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