This study clearly demonstrates that there is a need for more efficient management of diabetes in pregnancy. The majority of women taking part in this study spent more than 2 h every 1–2 weeks at the joint metabolic and obstetric antenatal clinic; this excludes the time spent getting to and from the clinic. According to the National Institute for Clinical Excellence (NICE) guidelines, women with diabetes in pregnancy are required to attend joint diabetic and obstetric clinics every 1–2 weeks from conception (T1DM and T2DM) or from GDM diagnosis (around week 24–28) for assessment of blood glucose control and foetal growth . Good glycaemic control in pregnant women with diabetes is key and it reduces complications associated with this condition in pregnancy [12,13,14,15]. The evidence that remote monitoring using digital technologies is acceptable to pregnant women and superior to the standard of care is limited [16,17,18,19]. A recent study using a remote blood glucose monitoring system demonstrated safety, user satisfaction and superior data capture. However, no differences in the maternal glucose management were observed, whereas pre-term births and caesarean deliveries were less common in the intervention group using a mobile-phone-based real-time blood glucose management system . There have been no health economic assessments of this approach compared to usual care which are important to consider in the future due to unprecedented increase in the number of women with diabetes in pregnancy . In a separate study, one of the authors (CO) conducted a virtual clinic at the same joint metabolic and obstetric antenatal clinic for pregnant women with diabetes who did not require frequent obstetrics appointments. This method identified that, on average 6–8 women (10%) were suitable candidates for remote monitoring. These women are likely to be diagnosed with GDM rather than more complex pregnancies in the presence of T1DM or T2DM. In our study, most of the women had GDM (68.2%), therefore, our findings are more relevant to this population of pregnant women. The growing number of women with diabetes in pregnancy, particularly GDM, is a significant burden for the healthcare systems globally. Considering pregnant women are generally motivated to self-monitor their condition remotely and are smartphone literate, digital technology for home monitoring provides an option for this cohort of women. Nevertheless, glucose management is often influenced by the obstetrics advice based on the foetal growth, which if restricted, in some cases requires admission to the hospital for steroid treatment. These obstetrics requirements exclude certain pregnant women for being suitable candidates for home monitoring. As a result, identifying pregnant women who can be safely monitored from home is a challenge that is influenced by obstetrics’ need.
The need for real-time data collection is also clear from this study. Indeed, only 60% of women record their blood glucose results at the time of monitoring (Table 1). Further studies are required to determine the clinical effectiveness of home monitoring interventions. Nonetheless, a systematic review of mobile phone-based interventions with clinical feedback showed that they improve glycaemic control (HbA1c) compared to standard care or other non-mHealth approaches by as much as 0.8% for T2M patients and 0.3% for T1D patients over the short-term (≤12 months) . This suggests a role for these devices during pregnancy. The main limitation of our study is the small sample size. Nevertheless our findings confirm the general consensus amongst the healthcare professionals and patients regarding the significant strain on specialist diabetic maternity services, which often results in a poor patient experience. This area of important research has not been quantified and reported until now.
In this study, it was clear that women were not only willing to manage blood glucose remotely but that they were willing to monitor other health indicators during pregnancy. Most of women do not have any concerns about using digital technology to manage their health in pregnancy and are willing to have video or telephone conversations with the clinicians. The advantage of capturing the data remotely and in real-time is that it may increase data accuracy and reduces the time commitment and stress of frequent clinical appointments.