Remote care appears safe in pregnancy diabetes

Remote care was comparable to usual care for pregnant women with diabetes and may reduce emergency cesarean births and newborn intensive care admissions.
*Systematic review/meta-analysis of RCTs and cohorts; Level 1a.

Citation

Sousi S, Lammila-Escalera E, Glynou SP, et al. The impact of remote care on the quality of care of pregnant women with diabetes: a systematic review and meta-analysis. eClinicalMedicine. 2026;99:104147. doi:10.1016/j.eclinm.2026.104147

Background

Diabetes during pregnancy increases risks for mothers and babies, and growing case numbers strain maternity services. Remote care may improve access while maintaining safety.

Patients

Pregnant women with gestational or pre-existing diabetes in 45 studies, totaling 26,562 participants. Studies limited to diabetes prevention, education-only, lifestyle-only, psychological support, rare diabetes types, case reports, abstracts, protocols, and qualitative-only designs were excluded.

Intervention

Remote care, including mobile apps, web systems, telephone or video care, remote glucose monitoring, and continuous glucose monitors.

Control

Usual in-person care or paper-based glucose logs.

Outcome

Maternal and newborn outcomes, plus cost, access, timeliness, satisfaction, and equity.

Follow-up Period

Mostly from diagnosis or enrollment to delivery; some included 6–12 weeks postpartum.

Results

OutcomeEvidence sourceEffect
Emergency cesarean birthRandomized trialsRR 0.59 (95% CI 0.38 to 0.92)
Newborn intensive care admissionRandomized trialsRR 0.73 (95% CI 0.57 to 0.92)
Unspecified cesarean birthNonrandomized studiesRR 0.95 (95% CI 0.91 to 0.99)
Postpartum HbA1cNonrandomized studiesMD −0.08% (95% CI −0.15 to −0.01)
Postpartum 2-hour glucose after mealsNonrandomized studiesMD −1.04 mmol/L (95% CI −1.59 to −0.48)

RR = relative risk; MD = mean difference; HbA1c = average blood sugar marker.

Patient satisfaction was consistently high. Cost and visit-frequency findings were mixed. Absolute event rates were not consistently available, so number needed to treat could not be calculated.

Limitations

Many studies were observational, varied in design, and mostly included gestational diabetes. Higher-risk type 1 or insulin-treated type 2 diabetes was underrepresented. Small HbA1c and unspecified cesarean differences may not be clinically meaningful to patients. Equity outcomes were rarely measured.

Funding

NIHR funded; one author employed by eConsult Health.

Clinical Application

Consider remote care for suitable lower-risk gestational diabetes patients, with risk stratification and attention to digital access barriers.