Background
Methods
Search strategy and selection criteria
Inclusion criteria
Exclusion criteria
Outcomes
Study selection, data extraction, and quality assessment
Data synthesis and analysis
Results
Study selection process and basic characteristics of the included studies
Study | Country/region | Sample size (Trial/Control) | TM interventiona | Mean age (year) | College education (%) | Gestational age at enrolment (week) | Outcomeb |
---|---|---|---|---|---|---|---|
Carral 2015 [29] | Spain | 77 (30/47) | Web-based system | 33.8 | 22.1 | 21.1 | ① |
Dalfra 2009 [30] | Italy | 203 (88/115) | Health device | 34.0 | – | 28.0 | ①④⑦ |
Given 2015 [31] | North Ireland and Ireland | 50 (24/26) | Health device | 31.7 | – | 28.0 | ④⑦⑧⑨⑩⑫ |
Guo 2019 [6] | China | 124 (64/60) | Health app | 30.9 | 55.6 | 24.9 | ①②③④⑦⑪ |
Homko 2007 [32] | USA | 57 (32/25) | Web-based system | 29.5 | 43.9 | 27.6 | ②④⑤⑥⑧⑨⑩⑪⑫ |
Homko 2012 [33] | USA | 80 (40/40) | Web-based system | 30.2 | 60.0 | 28.5 | ②④⑤⑥⑧⑨⑩⑪⑫ |
Mackillop 2018 [7] | UK | 203 (101/102) | Health app | 33.5 | 48.5 | 31.0 | ②④⑤⑦⑧⑨⑪⑫ |
Miremberg 2018 [4] | Israel | 120 (60/60) | Health app | 31.9 | 32.5 | – | ④⑤⑧⑩⑪⑭ |
Perez-Ferre 2010 [34] | Spain | 97 (49/48) | Health app | 33.8 | 15.5 | – | ④⑤⑪⑫ |
Rasekaba 2018 [35] | Australia | 95 (61/34) | Web-based system | 32.0 | – | 28.0 | ②③④⑦⑧ |
Yang 2018 [36] | China | 107 (57/50) | WeChat | 31.9 | – | – | ②③④⑤⑥⑦⑧⑨⑪⑫ |
Carolan-Olah 2019 [37] | Australia | 110 (52/58) | Web-based system | 31.7 | 47.3 | 28–30 | ⑦ |
Kim 2019 [3] | Korea | 44 (22/22) | Web-based system | 35.8 | 97.7 | 27.4 | ①② |
Gao 2017 [18] | China | 58 (28/30) | Health app | 27.8 | 31.0 | – | ①②③ |
Hua 2018 [19] | China | 120 (60/60) | WeChat | 27.6 | 25.8 | 24.0 | ①②③④⑦⑪⑫ |
Zhang 2018 [38] | China | 80 (40/40) | Health app | 29.5 | – | 26.9 | ②③ |
Zhao 2018 [39] | China | 60 (30/30) | Health app | – | – | – | ②③ |
Zeng 2017 [40] | China | 86 (43/43) | WeChat | – | 74.4 | – | ④⑪ |
Fang 2017 [41] | China | 60 (30/30) | WeChat | 30.8 | – | 23.0 | ①②③④⑥⑦⑨⑪⑫⑬ |
Ge 2017 [23] | China | 586 (308/278) | WeChat | 30.5 | 45.1 | 26.0 | ④⑦ |
Huang 2016 [42] | China | 80 (40/40) | WeChat | 39.0 | 28.8 | 36.7 | ①②③④ |
Jiang 2017 [43] | China | 150 (78/72) | WeChat | 28.0 | – | 29.5 | ①②③④⑤⑦⑩⑪⑭ |
Jiang 2019 [44] | China | 200 (100/100) | WeChat | 28.7 | – | – | ④⑤⑦⑫⑬⑭ |
Jiang 2016 [20] | China | 120 (60/60) | WeChat | 25.3 | – | 22.8 | ⑤⑦⑫⑭ |
Liu 2018 [45] | China | 98 (49/49) | Health device | 27.8 | – | 30.3 | ①②③ |
Lu 201 [21] | China | 280 (140/140) | WeChat | 26.1 | 47.9 | – | ①②③⑤⑦⑫⑬⑭ |
Luo 2017 [46] | China | 107 (57/50) | WeChat | 31.9 | – | – | ②④⑥ |
Shao 2018 [47] | China | 410 (205/205) | WeChat | 30.5 | 52.9 | – | ②③⑦ |
Su 2018 [22] | China | 820 (420/400) | Web-based system | 28.2 | 27.0 | – | ②③⑤⑥⑦⑫⑬⑭ |
