The Effect of Smartphone Application-Based Self-Management Interventions Compared to Face-to-Face Diabetic Interventions for Pregnant Women With Gestational Diabetes Mellitus: A Meta-Analysis.

Abstract

Background: Face-to-face diabetic interventions (FFIs) are the gold standard for diabetic care, and smartphone application (app)-based self-management interventions (SBIs) can be a potential alternative. A few previous reviews compared the effects of both practices. Objectives: This study is aimed at (1) comparing the effectiveness of FFIs and SBIs on maternal and neonatal outcomes in pregnant women with gestational diabetes mellitus (GDM) and (2) exploring potential covariates affecting those outcomes. Methods: Randomized controlled trials (RCTs) were retrieved from PubMed, EMBASE, CINAHL, Cochrane Library, Scopus, and Web of Science from inception to January 15, 2024. Meta-analyses, subgroup analyses, and metaregression analyses were conducted using the R software package meta, Version 4.3.1. Cochrane risk of bias Version 2 (RoB2) and grading of recommendations, assessment, development, and evaluation (GRADE) criteria were employed to appraise the quality of studies and certainty of outcomes. Results: We selected 15 RCTs from 2505 women with GDM across 11 countries for this review. The meta-analyses revealed that women in the SBIs can significantly reduce gestation weight gain (t = -2.45, p = 0.04) and macrosomia (t = -3.35, p = 0.02) when compared to those in the FFIs. We observed a higher likelihood of cesarean delivery when using generic apps (RR = 1.12, 95% confidence interval (CI): 0.59, 2.13) than GDM-specific apps (RR = 0.82, 95% CI: 0.64, 1.06). There was similar fasting plasma glucose, 2-h postprandial plasma glucose, hemoglobin A1c (HbA1c), cesarean section delivery rate, neonatal birthweight, large for gestational age, neonatal hypoglycemia, and neonatal intensive care unit admission between SBIs and FFIs. More than half (52%) were rated low risk based on RoB2. According to the GRADE criteria, very low to moderate evidence was found. Conclusions: SBIs can be considered an alternative management method for women with GDM to reap the benefits of smartphone apps. More high-quality RCTs are required to reaffirm the findings.