3. Discussion and Conclusions
To manage disease and reduce the impact of chronic diseases, mobile health technologies can be useful through promotion of healthy behavior (15, 66, 67). These newly introduced technologies can be served as self-monitoring tools for individual patients (68-70) and can effectively enhance women’s health (71).
Literature review has supported the efficacy of mobile-health interventions in the management of diabetes, contributing patients, especially GDM patients (to control their blood sugar levels (20, 31, 72-80).
In the current investigation, all findings in this regard are presented using a structure composed of four main categories of m-health intervention. In the following these four branches are explained:
1. smartphone-based: Smartphones to support various aspects of care and patient-clinician interactions, provide high quality care and to support self-management of GDM (46, 47, 54, 57, 58, 62), The use of m-health can increase GDM patients’ compliance with lifestyle interventions and reduce future risk of T2DM and its sequelae (81); however, this result was not supported by McLean et al (41).
2. Smartphone-based telemedicine system: The impact of telemedicine interventions on GDM management have been investigated by a number of studies (43, 44, 48, 63, 65). For instance, some studies have revealed the efficacy of telemedicine system in monitoring glucose, improving pregnancy outcomes in women with GDM, and enhancing quality of life of pregnant women with diabetes (44, 48, 63, 65). These findings are in line with the results of other studies (4, 82, 83). Nevertheless, Homko et al (43) and Rasekaba et al (82) found no assciation between using a telemedicine system and pregnancy outcomes improvement.
4. SMS and reminders: Studies have demonstrated the potential and important role of SMS in altering the current paradigm of pregnancy care among women suffering from GDM (49, 52, 61). Poorman has supported the usefulness of SMS for maternal and infant health, especially for women who cannot outreach traditional communication methods (33) . Another study has revealed that Text4baby, a free mobile health information service delivering health-related SMS to pregnant and postpartum women, can enhance physical activity participation (84). Given that most of women suffering from GDM do not present for postpartum glucose testing despite recommendations, SMS can play an important role in increasing postpartum return rate ofwomen with GDM for diabetic screening test (56), However, Van Ryswyk has not confirmed this finding (40).
3. Mobile application: Nine out of 27 selected studies have evaluated the efficacy of mobile applications. Eight ones have provided evidence supporting the usefulness of mobile applications for managing GDM (9, 45, 50, 51, 53, 55, 59, 64). In contrast, Kennelly et al (42), in line with two other studies (85, 86) have reported lack of assoaciation between GDM management and using mobile applications.
Patient’s satisfaction is one of the key issues in using mobile devices. We found that six studies (46, 47, 49, 51, 57, 61) have addressed the effect of m-health interventions on patient’s satisfaction, revealing higher satisfaction level in pregnant women who received prenatal support via mobile phone. This finding is in line with findings of previous study (87, 88), Kim et al., also have demonstrated the association between high level of user satisfaction and using diabetes notepad application and the positive effect of this application on diabetes self-management (75).
Six studies have evaluated disease costs and reported that m-health intervention are economically cost effective benefit and can reduce disease costs (49, 51, 54, 58, 61, 64).
Considering the widespread use of mobile phones, various m-health tools have been developed for disease management and monitoring. However, the most effective tool for the management of GDM has not been reported yet. Therefore, in this systematic review, we have summarized the findings of previous studies on the effect of m-health interventions on GMD management.
The major limitation of this study is that only 4 databases were searched that could have led to missing of high-quality articles on m-health intervention for GDM. Published studies on GDM-related m-health interventions are increasing; however, the results are not consistent. Therefore, further evaluations are needed to obtain consistent conclusions regarding the usefulness of m-health interventions for GDM management. Future research are recommended to evaluate m-health interventions using multiple functions or stages, especially those popular outside clinical practice. we can conclude that m-health intervention is one of the most important technologies for GDM management.
Funding: None Declared
Key Message: Due to the risks of gestational diabetes and the growing incidence of this disease, by proper monitoring, the risk and the disease costs will be reduced for a pregnant woman. The widespread adoption of mobile phone technologies offers a promising opportunity to promote diabetes care and self-management by promote healthy behavior.
Conflicting interests: None Declared/ The Author(s) declare(s) that there is no conflict of interest.Ethical approval: Not ApplicableContributorship: MZ and YGH researched literature and conceived the study. MZ and YGH designed the study and conducted the search. MZ, AY, ZK, MA and MS selected articles for inclusion according to the inclusion/exclusion criteria. MZ wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript.
Acknowledgements: None