Effects of Continuous Care on Gestational Diabetes Mellitus Patients: A Systematic Review and Meta-analysis of 22 RCTs

Background This study aimed to investigate the effects of continuous care on blood glucose and pregnancy outcomes in patients with gestational diabetes mellitus (GDM) through meta-analysis. Method Searches were conducted in PubMed, Web of Science, OVID-Embase, The Cochrane Library, Sinomed, ScienceDirect, IEEE, ProQuest, SpringerLink, EBSCO, JSTOR, BMJ, Taylor, UpToDate, JAMA (Journal of the American Medical Association), CNKI (China National Knowledge Infrastructure), WanFang Data, VIP Database for Chinese Technical Periodicals, China Biology Medicine disc (CBMdisc), Chinese Medical Association Journal Database were systematically searched for randomized controlled trials on the effects of continuous care on blood glucose and pregnancy outcomes in GDM patients from inception to June 2023. Data were then pooled and analyzed using Stata 18.0 software. Results The meta-analysis included 22 randomized controlled trials, comprising 12 English and 10 Chinese publications, involving 2808 patients, with 1410 in the continuous care group and 1398 in the dietary intervention group. Meta-analysis results showed that compared with routine care, continuous care had statistically significant differences in fasting blood glucose [WMD=-0.37, 95%CI (-0.63,-0.11), P < 0.0001], average blood glucose at 2 hours after meals [WMD=-1.34, 95%CI=(-1.93,-0.76), P = 0.0000], HbA1c levels [WMD=-0.78, 95%CI=(-0.89, -0.67), P = 0.353], preterm birth rate [RR = 0.39, 95%CI=(0.26, 0.59), P = 0.085], cesarean section rate [RR = 0.60, 95%CI=(0.52,0.68), P < 0.01], macrosomia rate [RR = 0.42, 95%CI=(0.30,0.59), P = 0.040], postpartum hemorrhage rate [RR = 0.20, 95%CI=(0.10,0.41), P = 0.910], neonatal hypoglycemia rate [RR = 0.17, 95%CI(0.08,0.34), P = 0.291], neonatal asphyxia rate [RR = 0.29, 95%CI=(0.10,0.85), P = 0.996], and low birth weight rate [RR = 0.53, 95%CI=(0.24, 1.20), P = 0.400]. Conclusions Our study systematically evaluates the effects of continuous care on GDM outcomes, affirming its positive impact on blood glucose levels and some adverse pregnancy outcomes in patients with GDM.