Implementing telemedicine for the care of women with gestational diabetes mellitus in a rural hospital: an observational retrospective study

Gestational diabetes mellitus (GDM) can adversely impact pregnancy outcomes. LGA is a common complication of GDM. Telemedicine is increasingly used for the follow-up of chronic diseases. The objective of this study was to evaluate if implementing a telemedicine solution for GDM could decrease the frequency of large for gestational age (LGA) newborns in a rural hospital. This retrospective interrupted-time-series study was conducted in a rural French hospital. An LGA newborn was defined as a newborn with weight ≥ 90 percentile. The intervention period was defined as starting 45 days after the initial introduction of the telemedicine solution. The two timeframes were: 1 January 2015 to 28 April 2017 (baseline period) and 12 June 2017 to 31 December 2021 (intervention period). Between 2015 and 2021, 14,382 single births were registered in the hospital and 1,981 births from women with GDM were included. The mean age of mothers was 31.71 ± 5.54 and 32.30 ± 5.14 in women with newborns with birthweights lower and higher than the 90 percentile respectively (p=0.09). LGA births were reduced from 76/533 (14.3%) in the baseline period to 170/1,448 (11.7%) in the intervention period. This reduction became statistically significant in the multivariate analysis (protective OR: 0.541, 95%CI [0.311 to 0.930],p=0.13). Obesity was associated with LGA (OR: 1.877, 95%CI [1.394 to 2.558]). The implementation of a telemedicine solution for GDM care in a rural general hospital was associated with a decrease in the adjusted odds of LGA births.