Remote monitoring for gestational diabetes: neonatal and maternal outcomes compared to usual care

Digital care is increasingly used to alleviate capacity use in hospital care. This pre-post study assesses the effect of remote monitoring compared to usual care in a large cohort of women with gestational diabetes mellitus (GDM). We assessed large for gestational age (LGA) newborns, caesarean sections, pregnancy-related maternal and neonatal complications, and hospital service use. Two independent groups of women treated for GDM in a large teaching hospital in the Netherlands were compared: a group from January 2020 until November 2022 receiving usual care, and a group between December 2022 and February 2025, predominantly receiving remote monitoring (intervention). Routine antenatal care was provided in parallel. The usual care group received GDM care according to hospital guidelines. The intervention group received remote monitoring by default, with glucose measurements transmitted via an application and monitored by Virtual Care Centre nurses. Data was collected on demographical and clinical characteristics, LGA, complications, hospital service use, and remote monitoring aspects. A non-inferiority margin of 8% points was set for LGA. In total, 623 patients with GDM were included. In the intervention group 81% received remote monitoring. LGA was present in 20.3% of newborns in the remote monitoring group and 17.8% in the usual care group (estimated difference 2.5% (95% CI: -3.9 to 9.0%)). The upper-bound of 9% exceeded the pre-specified 8% non-inferiority margin, and thus results are inconclusive. No significant differences in complication rates were found. The mean number of outpatient clinic visits per patient during pregnancy for the internal medicine department was 1.6 ± 1.2 for the remote monitoring group, and 2.8 ± 1.9 for the usual care group ( p <.001). Adherence to glucose measurements was good. Most patients did not need Virtual Care Centre nurse interventions and most messages sent to patients were automatically generated. No statistically significant difference in LGA proportions was observed between groups, however sample sizes were insufficient to establish non-inferiority. Remote monitoring did not affect caesarean sections and pregnancy-related maternal and neonatal complication rates. Hospital service use was reduced. Further research on subjective experiences and clinical outcomes of GDM may contribute to optimizing remote monitoring and reducing capacity use.