Impact of Telemedicine-Enhanced Integrated Management of Gestational Diabetes on Pregnancy Outcomes and Glycemic Control: Real-World Study Using TangMama App.

Background: Gestational diabetes mellitus (GDM) is associated with substantial risks of adverse maternal and neonatal outcomes. Contemporary management approaches for GDM exhibit insufficient implementation, resulting in suboptimal glycemic control and preventable perinatal complications. The rapid evolution of mobile health technologies offers potential to enhance GDM care, yet evidence from large real-world studies remains limited. Objective: This study aimed to evaluate the impact of a telemedicine-enhanced integrated management system on pregnancy outcomes and glycemic control in women with GDM and to explore the dose-response relationship between telemedicine engagement intensity and clinical outcomes. Methods: In this real-world, prospective cohort study conducted at a provincial-level medical center in China, women with GDM were categorized into a standard care group and a telemedicine-enhanced group receiving the TangMama smartphone app in addition to standard care. We compared pregnancy outcomes and glycemic parameters between the 2 groups in an inverse probability of treatment weighting population based on propensity scores. Mediation analyses and dose-response analyses were additionally conducted to explore potential mechanisms and engagement effects. Results: A total of 4621 women with GDM were included, with 1711 in the telemedicine-enhanced group and 2910 in the standard care group. Upon inverse probability of treatment weighting analysis, the telemedicine-enhanced group demonstrated significantly lower gestational weight gain (adjusted mean difference -1.49 kg, 95% CI -1.81 to -1.17), reduced rates of excessive gestational weight gain (adjusted odds ratio [aOR] 0.61, 95% CI 0.54-0.69), cesarean section (aOR 0.80, 95% CI 0.71-0.91), hypertensive disorders in pregnancy (aOR 0.76, 95% CI 0.64-0.90), and pre-eclampsia (aOR 0.64, 95% CI 0.49-0.83). Glycemic control in the third trimester was significantly improved, with lower glycated hemoglobin A1c (HbA1c) levels (adjusted mean difference -0.05%, 95% CI -0.08 to -0.03) and higher HbA1c on-target rates. For neonatal outcomes, telemedicine-enhanced management was associated with lower rates of preterm birth (aOR 0.47, 95% CI 0.38-0.59), large-for-gestational age (aOR 0.81, 95% CI 0.69-0.96), neonatal unit admission (aOR 0.80, 95% CI 0.71-0.91), neonatal hypoglycemia (aOR 0.64, 95% CI 0.45-0.93), and neonatal hyperbilirubinemia (aOR 0.69, 95% CI 0.58-0.82). Mediation analyses identified gestational weight gain and third-trimester fasting plasma glucose as significant mediators. Higher telemedicine engagement was associated with improved glycemic control and reduced adverse outcomes in a dose-response manner. Conclusions: Telemedicine-enhanced integrated management is associated with improved maternal glycemic control and substantial reductions of adverse pregnancy outcomes among women with GDM. The observed dose-response relationship between engagement intensity and outcomes underscores the importance of promoting active patient participation. These findings support the broader integration of telemedicine into routine GDM care pathways to optimize maternal and neonatal health.