The impact of remote care on the quality of care of pregnant women with diabetes: a systematic review and meta-analysis
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Diabetes during pregnancy, whether gestational (GDM) or pre-existing, is associated with increased maternal and neonatal risks. Remote care has shown promise in diabetes management, however, its impact on antenatal diabetes care remains unclear. This review evaluates its impact compared with usual care for pregnant women with diabetes, using the Institute of Medicine's healthcare quality framework: effectiveness, safety, efficiency, timeliness, patient-centredness, and equity.
Methods
A systematic review and meta-analysis was conducted. Seven electronic databases (MEDLINE, EMBASE, CINAHL, MIDIRS, Scopus, Cochrane, and Global Health) were searched for studies published between January 01, 2005 and April 30, 2026, with no geographic or language restrictions. Two independent reviewers screened studies and assessed quality using Cochrane tools. A narrative synthesis and meta-analyses were performed. This review was registered with PROSPERO (CRD420251024685).
Findings
Of 1106 unique studies retrieved, 45 were included (n = 26,562), comprising 20 randomised controlled trials (RCTs) and 25 non-randomised studies. Most studies focused on GDM only (n = 37), with the remainder including mixed GDM and pre-gestational diabetes (n = 6) or pre-gestational diabetes only (n = 2). Remote care was generally comparable to usual care across most effectiveness and safety outcomes. In non-randomised studies, remote care was associated with lower unspecified caesarean section rates (relative risk [RR] 0.95, 95% CI 0.91–0.99), postpartum HbA1c (MD −0.08%, 95% CI −0.15 to −0.01), and postpartum 2-h post-prandial glucose levels (MD −1.04 mmol/L, 95% CI −1.59 to −0.48). In RCTs, remote care was associated with reduced emergency caesarean section (RR 0.59, 95% CI 0.38–0.92) and neonatal intensive care unit (NICU) admission (RR 0.73, 95% CI 0.57–0.92). For patient-centredness, patient satisfaction was consistently high. Efficiency findings (cost savings and appointment frequency) were mixed. Three studies assessed timeliness, with no differences observed. Equity outcomes were rarely quantified, though several interventions incorporated cultural, linguistic, or technological adaptations to improve accessibility.
Interpretation
Remote care is a safe and effective alternative to usual care for pregnant women with diabetes, with safety advantages including reduced emergency caesarean sections and NICU admissions. Further research is required to evaluate long-term postpartum outcomes and equitable adoption across diverse populations.
Funding
This study was supported by the National Institute for Health and Care Research (NIHR) North West London Patient Safety Research Collaboration (NIHR NWL PSRC, NIHR204292).
Diabetes during pregnancy, whether gestational (GDM) or pre-existing, is associated with increased maternal and neonatal risks. Remote care has shown promise in diabetes management, however, its impact on antenatal diabetes care remains unclear. This review evaluates its impact compared with usual care for pregnant women with diabetes, using the Institute of Medicine's healthcare quality framework: effectiveness, safety, efficiency, timeliness, patient-centredness, and equity.
Methods
A systematic review and meta-analysis was conducted. Seven electronic databases (MEDLINE, EMBASE, CINAHL, MIDIRS, Scopus, Cochrane, and Global Health) were searched for studies published between January 01, 2005 and April 30, 2026, with no geographic or language restrictions. Two independent reviewers screened studies and assessed quality using Cochrane tools. A narrative synthesis and meta-analyses were performed. This review was registered with PROSPERO (CRD420251024685).
Findings
Of 1106 unique studies retrieved, 45 were included (n = 26,562), comprising 20 randomised controlled trials (RCTs) and 25 non-randomised studies. Most studies focused on GDM only (n = 37), with the remainder including mixed GDM and pre-gestational diabetes (n = 6) or pre-gestational diabetes only (n = 2). Remote care was generally comparable to usual care across most effectiveness and safety outcomes. In non-randomised studies, remote care was associated with lower unspecified caesarean section rates (relative risk [RR] 0.95, 95% CI 0.91–0.99), postpartum HbA1c (MD −0.08%, 95% CI −0.15 to −0.01), and postpartum 2-h post-prandial glucose levels (MD −1.04 mmol/L, 95% CI −1.59 to −0.48). In RCTs, remote care was associated with reduced emergency caesarean section (RR 0.59, 95% CI 0.38–0.92) and neonatal intensive care unit (NICU) admission (RR 0.73, 95% CI 0.57–0.92). For patient-centredness, patient satisfaction was consistently high. Efficiency findings (cost savings and appointment frequency) were mixed. Three studies assessed timeliness, with no differences observed. Equity outcomes were rarely quantified, though several interventions incorporated cultural, linguistic, or technological adaptations to improve accessibility.
Interpretation
Remote care is a safe and effective alternative to usual care for pregnant women with diabetes, with safety advantages including reduced emergency caesarean sections and NICU admissions. Further research is required to evaluate long-term postpartum outcomes and equitable adoption across diverse populations.
Funding
This study was supported by the National Institute for Health and Care Research (NIHR) North West London Patient Safety Research Collaboration (NIHR NWL PSRC, NIHR204292).
Date Issued
2026-09-01
Date Acceptance
2026-07-28
Citation
EClinicalMedicine, 2026, 99
ISSN
2589-5370
Publisher
Elsevier
Journal / Book Title
EClinicalMedicine
Volume
99
Copyright Statement
© 2026 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
License URL
Subjects
Gestational diabetes mellitus
Diabetes in pregnancy
Remote care
Virtual care
mHealth
Quality of care
Publication Status
Published
Article Number
104147
Date Publish Online
2026-08-18