1. Introduction
High-risk complications are estimated to occur in 10 percent of
pregnancies and the evidence reveals the growing rate of high risk
pregnancies(1). One of the most common complications that can occur
during pregnancy is gestational diabetes mellitus (GDM) (2, 3),
accounting for more than 80% of diabetes cases during pregnancy(2). GDM
is found in 2% to 16% of all pregnancies(4), affecting about 150,000
pregnancies annually (5, 6). GDM affects both mother and child(7), and
poses mother and child at risk of preeclampsia, cesarean delivery,
congenital anomalies, fetal macrosomia, and the later development of
type 2 diabetes(8). Given the increasing prevalence of GDM, new
challenges are developed for health care professionals in antenatal care
(9). High-risk pregnancies are often managed by hospitalizing patients
for days and sometimes even weeks, leading to increase of financial
burden (10) and stress for the patients (11). By proper monitoring, the
risk and the disease costs will be reduced for a pregnant woman (12-14).
The recent advances in medical devices couple with development of
intelligent sensors, Internet of Things (IoT), efficient
telecommunication and information based smart decision support system
(DSS), and m-health technologies have unlocked the door of ample
opportunities for patients’ remote monitoring and health parameters
tracking , thus enabling a paradigm shift in maternal health care (13,
15).
Recently, the dramatic advancements of information and communication
technologies (ICTs) in health care has led to the development of
m-health, creating substantial improvement in the provision of health
services (16). M-health interventions have been developed along with
technology advances (17). The widespread adoption of mobile phone
technologies offers a promising opportunity to promote diabetes care and
self-management (18-20) through creating an active interaction between
patients and healthcare professionals (9, 20).
The increasing storage capacity of mobile phones along with Wi-Fi
accessibility represent the opportunity to offer mobile applications
with the capabilities of tracking one or more health parameters such as
glucose, diet, exercise and medication (19, 21-25). Mobile phone text
messaging has enabled the provision of timely access to health advice,
prompt self-monitoring, and individuals education about preventive
health care services (26). Immediate delivery of short messages or
direct calls to individuals is facilitated by mobile phone. Patients can
be reminded over the cell phone at the time of the blood glucose
measurement or other event (medication), leading to improvement of HbA1c
levels and self-care regarding diet, medication, and exercise (20).
Following emergent of m-health interventions in GDM, the development and
evaluation of individual interventions have attracted more attention by
the researchers. The previous systematic reviews either have focused on
the effectiveness of m-health interventions (4, 16, 27-34) or on a
single condition (35-38). However, minimal evidence has been provided on
the healthcare utilization or cost analyses.
Therefore, the present study was attempted to systematically review the
effectiveness of GDM-related m-health interventions from different
perspectives. Recently, m-health has been introduced as a novel approach
in GDM management. The delivery of face-to-face support has been
examined in previous research; however, little is known about the
implementation of m-health as a possible alternative form of health
service delivery for GDM patients. The aim of this descriptive
literature review was to assess the evidence provided for or against the
efficacy of m-health in GDM monitoring.