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.