Weng 2018 [48] | China | 120 (60/60) | WeChat | 39.5 | 53.3 | 36.6 | ①②③④ |
Xiao 2016 [24] | China | 206 (103/103) | WeChat | 29.7 | – | 26.4 | ⑦⑪ |
Yang 2015 [49] | China | 100 (50/50) | WeChat | 30.0 | 80.0 | – | ⑤⑥⑦⑫⑬⑭ |
Assessment of the risk of bias
Glycaemic control
Maternal and neonatal/foetal complications
Outcome | No. of trials | Pooled effect | Heterogeneity | |||
---|---|---|---|---|---|---|
Effect size | 95%CI | P | I2 | P | ||
Caesarean section | RR = 0.82 | (0.69, 0.97) | 0.02 | 57 | 0.01 | |
PIH or preeclampsia | RR = 0.48 | (0.40, 0.58) | < 0.01 | 11 | 0.34 | |
Premature rupture of membranes | RR = 0.61 | (0.50, 0.76) | < 0.01 | 15 | 0.31 | |
Macrosomia | RR = 0.49 | (0.30, 0.80) | < 0.01 | 77 | < 0.01 | |
Neonatal hypoglycaemia | RR = 0.67 | (0.51, 0.87) | < 0.01 | 39 | 0.08 | |
Preterm birth | RR = 0.27 | (0.20, 0.35) | < 0.01 | 38 | 0.08 | |
Neonatal asphyxia | RR = 0.17 | (0.08, 0.33) | < 0.01 | 0 | 0.85 | |
Polyhydramnios | RR = 0.16 | (0.10, 0.28) | < 0.01 | 0 | 0.99 | |
Admission to the NICU | RR = 0.89 | (0.60, 1.32) | 0.57 | 20 | 0.28 | |
Neonatal jaundice or hyperbilirubinemia | RR = 1.00 | (0.64, 1.55) | 0.99 | 0 | 0.68 | |
NARDS | RR = 0.66 | (0.33, 1.33) | 0.25 | 0 | 0.41 |
Subgroup analysis
Outcome | TM tools | No. of trials | Pooled effect | Heterogeneity | |||
---|---|---|---|---|---|---|---|
Effect size | 95% CI | P | I2 | P | |||
Change in HbA1c | Health app or device | 4 | MD = -0.75 | (− 1.25, − 0.25) | < 0.01 | 95 | 0.01 |
WeChat | 6 | MD = -0.84 | (−1.46, − 0.22) | < 0.01 | 95 | < 0.01 | |
Change in FBG | Health app or device | 6 | MD = -0.05 | (−0.23, 0.12) | 0.54 | 16 | 0.31 |
Web-based system | 5 | MD = -0.48 | (− 0.95, − 0.00) | 0.05 | 91 | < 0.01 | |
WeChat | 9 | MD = -0.85 | (−1.35, −0.35) | < 0.01 | 96 | < 0.01 | |
Change in 2hBG | Health app or device | 5 | MD = -0.50 | (−0.97, − 0.03) | 0.04 | 38 | 0.17 |
WeChat | 8 | MD = -1.26 | (−2.63, 0.11) | 0.07 | 98 | < 0.01 | |
Caesarean section | Health app or device | 6 | RR = 0.76 | (0.60, 0.97) | 0.03 | 33 | 0.19 |
Web-based system | 3 | RR = 1.19 | (0.69, 2.06) | 0.54 | 67 | 0.05 | |
WeChat | 10 | RR = 0.82 | (0.60, 0.96) | 0.02 | 56 | 0.02 | |
PIH or preeclampsia | Health app or device | 3 | RR = 0.76 | (0.28, 2.09) | 0.60 | 35 | 0.22 |
Web-based system | 3 | RR = 0.50 | (0.40, 0.62) | < 0.01 | 70 | 0.04 | |
WeChat | 6 | RR = 0.39 | (0.26, 0.61) | < 0.01 | 0 | 0.93 | |
Premature rupture of membranes | Web-based system | 3 | RR = 0.56 | (0.44, 0.71) | < 0.01 | 21 | 0.28 |
WeChat | 3 | RR = 0.80 | (0.53, 1.19) | 0.27 | 0 | 0.51 | |
Macrosomia | Health app or device | 4 | RR = 1.16 | (0.65, 2.06) | 0.62 | 27 | 0.25 |
Web-based system | 3 | RR = 0.61 | (0.07, 5.58) | 0.66 | 81 | < 0.01 | |
WeChat | 11 | RR = 0.44 | (0.32, 0.59) | < 0.01 | 4 | 0.40 | |
