Design: Systematic review and meta-analysis of randomised trials
Population: 23 trials, 3,055 women with gestational diabetes
Primary outcome: Glycaemic control and pregnancy outcomes
Effect: Fasting glucose MD -0.26 (95% CI -0.42 to -0.09), I-squared above 90%, low to very low certainty

A meta-analysis pooled 23 randomised trials covering 3,055 women with gestational diabetes, comparing telemedicine-supported care with usual care.

Telemedicine was associated with slightly lower fasting glucose (mean difference -0.26, 95% CI -0.42 to -0.09) and 2-hour post-meal glucose (-0.50, -0.87 to -0.14), and less gestational weight gain. Lower rates of caesarean section, macrosomia, neonatal hypoglycaemia and respiratory distress were also reported. HbA1c, preterm birth and neonatal unit admission did not differ.

The heterogeneity for the glucose and weight outcomes was extreme (I-squared above 90%), and the prediction intervals crossed zero, meaning a future trial could easily find no effect. The authors rated certainty as low to very low throughout.

Remote glucose review is a reasonable supplement where clinic visits are hard to reach, which applies to much of rural India, but the evidence does not support replacing in-person antenatal care.

Remote review of glucose diaries can supplement, not replace, scheduled antenatal visits.
Consider it for women who live far from clinic or struggle to attend.
Keep in-person checks for fetal growth and blood pressure.
Agree in advance what readings should trigger a call or an earlier visit.

Why it matters

Remote follow-up looks safe to add, but the case for it rests on inconsistent trials.

The statistics, in plain English

I-squared above 90% means the trials disagreed far more than chance would explain, so the pooled average hides very different results. A prediction interval crossing zero means the next trial might show no benefit. Low-certainty evidence means the true effect could be substantially different.