The following is a summary of “Remote patient monitoring for management of diabetes mellitus in pregnancy is associated with improved maternal and neonatal outcomes,” published in the JUNE 2023 issue of Obstetrics and Gynecology by Kantorowska, et al.

For a retrospective cohort study, researchers sought to assess the impact of remote patient monitoring on maternal and neonatal outcomes in managing diabetes mellitus during pregnancy. Diabetes mellitus during pregnancy is a complex condition requiring careful management. Mobile health tools and remote patient monitoring have become potential strategies to enhance care. However, previous studies investigating the effectiveness of these technologies in pregnancy-related diabetes have been limited in scope and inconclusive.

The study included pregnant patients with diabetes mellitus managed by the maternal-fetal medicine practice at a single academic institution between October 2019 and April 2021. In February 2020, the practice transitioned from paper-based blood glucose logs to remote patient monitoring. The remote patient monitoring options offered were device integration, where Bluetooth glucometers automatically uploaded glucose values to the patient’s Epic MyChart application, and manual entry, where patients manually logged their glucose readings into the MyChart application. The values in the MyChart application were then directly transferred to the patient’s electronic health record for review and management by clinicians. A total of 533 patients were included in the study, with 173 managed using paper logs and 360 managed using remote patient monitoring (176 with device integration and 184 with manual entry). The primary outcomes assessed were composite maternal morbidity, including various complications such as lacerations, hemorrhage, and infection, and composite neonatal morbidity (which included umbilical cord pH <7.00, 5-minute Apgar score <7, respiratory morbidity, hyperbilirubinemia, meconium aspiration, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, pneumonia, seizures, hypoxic-ischemic encephalopathy, shoulder dystocia, trauma, brain or body cooling, and neonatal intensive care unit admission), including factors such as Apgar score, respiratory morbidity, and sepsis. Secondary outcomes included measures of glycemic control and individual components of the primary outcomes. A secondary analysis was also performed to compare patients using the two remote patient monitoring options. Statistical tests, such as chi-square, Fisher’s exact, 2-sample t, and Mann-Whitney tests, were used to compare the groups, with a significance level set at P<.05.

Baseline characteristics of the maternal population were comparable between the remote patient monitoring and paper groups, except for a slightly higher rate of chronic hypertension in the remote patient monitoring group (6.1% vs. 1.2%; P=.011). There were no significant differences in composite maternal morbidity or composite neonatal morbidity between the two groups. However, patients in the remote patient monitoring group submitted a greater number of glucose values (177 vs 146; P=.008) and were more likely to achieve glycemic control within the target range (79.2% vs 52.0%; P<.0001) and at an earlier time point (median, 3.3 vs 4.1 weeks; P=.025) compared to those managed with paper logs. These improvements were achieved without an increase in in-person visits. Additionally, the remote patient monitoring group had lower rates of preeclampsia (5.8% vs 15.0%; P=.0006), and their infants had lower rates of neonatal hypoglycemia within the first 24 hours of life (29.8% vs. 51.7%; P<.0001).

The study’s findings suggested that remote patient monitoring is superior to traditional paper-based methods for managing diabetes mellitus in pregnancy. It was associated with improved glycemic control and maternal and neonatal outcomes, including reduced preeclampsia and neonatal hypoglycemia rates.

Source: ajog.org/article/S0002-9378(23)00116-3/fulltext