Admission to the NICU | Health app or device | 3 | RR = 0.74 | (0.44, 1.24) | 0.25 | 14 | 0.32 |
Web-based system | 3 | RR = 1.33 | (0.69, 2.59) | 0.40 | 46 | 0.16 | |
Neonatal hypoglycaemia | Health app or device | 4 | RR = 1.25 | (0.81, 1.92) | 0.31 | 0 | 0.78 |
WeChat | 6 | RR = 0.40 | (0.28, 0.59) | < 0.01 | 0 | 0.86 | |
Preterm birth | Health app or device | 3 | RR = 0.40 | (0.17, 0.96) | 0.04 | 0 | 0.75 |
Web-based system | 3 | RR = 0.22 | (0.15, 0.32) | < 0.01 | 84 | < 0.01 | |
WeChat | 7 | RR = 0.32 | (0.21, 0.48) | < 0.01 | 0 | 0.66 | |
Neonatal asphyxia | WeChat | 4 | RR = 0.17 | (0.08, 0.33) | < 0.01 | 0 | 0.88 |
Polyhydramnios | WeChat | 5 | RR = 0.17 | (0.08, 0.35) | < 0.01 | 0 | 0.99 |
Outcome | TM pattern | No. of trials | Pooled effect | Heterogeneity | |||
---|---|---|---|---|---|---|---|
Effect size | 95% CI | P | I2 | P | |||
Change in HbA1c | Group 1 | 5 | MD = -0.34 | (−0.67, −0.01) | 0.04 | 94 | < 0.01 |
Group 2 | 3 | MD = -0.63 | (−1.11, −0.14) | 0.01 | 83 | < 0.01 | |
Change in FBG | Group 1 | 8 | MD = -0.25 | (−0.43, −0.08) | < 0.01 | 56 | 0.03 |
Group 2 | 4 | MD = -0.29 | (− 0.65, 0.06) | 0.11 | 84 | < 0.01 | |
Group 3 | 6 | MD = -0.64 | (−1.26, −0.02) | 0.04 | 94 | < 0.01 | |
Change in 2hBG | Group 1 | 4 | MD = -0.29 | (−0.70, 0.11) | 0.15 | 26 | 0.26 |
Group 2 | 4 | MD = -0.60 | (−1.92, 0.72) | 0.37 | 97 | < 0.01 | |
Group 3 | 5 | MD = -1.55 | (−2.29, −0.81) | 0.02 | 92 | < 0.01 | |
Caesarean section | Group 1 | 10 | RR = 0.96 | (0.73, 1.27) | 0.77 | 65 | < 0.01 |
Group 2 | 3 | RR = 0.67 | (0.57, 0.92) | 0.01 | 0 | 0.50 | |
Group 4 | 5 | RR = 0.67 | (0.57, 0.80) | < 0.01 | 0 | 0.73 | |
PIH or preeclampsia | Group 1 | 7 | RR = 0.69 | (0.44, 1.08) | 0.10 | 16 | 0.31 |
Group 3 | 3 | RR = 0.44 | (0.35, 0.56) | < 0.01 | 0 | 0.98 | |
Premature rupture of membranes | Group 1 | 4 | RR = 0.76 | (0.40, 1.44) | 0.40 | 22 | 0.28 |
Macrosomia | Group 1 | 7 | RR = 0.95 | (0.55, 1.65) | 0.85 | 32 | 0.19 |
Group 2 | 5 | RR = 0.43 | (0.20, 0.92) | 0.03 | 48 | 0.10 | |
Group 3 | 3 | RR = 0.21 | (0.09, 0.48) | < 0.01 | 61 | 0.08 | |
Group 4 | 3 | RR = 0.44 | (0.27, 0.71) | < 0.01 | 0 | 0.64 | |
Neonatal hypoglycaemia | Group 1 | 7 | RR = 1.20 | (0.81, 1.78) | 0.36 | 0 | 82.4 |
Group 2 | 3 | RR = 0.36 | (0.22, 0.60) | < 0.01 | 0 | 0.78 | |
Preterm birth | Group 1 | 7 | RR = 0.42 | (0.22, 0.80) | < 0.01 | 20 | 0.27 |
Group 3 | 3 | RR = 0.21 | (0.13, 0.32) | < 0.01 | 16 | 0.30 | |
Polyhydramnios | Group 3 | 3 | RR = 0.17 | (0.09, 0.32) | < 0.01 | 0 | 0.92 |
Admission to NICU | Group 1 | 7 | RR = 0.88 | (0.56, 1.40) | 0.60 | 20 | 0.28 |
Neonatal jaundice or hyperbilirubinemia | Group 1 | 5 | RR = 1.09 | (0.69, 1.71) | 0.71 | 0 | 0.72 |
NARDS | Group 1 | 4 | RR = 0.81 | (0.37, 1.77) | 0.60 | 0 | 0.47 |