Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway.
Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Syst Rev. 2023 Sep 28;12(1):178. doi: 10.1186/s13643-023-02343-w.
Globally, gestational diabetes mellitus complicates 1 in 6 pregnancies and increases future risk of type 2 diabetes and cardiovascular disease in the affected women. There is a lack of consensus on the optimal follow-up of these women. eHealth is emerging as a health care tool, but its practical utility and advantages over standard care in the follow-up after pregnancy complications remains to be determined. Our aim was to systematically review the existing literature on cardiovascular follow-up after gestational diabetes, the utility of eHealth technology for this purpose, and to identify research gaps.
We performed a systematic scoping review following a published protocol and the Joanna Briggs methodology for studies up until May 2022. Four databases were searched: Ovid MEDLINE, Embase, Maternity and Infant Care, and Cochrane Database of Systematic Reviews. Primary research articles and systematic reviews were included in the final analyses. Two reviewers independently screened abstracts and performed full text assessment. Data was extracted using a data charting form. In all stages of the process, if consensus was not reached, a third reviewer was consulted. The findings from the data charting process provided the basis for summarizing the findings from the included studies.
The search of the databases generated 2772 hits. After removing duplicates and manually adding a total of 19 studies, reviews, and guidelines, a total of 2769 titles and abstracts were screened, and 97 papers underwent full-text review. In the final analyses, 15 articles and 12 systematic reviews were included, whereas guidelines are presented as supplementary material. No studies were identified that examined follow-up regarding long-term overall cardiovascular risk after gestational diabetes. Various lifestyle interventions were tested for individual cardiovascular risk factors, with diverging effects. eHealth technologies were found acceptable by participants but had no consistent, statistically significant effect on relevant health outcomes.
This scoping review of the existing literature revealed neither an established systematic cardiovascular follow-up strategy for women after gestational diabetes nor evidence that eHealth technologies are superior to conventional follow-up. Further research into the utility of eHealth in cardiovascular follow-up after complicated pregnancies should include longer-term follow-up and core cardiovascular outcomes.
The protocol for this scoping review was published at Open Science Framework (osf.io/p5hw6).
全球范围内，妊娠糖尿病影响了六分之一的妊娠，增加了这些女性未来患 2 型糖尿病和心血管疾病的风险。对于这些女性的最佳随访，目前尚未达成共识。电子健康正在成为一种医疗工具，但它在妊娠并发症后随访中的实际效用及其相对于标准护理的优势仍有待确定。我们的目的是系统地回顾现有的关于妊娠糖尿病后心血管随访的文献，评估电子健康技术在这方面的应用，并确定研究空白。
我们按照已发表的方案和乔安娜·布里格斯（Joanna Briggs）的方法，对截至 2022 年 5 月的研究进行了系统的范围界定审查。我们检索了四个数据库：Ovid MEDLINE、Embase、母婴保健和 Cochrane 系统评价数据库。主要的研究文章和系统评价被纳入最终分析。两名评审员独立筛选摘要并进行全文评估。使用数据图表表格提取数据。在整个过程的各个阶段，如果无法达成共识，则会咨询第三名评审员。数据图表过程中的发现为总结纳入研究的结果提供了依据。
数据库的搜索产生了 2772 个结果。在去除重复项并手动添加总共 19 项研究、综述和指南后，共筛选了 2769 个标题和摘要，97 篇论文进行了全文审查。在最终分析中，纳入了 15 篇文章和 12 篇系统评价，而指南则作为补充材料呈现。没有发现研究探讨过妊娠糖尿病后长期整体心血管风险的随访。针对个体心血管风险因素，各种生活方式干预措施已被测试，但效果各异。电子健康技术被参与者认为是可以接受的，但对相关健康结果没有一致的、统计学上显著的影响。
本研究对现有文献的系统回顾表明，对于妊娠糖尿病后女性，既没有建立起系统的心血管随访策略，也没有证据表明电子健康技术优于传统随访。进一步研究电子健康在复杂妊娠后心血管随访中的效用，应包括更长期的随访和核心心血管结局。
本范围界定综述的方案已在 Open Science Framework（osf.io/p5hw6）上发布。
