Effect of mHealth on Blood Glucose Control in Pregnancies Complicated by Diabetes: A Systematic Review

Introduction: For women with diabetes, optimizing blood glucose is critical during pregnancy to reduce the risk of complications. Mobile health interventions contribute to improved blood glucose control among non-pregnant adults with diabetes, but their effect during pregnancy is not known.  Methods: We conducted a systematic review to determine the effect of mobile health interventions on blood glucose control among women with type 1 diabetes, type 2 diabetes, and gestational diabetes mellitus during pregnancy. We searched the databases Ovid Medline, Ovid Embase, The Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from inception to August 2020. We did not apply limitations to our search. We also examined grey literature and reviewed the reference lists of relevant articles. Studies were eligible for inclusion if they used a randomized controlled trial to determine the effect of mobile health on blood glucose control among women with type 1 diabetes, type 2 diabetes, or gestational diabetes mellitus during pregnancy. A modified version of the Cochrane Randomized Control Trial data collection form and the Template for Intervention Description and Replication checklist guided data collection. We used the Cochrane Risk of Bias 2.0 tool and the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the risk of bias and certainty of the evidence, respectively. Cochrane guidelines for Synthesis Without Meta-analysis informed data analysis.   Results: We included four randomized controlled trials on the effect of mobile health as compared to usual care on blood glucose control among women with gestational diabetes mellitus. Discussion: Only one of the four trials reported a positive effect direction, while the remaining studies reported negative or conflicting/unclear effects. The certainty of the evidence was low.  Conclusion: Mobile health may have little to no effect on blood glucose control among women with gestational diabetes mellitus. Our synthesis revealed non-significant results and the certainty of evidence was low. However, as there is a current scarcity of randomized controlled trials, future studies are warranted to explore this topic, particularly given the emphasis on virtual healthcare as a result of the COVID-19 pandemic.