Web-based interventions for pregnant women with gestational diabetes mellitus: A systematic review and meta-analysis (Preprint)

BACKGROUND Gestational diabetes mellitus (GDM) is one of the most prevalent diseases during pregnancy and is closely related to considerable short-term and long-term maternal and neonatal complications, so effective management of GDM is essential. Web-based interventions (WBIs) have been applied to assist in managing GDM due to the advantages of high accessibility and efficiency, but findings across studies were inconsistent. OBJECTIVE This systematic review and meta-analysis aimed to comprehensively evaluate the efficacy of WBIs on maternal glycemic control, behavioral outcomes, cognitive and attitudinal outcomes, mental health, maternal and neonatal clinical outcomes, as well as medical service utilisation and costs in pregnant women with GDM. METHODS PubMed, Embase, Cochrane Library, Web of Science and CINAHL were searched from each database inception to January 2022 to identify relevant randomized controlled trials (RCTs) and controlled clinical trials (CCTs). The methodological quality of included studies were assessed using the Effective Public Health Practice Project tool. Meta-analysis was conducted using Stata 12.0 software. Three subgroup analyses regarding the intervention interactivity, format and technology were also performed based on the outcome data of glycaemic control parameters. RESULTS A total of 22 publications arising from 19 RCTs/CCTs were included. The overall meta-analyses on glycemic control parameters demonstrated that compared with the control group, WBIs could significantly improve fasting blood glucose (SMD =-1.95, 95% CI [-3.29, -.61]; P=.004) and 2‑hour postprandial blood glucose (SMD =-1.53, 95%CI [-2.82, -.25]; P=.02), while no significant effect was found on glycated haemoglobin and 1‑hour postprandial blood glucose. The results of subgroup analyses indicated that mobile application-delivered interventions with personalized format and interactive function showed more beneficial effects on maternal glycemic control. Moreover, WBIs could jointly enhance the compliance with self-monitoring of blood glucose, improve the satisfaction with care, increase normal vaginal delivery, as well as decrease emergency caesarean and composite neonatal complication, while the effectiveness on other outcomes were either not significant or inconclusive. CONCLUSIONS WBIs are promising approaches for GDM management. Personalized, interactive and mobile application-delivered interventions seems to be more worthy of being recommended for future clinical practice. More high-quality studies are required to verify these findings before strong recommendations. CLINICALTRIAL PROSPERO CRD 42022296625;https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=296625