Axelrod Michal, Lahav Ezra Hila, Galler Esther, Nir Omer, Ofir Keren, Barkai Galia, Sivan Eyal, Mazaki-Tovi Shali, Tsur Abraham
The Josef Buchmann Gynecology and Maternity Center, Sheba Medical Center, Tel Hashomer, Israel.
The School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Int J Gynaecol Obstet. 2025 Jul;170(1):430-438. doi: 10.1002/ijgo.16148. Epub 2025 Jan 24.
This study explores a hybrid approach to maternal-fetal care for gestational diabetes (GD), integrating virtual visits seamlessly with in-clinic assessments. We assessed the feasibility, time efficiency, patient satisfaction, and clinical outcomes to facilitate wider adoption of maternal-fetal telemedicine.
We conducted a 4-week prospective study involving 20 women with GD at ≥32 weeks of pregnancy, alternating between remote and in-clinic weekly visits. Remote assessments began with women self-measuring vital signs and using a digital urine dipstick. The remote encounter started with a midwife performing anamnesis and remotely connecting women to the fetal nonstress test. A physician concluded the meeting with remote sonographic assessment of amniotic fluid maximal vertical pocket that together with the nonstress test provided the modified biophysical assessment as well as a video encounter and ongoing glycemic control assessment. We assessed the feasibility of remote visits, compared visit durations, evaluated women's satisfaction using the Telehealth Usability Questionnaire, examined glucose documentation adherence during hybrid care compared with the following period until birth, and assessed GD-related clinical outcomes.
Remote visits had a success rate of 97.4% (38 of 39), with significantly shorter durations compared with in-clinic visits (median 59.0 min vs. 159.0 min, P < 0.001). Women expressed high satisfaction (6.6 of 7), and adherence with recording fasting glucose values during the study period was significantly higher than the following period until birth (92.2% vs. 61.8%, P = 0.001). Notably, none required induction of labor for glycemic control imbalance, and there were no cases of macrosomia, shoulder dystocia, or neonatal hypoglycemia.
The hybrid approach to maternal-fetal care for GD demonstrated feasibility, safety, time efficiency, improved patient satisfaction, and enhanced glycemic control adherence.
本研究探索一种妊娠期糖尿病（GD）母婴护理的混合方法，将虚拟就诊与门诊评估无缝整合。我们评估了其可行性、时间效率、患者满意度和临床结局，以促进母婴远程医疗的更广泛应用。
我们进行了一项为期4周的前瞻性研究，纳入20名孕周≥32周的GD孕妇，每周在远程和门诊就诊之间交替。远程评估开始于孕妇自行测量生命体征并使用数字尿试纸。远程会诊由助产士进行问诊，并将孕妇远程连接至胎儿无应激试验。医生通过远程超声评估羊水最大垂直深度来结束会诊，该评估与无应激试验一起提供改良生物物理评分，同时还有视频会诊和持续的血糖控制评估。我们评估了远程就诊的可行性，比较了就诊时长，使用远程医疗可用性问卷评估了孕妇的满意度，检查了混合护理期间与直至分娩的后续时间段相比的血糖记录依从性，并评估了与GD相关的临床结局。
远程就诊成功率为97.4%（39次中的38次），与门诊就诊相比，时长显著缩短（中位数59.0分钟对159.0分钟，P<0.001）。孕妇表示高度满意（7分中的6.6分），研究期间空腹血糖值记录的依从性显著高于直至分娩的后续时间段（92.2%对61.8%，P=0.001）。值得注意的是，没有因血糖控制失衡而需要引产的情况，也没有巨大儿（胎儿体重过重）、肩难产或新生儿低血糖的病例。
GD母婴护理的混合方法显示出可行性、安全性、时间效率、提高了患者满意度并增强了血糖控制依从性。
