国生物医学和 VIP 数据库中搜索了有关远程医疗干预对 GDM 有效性的随机对照试验（RCT）。语言仅限于英语和中文。文献筛选、数据提取和偏倚风险评估由两名评审员独立完成。Meta 分析和试验序贯分析分别在 Stata 14.0 和 TSA v0.9.5.10 beta 中进行。
共纳入 32 项 RCT，共 5108 例患者。Meta 分析显示，与标准护理组相比，远程医疗组糖化血红蛋白（HbA1c）[平均差值（MD）=-0.70，P<0.01]、空腹血糖（FBG）（MD=-0.52，P<0.01）和餐后 2 小时血糖（2hBG）（MD=-1.03，P=0.01）控制更有效。在远程医疗组中，剖宫产[相对风险（RR）=0.82，P=0.02]、新生儿低血糖（RR=0.67，P<0.01）、胎膜早破（RR=0.61，P<0.01）、巨大儿（RR=0.49，P<0.01）、妊娠高血压或子痫前期（RR=0.48，P<0.01）、早产（RR=0.27，P<0.01）、新生儿窒息（RR=0.17，P<0.01）和羊水过多（RR=0.16，P<0.01）的发生率较低。试验序贯分析明确表明，HbA1c 变化、2hBG 变化、FBG 变化、剖宫产率、妊娠高血压或子痫前期、胎膜早破、早产、新生儿窒息和羊水过多发生率的 Meta 分析结果是稳定的。
与标准护理相比，远程医疗干预可更有效地降低 GDM 患者的血糖水平，并降低母婴/胎儿并发症的风险。
