- Design
- Systematic review and meta-analysis of 23 randomised trials
- Population
- 3,055 women with gestational diabetes
- Primary outcome
- Glycaemic control and perinatal outcomes
- Effect
- Fasting glucose MD −0.26 mmol/L (−0.42 to −0.09); 2-h glucose MD −0.50 (−0.87 to −0.14); I² over 90%
This meta-analysis pooled 23 randomised trials covering 3,055 women with gestational diabetes, comparing telemedicine-supported care with standard antenatal care.
Telemedicine was associated with slightly lower fasting glucose (−0.26 mmol/L) and 2-hour postprandial glucose (−0.50 mmol/L), less gestational weight gain (−0.78 kg), and fewer caesarean sections, macrosomia, neonatal hypoglycaemia and respiratory distress. HbA1c, preterm birth and NICU admission did not differ.
The caveats are large. Heterogeneity for the glucose and weight outcomes exceeded 90%, prediction intervals crossed no effect, and GRADE certainty was low to very low. Telemedicine looks like a reasonable supplement where in-person visits are hard to reach, which is relevant to many Indian settings, but not a replacement for antenatal care.
- Consider remote glucose review between visits for women who struggle to attend in person.
- Keep regular in-person antenatal care; the authors advise against replacing it.
- Expect small glucose differences: about 0.3 mmol/L fasting and 0.5 mmol/L after meals.
- Choose a model with a named clinician acting on readings, not just data upload.
Why it matters
Remote monitoring could reach women for whom repeated clinic visits are the main barrier.
Don't overread it
With over 90% heterogeneity and low-certainty evidence, these pooled benefits are tentative.
The statistics, in plain English
A prediction interval shows the range of effects a future trial might find. Here it crosses zero for glucose and weight gain, meaning some settings may see no benefit even though the average looked favourable.
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